Wetenschappelijk onderzoek over de ziekte van Crohn

Het protocol voor de behandeling van de ziekte van Crohn is op basis van wetenschappelijke publicaties ontwikkeld. Hierbij is gebruik gemaakt van hoog gekwalificerd recent onderzoek dat wordt gepubliceerd in de PubMed database. placebo controlled onderzoek, meta analyses en reviews hebben de voorkeur. Dit soort onderzoek valt onder Evidence Based Medicine.

Causes

Supplements

EPA/DHA

1. Turner D, Zlotkin SH, Shah PS, Griffiths AM. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD006320. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease
   Omega 3 fatty acids are safe and may be effective for maintenance of remission in CD when used in enteric coated capsules. However, there are not sufficient data to recommend the routine use of n-3 for maintenance of remission in CD. The small number of patients in the included studies warrants further larger RCTs.[Abstract]
2. Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. N Engl J Med. 1996 Jun 13;334(24):1557-60. Effect of an enteric-coated fish-oil preparation on relapses in Crohn’s disease
   In patients with Crohn’s disease in remission, a novel enteric-coated fish-oil preparation is effective in reducing the rate of relapse.[Article]
3. Nielsen AA, Jørgensen LG, Nielsen JN, Eivindson M, Grønbaek H, Vind I, Hougaard DM, Skogstrand K, Jensen S, Munkholm P, Brandslund I, Hey H. Aliment Pharmacol Ther. 2005 Dec;22(11-12):1121-8. Omega-3 fatty acids inhibit an increase of proinflammatory cytokines in patients with active Crohn’s disease compared with omega-6 fatty acids
   The proinflammatory and anti-inflammatory cytokines were measured in plasma from 31 patients with active Crohn’s disease. Patients were randomized for oral intake of omega-3 fatty acid (3-Impact Powder) or omega-6 fatty acids (6-Impact Powder). The 3-Impact Powder showed immunomodulatory properties and might inhibit an increase of proinflammatory cytokines in contrast to the 6-Impact Powder.[Article]
4. Bjørkkjaer T, Brunborg LA, Arslan G, Lind RA, Brun JG, Valen M, Klementsen B, Berstad A, Frøyland L. Scand J Gastroenterol. 2004 Nov;39(11):1088-94. Reduced joint pain after short-term duodenal administration of seal oil in patients with inflammatory bowel disease: comparison with soy oil
   Nineteen patients with IBD-related joint pain were included in the study; 9 had Crohn disease and 10 had ulcerative colitis. The results suggest distinctive, differential prolonged effects on IBD-related joint pain of short-term duodenal administration of n-3-rich seal oil (significant improvement) and n-6-rich soy oil (tendency to exacerbation).[Abstract]
5. Trebble TM, Arden NK, Wootton SA, Calder PC, Mullee MA, Fine DR, Stroud MA. Am J Clin Nutr. 2004 Nov;80(5):1137-44. Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease
   Dietary supplementation with fish oil plus antioxidants is associated with modified PBMC composition and lower production of PGE(2) and IFN-gamma by circulating monocytes or macrophages. The response of extraintestinal manifestations of CD should be investigated in a randomized controlled trial.[Article]
6. Geerling BJ, Badart-Smook A, van Deursen C, van Houwelingen AC, Russel MG, Stockbrügger RW, Brummer RJ. Inflamm Bowel Dis. 2000 May;6(2):77-84. Nutritional supplementation with N-3 fatty acids and antioxidants in patients with Crohn’s disease in remission: effects on antioxidant status and fatty acid profil
   In addition, supplementation with n-3 fatty acids plus antioxidants significantly changed the eicosanoid precursor profile, which may lead to the production of eicosanoids with attenuated proinflammatory activity. This study indicates that an immunomodulating formula containing n-3 fatty acids and/or AO may have the potential to play a role in the treatment of CD.[Abstract]
7. Macdonald A. Gastroenterol Nurs. 2006 Jul-Aug;29(4):295-301; quiz 302-3. Omega-3 fatty acids as adjunctive therapy in Crohns disease
   Crohns disease is an inflammatory bowel disease that can have a significant impact on the health of those afflicted. The results from clinical trials have been conflicting, but a new fish oil preparation that limits the side effects of traditional fish oil therapy shows promise as an adjunctive treatment for Crohns disease.[Abstract]
8. Miura S, Tsuzuki Y, Hokari R, Ishii H. J Gastroenterol Hepatol. 1998 Dec;13(12):1183-90. Modulation of intestinal immune system by dietary fat intake: relevance to Crohn’s disease
   In contrast, supplemental dietary fish oil apparently tends to prevent relapse of Crohn’s disease.[Abstract]

Boswelia serrata

1. Ammon HP. Planta Med. 2006 Oct;72(12):1100-16. Boswellic acids in chronic inflammatory diseases
   Clinical studies, so far with pilot character, suggest efficacy in some autoimmune diseases including rheumatoid arthritis, Crohn’s disease, ulcerative colitis and bronchial asthma. Side effects are not severe when compared to modern drugs used for the treatment of these diseases.[Abstract]
2. Ammon HP. Wien Med Wochenschr. 2002;152(15-16):373-8. Boswellic acids (components of frankincense) as the active principle in treatment of chronic inflammatory diseases
   A series of chronic inflammatory diseases are thought to be perpetuated by leukotrienes. In clinical trials promising results were observed in patients with rheumatoid arthritis, chronic colitis, ulcerative colitis, Crohn’s disease, bronchial asthma und peritumoral brains edemas.[Abstract]
3. Ammon HP. Phytomedicine. 2010 Sep;17(11):862-7. Modulation of the immune system by Boswellia serrata extracts and boswellic acids
   From the pharmacological properties of BEs and BAs it is not surprising that positive effects of BEs in some chronic inflammatory diseases including rheumatoid arthritis, bronchial asthma, osteoarthritis, ulcerative colitis and Crohn’s disease have been reported.[Abstract]
4. Joos S, Rosemann T, Szecsenyi J, Hahn EG, Willich SN, Brinkhaus B. BMC Complement Altern Med. 2006 May 22;6:19. Use of complementary and alternative medicine in Germany – a survey of patients with inflammatory bowel disease
   Boswellia serrata extracts (36%) and acupuncture/Traditional Chinese Medicine (TCM) (33%) were the most frequently used CAM methods. Patients using probiotics, acupuncture and Boswellia serrata extracts (incense) reported more positive therapeutic effects than others.[Article]
5. Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. Z Gastroenterol. 2001 Jan;39(1):11-7. Therapy of active Crohn disease with Boswellia serrata extract H 15
   The study confirms that therapy with H15 is not inferior to mesalazine. This can be interpreted as evidence for the efficacy of H15 according to the state of art in the treatment of active Crohn’s disease with Boswellia serrata extract, since the efficacy of mesalazine for this indication has been approved by the health authorities. Considering both safety and efficacy of Boswellia serrata extract H15 it appears to be superior over mesalazine in terms of a benefit-risk-evaluation.[Abstract]

Probiotica

1. Doré J, Corthier G. Gastroenterol Clin Biol. 2010 Sep;34 Suppl 1:S7-15. The human intestinal microbiota
   Notably, Crohn’s disease, an inflammatory bowel disease of yet unknown aetiology, is associated with intestinal dysbiosis with a lower representation of the Clostridium leptum group among the Firmicutes phylum.[Abstract]
2. Mitsuyama K, Toyonaga A, Sata M. J Gastroenterol. 2002 Nov;37 Suppl 14:73-7. Intestinal microflora as a therapeutic target in inflammatory bowel disease
   Although recent data support a potential therapeutic role for probiotics and prebiotics in patients with IBD, such treatments need to be further assessed by large, double-blind controlled trials. A better understanding of the intestinal microflora and the mechanisms of their action may help us to develop more effective treatment for IBD.[Abstract]
3. Hedin C, Whelan K, Lindsay JO. Proc Nutr Soc. 2007 Aug;66(3):307-15. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials
   The present article reviews the role of the intestinal microbiota in the pathogenesis of IBD and addresses the clinical evidence for the therapeutic manipulation of bowel microbiota using probiotics, prebiotics and synbiotics in IBD.[Abstract]
4. Mitsuyama K, Sata M. Expert Opin Ther Targets. 2008 Mar;12(3):301-12. Gut microflora: a new target for therapeutic approaches in inflammatory bowel diseas
   Altering the composition of intestinal microflora through prebiotics, probiotics and synbiotics may improve the clinical outcome of patients with inflammatory bowel disease.[Abstract]
5. Malchow HA. J Clin Gastroenterol. 1997 Dec;25(4):653-8. Crohn’s disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn’s disease?
   Application of the physiologic bacteria reduced the risk for relapse and minimized the need for glucocorticoids. Therefore we are convinced that in Crohn’s disease parts of the intestinal microflora, including the host’s immune response toward indigenous flora or an impairment of the gut flora’s metabolic activity are involved in the development or at least in the onset of relapse from remissive of colonic Crohn’s disease. However, more data are necessary to prove the benefit of E. coli strain Nissle 1917 as a new therapy to maintain remission of colonic Crohn’s disease.[Abstract]
6. Hedin C, Whelan K, Lindsay JO. Proc Nutr Soc. 2007 Aug;66(3):307-15. Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: a review of clinical trials
   The present article reviews the role of the intestinal microbiota in the pathogenesis of IBD and addresses the clinical evidence for the therapeutic manipulation of bowel microbiota using probiotics, prebiotics and synbiotics in IBD.[Abstract]
7. Fujimori S, Tatsuguchi A, Gudis K, Kishida T, Mitsui K, Ehara A, Kobayashi T, Sekita Y, Seo T, Sakamoto C. J Gastroenterol Hepatol. 2007 Aug;22(8):1199-204. High dose probiotic and prebiotic cotherapy for remission induction of active Crohn’s disease
   High-dose probiotic and prebiotic cotherapy can be safely and effectively used for the treatment of active CD.[Abstract]

Artemisia absinthium

1. Krebs S, Omer TN, Omer B Phytomedicine. 2010 Apr;17(5):305-9. Epub 2009 Dec 3. Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn’s disease – A controlled clinical trial
   On the clinical side, CDAI scores fell from 275+/-15 to below 175+/-12 in wormwood group with remission of symptoms in eight patients (CDAI score below 170 or reduction by 70 points), compared to only two in the placebo group (CDAI of placebo group 282+/-11 at baseline and 230+/-14 on week 6). IBDQ also reflected accelerated clinical response with wormwood. Of clinical significance were the findings that wormwood also improved mood of the CD patients, as reflected in Hamilton’s Depression Scale. These findings provide a base to test wormwood in clinical conditions thought to be mediated by increased production of pro-inflammatory cytokines such as TNF-alpha.[Abstract]
2. Omer B, Krebs S, Omer H, Noor TO. Phytomedicine. 2007 Feb;14(2-3):87-95. Epub 2007 Jan 19. Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn’s disease: a double-blind placebo-controlled study
   These results strongly suggest that wormwood has a steroid sparing effect. The improvements in HAMD scores indicate that wormwood also has an effect on the mood and quality of life of CD patients, which is not achieved by other standard medications.[Abstract]

Butyrate (Boterzuur)

1. Gassull MA, Cabré E. Curr Opin Clin Nutr Metab Care. 2001 Nov;4(6):561-9. Nutrition in inflammatory bowel disease
   In particular, recent data on the in-vivo anti-inflammatory actions of butyrate merit special mention.[Abstract]
2. Thibault R, Blachier F, Darcy-Vrillon B, de Coppet P, Bourreille A, Segain JP. Inflamm Bowel Dis. 2010 Apr;16(4):684-95. Butyrate utilization by the colonic mucosa in inflammatory bowel diseases: a transport deficiency
   Butyrate transport deficiency is expected to have clinical consequences. Particularly, the reduction of the intracellular availability of butyrate in colonocytes may decrease its protective effects [Article]
3. Segain JP, Raingeard de la Blétière D, Bourreille A, Leray V, Gervois N, Rosales C, Ferrier L, Bonnet C, Blottière HM, Galmiche JP Gut. 2000 Sep;47(3):397-403. Butyrate inhibits inflammatory responses through NFkappaB inhibition: implications for Crohn’s disease
   Butyrate decreases proinflammatory cytokine expression via inhibition of NFkappaB activation and IkappaBalpha degradation. These anti-inflammatory properties provide a rationale for assessing butyrate in the treatment of CD.[Article]

Multivitamine

1. Gezondheidsraad 2008
   “Een onvoldoende vitamine D status komt onder alle lagen van de bevolking voor”. Artikel
2. RIVM 2005
   “Het RIVM stelt in 2005 vast dat bij 50% van de deelnemers aan een voedingsonderzoek de inname van chroom lager uitkwam dan de Amerikaanse norm. Het RIVM heeft daarom besloten met prioriteit meer onderzoek te doen naar de chroom inname in Nederland.” Artikel
3. In Engeland
   is de seleniuminname de laatste
   20 jaar gedaald naar 30-40 microg/dag en daardoor onder
   de dagelijks aanbevolen dosis van 60 – 75 microg/dag gekomen
   In Nederland zal de situatie
   waarschijnlijk niet veel beter zijn. Abstract.
4. RIVM 2004
   “In dit rapport is de vitamine A inneming getoetst aan de behoefte. Voor 17 tot 30 procent van
   de volwassenen bleek de inneming inadequaat. Voor een aanzienlijk aantal daarvan was de
   vitamine A inneming meer dan 20 procent lager dan het niveau nodig om een adequate
   levervoorraad te kunnen handhaven.” Artikel.
5. RIVM 2011
   “Uit de peiling blijkt ook dat een deel van de bevolking
   minder vitamine A, B1, C en E, magnesium, kalium en zink
   binnen krijgt dan wordt aanbevolen. Onderzoek is nodig
   naar de effecten hiervan op de gezondheid”.Artikel.

5-ASA agents

1. Akobeng AK, Gardener E. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003715. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s Diseas
   We found no evidence in this review to suggest that 5-ASA preparations are superior to placebo for the maintenance of medically-induced remission in patients with Crohn’s disease. Therefore it appears that additional randomised trials of this regime are not justified. [Abstract]