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Crohn's Disease- Pathophysiology and Conventional and Alternative Treatment Options
Botanicals in the Treatment of Crohn's Disease
TNF-alpha elevation is part of the inflammatory process involved in the pathogenesis of Crohn's Disease. Curcumin, a flavonoid from Curcuma longa (turmeric) is a known inhibitor of TNF-alpha. An in vitro study found TNF-alpha increased intestinal permeability and curcumin inhibited the NFkappaB- induced-TNF-alpha-stimulated increase in intestinal permeability.109
An interesting text-mining experiment, a Medline search that uses a specific algorithm to make discoveries, was used to determine medical uses for Curcuma longa. The goal was to determine possible connections between substances and conditions warranting research, rather than to locate research already conducted. For instance, curcumin’s influence on TNF-alpha might be connected to the increased TNF-alpha associated with Crohn's Disease, providing possible mechanisms for its usefulness in that disease. Analysis of the "mining expedition" resulted in the suggestion of evidence for the beneficial role of curcumin in Crohn’s disease, as well as spinal cord and retinal diseases. Curcumin inhibits several of the cytokines and genes involved in the pathogenesis of Crohn's Disease.254 Clearly, clinical trials are necessary to confirm curcumin’s benefit in Crohn's Disease.
Boswellia serrata is a botanical with significant anti-inflammatory activity. In vitro, this botanical inhibits the 5-lipoxygenase product LTB4, which has been implicated in Crohn's Disease.255 A randomized, double-blind, clinical trial examined the effect of a Boswellia extract (n=44) or mesalamine (n=39) in 102 Crohn's Disease patients. The primary outcome measured was change in CDAI between baseline and end of the study (article was in German; abstract only in English – which did not note length of study or dosages used). Patients treated with the Boswellia extract exhibited an average 90-point decrease in CDAI, while those on mesalamine averaged a 53-point decrease. 256 Although the difference between Boswellia and mesalamine was not considered statistically significant, Boswellia appeared to perform better than mesalamine. A larger study with more statistical power is warranted.
The inflammatory cytokine IL-8 is increased
in Crohn's Disease. An animal study of
trinitrobenzenesulfonic acid-induced colitis (an
experimental model for Crohn’s disease) found the
alkaloid berberine (7.5-15 mg/kg/day), administered
orally for one week, inhibited decreased colonic
tissue damage measured histologically and
macroscopically. Cultured tissue exposed to berberine
also demonstrated inhibition of IL-8.257
Berberine is an active constituent of several botanicals,
including goldenseal, Oregon grape,
Coptis, and barberry.
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