Inflammatory Bowel Diseases

Transcription

1 Inflammatory Bowel Diseases

2 Row 1 (left to right): Dr. John Fell, Prof. Nezha Mouane, Prof. Anne Griffiths, Prof. Ernest Seidman, Prof. Ian Sanderson, Dr. Eric Vasiliauskas, Prof. Robert Grimble, Dr. Amy DeFelice, Prof. Bruce Bistrian, Dr. Thomas Ziegler, Dr. David Alpers, Prof. Philippe Marteau, Dr. Jean-Pierre Hugot, Dr. Anders Ekbom, Prof. K.N. Jeejeebhoy, Dr. Andrea Belluzzi, Prof. Herbert Lochs, Linda Hsieh Row 2 (left to right): Prof. J.-C. Grimaud, Dr. Kin-Hung Poon, Dr. Jon Vanderhoof, Dr. Pierre Guesry, Dr. Rémy Meier, Dr. Dominique Belli, Prof. Eva Micskey, Prof. Judit Kovacs, Dr. Dong-Lian Cai, Dr. Paolo Orlandoni, Dr. Philippe Steenhout, Bianca-Maria Exl, Dr. Elisabeth Pasche, Dr. Hassan Afilal, Dr. Vay Liang W. Go, Dr. George Ferry, Dr. Vikram Khoshoo, Dr. Charles Baum, Janice Brooks, Dr. Harland Winter, Tina Vaughn Row 3 (left to right): Dr. Franck Arnaud-Battandier, Dr. John Kinney, Dr. Ross Butler, Ron DeChant, Dr. Lubos Sobotka, Cynthia Brown, Terri Voss, Dr. Francisco José Penna, Dr. André Van Gossum, Dr. Robert Dobbie, Dr. Robert Martindale, Dr. Roger Clemens, Prof. Ferdinand Haschke, Dr. Thierry Von de Weid, Dr. John Kerner, Dr. James Noel, Dr. Robert Issenman, Dr. Dieter Schwab, Dr. Claude Pichard, Dr. Trevor Winter, Dr. Livia Gallitelli, Dr. Douglas Seidner Also in attendance but not in picture: Rolando Rolandelli, MD

3 Nestlé Nutrition Workshop Series Clinical & Performance Programme Volume 2 Inflammatory Bowel Diseases Editors Bruce R. Bistrian, Boston, Mass., USA John A. Walker-Smith, London, UK ABC

4 Nestec Ltd., 55 Avenue Nestlé, CH 1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN Library of Congress Cataloging-in-Publication Data Inflammatory bowel diseases / editors, Bruce R. Bistrian, John A. Walker-Smith. (Nestlé Nutrition workshop series. Clinical & performance programme; v. 2) Nestlé Nutrition Services. Includes bibliographical references and index. 1. Inflammatory bowel diseases Congresses. 2. Inflammatory bowel diseases Nutritional aspects Congresses. I. Bistrian, Bruce R. II. Walker-Smith, John A. III. Nestlé Nutrition Services. IV. Series. [DNLM: 1. Inflammatory Bowel Diseases diagnosis Congresses. 2. Inflammatory Bowel Diseases immunology Congresses. 3. Inflammatory Bowel Diseases therapy Congresses. 4. Nutrition Congresses. 5. Nutritional Support Congresses. WI 420 I ] RC862.I53I dc21 ISBN (hard cover) ISSN The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein.

5 Contents VII Preface IX Foreword XI Contributors 1 Role of the Systemic Inflammatory Response in the Development of Protein-Energy Malnutrition in Inflammatory Bowel Disease B.R. Bistrian (Boston, Mass.) 7 Epidemiology of Inflammatory Bowel Disease A. Ekbom (Stockholm) 23 Genetic Aspects of Inflammatory Bowel Disease J.-P. Hugot (Paris) 41 Immunopathogenesis of Inflammatory Bowel Disease: Role of Cytokines and Immune Cell-Enterocyte Interactions S. Dionne, F.M. Ruemmele, E.G. Seidman (Montréal) 63 Nutritional Influences on Inflammation R.F. Grimble (Southampton) 83 Clinical and Pathological Aspects of Inflammatory Bowel Disease Ph. Marteau (Paris) 93 Diagnostic Criteria for Inflammatory Bowel Disease in Adults Ph. Marteau (Paris) 107 Diagnostic Criteria for Chronic Inflammatory Bowel Disease in Childhood J.A. Walker-Smith, I.R. Sanderson (London) 121 Nutrition and Gene Expression I.R. Sanderson (London) V

6 Contents 139 Nutrition versus Drug Therapy K.N. Jeejeebhoy (Toronto) 155 Use of Macro- and Micronutrients for Nutrition Support in Inflammatory Bowel Disease D.H. Alpers (St. Louis, Mo.) 171 Enteral Nutrition in Children A.M. Griffiths (Toronto) 187 Remission Induced by a New Specific Oral Polymeric Diet in Children with Crohn s Disease J.M.E. Fell (London), M. Paintin, A. Donnet-Hughes (Lausanne), F. Arnaud-Battandier (Sèvres), T.T. MacDonald, J.A. Walker-Smith (London) 199 Lipid Treatment in Inflammatory Bowel Disease A. Belluzzi (Bologna) 217 Potential Role of Glutamine Administration in Inflammatory Bowel Disease C.R. Jonas, Th.R. Ziegler (Atlanta, Ga.) 237 Monoclonal Antibody Therapy in Inflammatory Bowel Disease E.A. Vasiliauskas (Los Angeles, Calif.) 257 Closing Remarks 259 Subject Index VI

7 Preface Crohn s disease and ulcerative colitis are disorders of particular importance to gastroenterologists who care for both children and adults. Although these chronic inflammatory bowel diseases are still largely of unknown etiology, there is an increase in knowledge of their immunopathology. In particular it is clear that cytokine production is typically abnormal in these disorders and furthermore that these can be influenced by nutritional therapy. Increasingly it is clear that nutrition may have a major role in management of these disorders. Hence we (a pediatric gastroenterologist and a nutritionist) were invited to co-chair a Nestlé Nutrition Workshop on the theme of inflammatory bowel disease in Pasadena. A distinguished group of colleagues from various interrelated disciplines was assembled. This book represents the outcome of their discussions. Of key importance is the demonstration of increased levels of three proinflammatory cytokines, namely interleukin-1, tumor necrosis factor, and interleukin-6 in inflammatory bowel disease generally. However, overproduction of pro-inflammatory cytokines, and tumor necrosis factor especially, is of particular importance in Crohn s disease. This explains the greater likelihood of response to anti-tnf treatment by nutritional manipulation or by specific antibody therapy. Nutritional therapy is important both for repletion of associated protein-energy malnutrition and its modulation of the inflammatory response. In pediatric practice there is a growing use of enteral nutrition as primary treatment. The ideal composition of enteral nutrition for such treatment is not yet clear. In relation to protein, polymeric formulas or protein hydrolysates are as effective as amino acid formulas. However, in relation to fat, the situation is not yet clear. Yet there is good evidence that diets with increased amounts of ˆ 3 fatty acids (known to VII

8 have anti-inflammatory properties) can improve clinical responses, whereas ˆ 6 fatty acids have a pro-inflammatory effect. In this book, these and related aspects of inflammatory bowel disease are reviewed in an authoritative way that provides data of considerable value for those caring for this difficult group of patients and hopefully may inspire further research. J.A. Walker-Smith, B.R. Bistrian VIII

9 Foreword There is substantial evidence that the systemic inflammatory response, mediated both locally and systemically, plays an important pathogenic role in inflammatory bowel disease. The systemic inflammatory response produces protein-energy malnutrition. Anorexia and the resultant semistarvation cause lean tissue loss. Reduction in voluntary motor activity causes further lean tissue loss. Whole-body protein synthesis is diminished, while protein catabolism is increased in skeletal muscle and connective tissue. Therefore, both the treatment of inflammatory bowel disease and the prevention of malnutrition must be primary goals for improved long-term outcome. The relative merits of treating Crohn s disease and ulcerative colitis with antiinflammatory drugs have been well established. However, the severe adverse effects of corticosteroid treatment on growth of pediatric patients are also well documented. An attractive alternative for treatment, therefore, is the search for an enteral nutrition product that has anti-inflammatory properties and prevents malnutrition. This Workshop discusses the possibilities of using enteral nutrition products which are rich in transforming growth factor ß 2 (TGF-ß 2 ), which may contribute to their therapeutic action. There is scientific evidence that treatment with these enteral nutrition products reduces inflammation in the mucosa with histological improvement, and reduces the number of mucosal cells producing pro-inflammatory cytokines. Of interest also is the effect of enteral nutrition products that are based on protein hydrolysates. Several controlled trials employing fish oil as a source of ˆ 3 fatty acids to alter cytokine and eicosanoid production in Crohn s disease and ulcerative colitis have been reported. In addition, it appears that in patients with Crohn s disease, fish oil may be effective in preventing relapse. IX

10 Foreword I would like to thank the Chairmen, Bruce Bistrian and John Walker-Smith, for organizing a workshop which allowed the synergistic effects of enteral nutrition and drugs in inflammatory bowel disease to be discussed. The speakers provided sound background information and highlighted controversial issues. A group of experts who were invited to discuss the speakers prepared manuscripts raised many important points which will stimulate the research on treatment of inflammatory bowel disease in the near future. Finally, I would like to thank Nestlé Clinical Nutrition, USA, and the Nestlé Nutrition Division, Vevey, Switzerland, for providing the logistic support which made this meeting possible. Prof. Ferdinand Haschke, MD Vice-President Nestec Ltd., Vevey, Switzerland X

11 Contributors Speakers David Alpers Department of Internal Medicine/ Division of Gastroenterology Box 1824 Washington University School of Medicine 660 S Euclid Ave St. Louis, MO , USA Tel Fax Andrea Belluzzi University of Bologna Via Vizzani 36 I Bologna, Italy Tel Fax belluzzi@altavista.net Bruce Bistrian Beth Israel Deaconess Medical Center 194 Pilgrim Road Boston, MA 02215, USA Tel Fax bbistria@caregroup.harvard.edu Anders Ekbom University Hospital Cancer Epidemiology Karolinska Institutet PO Box 281 SE Stockholm, Sweden Tel Fax anders.ekbom@mep.ki.se John Fell Consultant Paediatric Gastroenterologist Chelsea & Westminster Hospital 369 Fulham Road London SW10 9NH, UK Tel Fax Anne Griffiths Division of Gastroenterology and Clinical Nutrition Hospital for Sick Children University of Toronto 555 University Ave Toronto, Ont. M5G 1X8, Canada Tel Fax anne.griffiths@mailhub.sickkids.on.ca XI

12 Contributors Robert F. Grimble Institute of Human Nutrition School of Biological Sciences University of Southampton Bassett Crescent East Southampton SO16 7PX, UK Tel Fax Jean-Pierre Hugot Fondation Jean Dausset 27, rue Juliette Dodu F Paris, France Tel Fax jean-pierre.hugot@cephb.fr K.N. Jeejeebhoy Division of Gastroenterology St. Michael s Hospital 30 Bond Street Toronto, Ont. M5B 1W8, Canada Tel Fax khush.jeejeebhoy@utoronto.ca Herbert Lochs IV. Medizinische Klinik für Gastroenterologie Charité Campus Schumannstrasse 20/21 D Berlin, Germany Tel Fax lochs@rz.charite.hu-berlin.de Philippe Marteau Hôpital Laènnec 42, rue de Sèvres F Paris, France Tel Fax philippe.marteau@lnc.ap-hop-paris.fr Ian Sanderson Department of Paediatric Gastroenterology St. Bartholomew s Hospital & oyal London School of Medicine 59 St. Bartholomew s Close London EC1A 7BE, UK Tel Fax i.r.sanderson@mds.qmw.ac.uk Ernest Seidman Paediatric Gastroenterology and Nutrition Department Sainte-Justine Hospital 3175 Cote Ste-Catherine Road Montreal, Que. H3T 1C5, Canada Tel (#6666) Fax seidmane@ere.umontreal.ca Eric Vasiliauskas Cedars-Sinai Inflammatory Bowel Disease Center 8631 W. Third Street, Suite 245E Los Angeles, CA 90048, USA Tel Fax vasiliauskas@csmc.edu John Walker-Smith Royal Free Hospital Pond Street London NW3 2QG, UK Tel , Fax Thomas Ziegler The Emory Clinic, Inc Clifton Road, NE Building A, 4th Floor Atlanta, GA 30322, USA Tel Fax XII

13 Contributors Participants Australia Ross Butler Belgium André Van Gossum Brazil Francisco José Penna Canada Robert Issenman China Dong-Lian Cai Kin-Hung Poon Czech Republic Lubos Sobotka France J.-C. Grimaud Germany Dieter Schwab Hungary Judit Kovacs Eva Micskey Italy Livia Gallitelli Paolo Orlandoni Morocco Hassan Afilal Nezha Mouane South Africa Trevor Winter Switzerland Dominique Belli Rémy Meier Claude Pichard USA Charles Baum Amy DeFelice George Ferry Vay Liang W. Go John Kerner Vikram Khoshoo John Kinney Robert Martindale James Noel Rolando Rolandelli Douglas Seidner Jon Vanderhoof Harland Winter Nestlé attendees Steve Allen / USA Franck Arnaud-Battandier / France Catherine Bailly / Switzerland Janice Brooks / Canada Cynthia Brown / Switzerland Roger Clemens / USA Ronald DeChant / USA Robert Dobbie / USA Bianca-Maria Exl / Switzerland Pierre Guesry / Switzerland Lajos Hanzel / Hungary Ferdinand Haschke / Switzerland Linda Hsieh / USA Evangelos Kaloussis / Switzerland Sam Lee / USA Elisabeth Pasche / Switzerland Lenny Simak / Canada Philippe Steenhout / Switzerland Ernie Strapazon / Switzerland Laura Taylor / USA Tina Vaughn / USA Thierry Von der Weid / Switzerland Terri Voss / USA XIII