dc.contributor.author | Kamperidis, Nikolaos | |
dc.date.accessioned | 2017-06-01T13:08:42Z | |
dc.date.available | 2017-06-01T13:08:42Z | |
dc.date.issued | 2016-05-27 | |
dc.date.submitted | 2017-06-01T13:51:14.825Z | |
dc.identifier.citation | Kamperidis, N. 2016. NUTRIENT EFFECTS IN INFLAMMATORY BOWEL DISEASE. Queen Mary University of London | en_US |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/23488 | |
dc.description | PhD | en_US |
dc.description.abstract | Abstract
Background: Not only does IBD lead to nutritional deficiencies, but also nutrients
influence its pathophysiology: exclusive enteral nutrition (EEN) is an effective primary
treatment in Crohn’s disease; and vitamin D (VitD) is involved in its pathogenesis and
course.
Aims: We hypothesised that nutrients impact on the course of IBD. We therefore studied
the effect of EEN i) on long term clinical course in children; ii) on CD58, a costimulatory
molecule at the intestinal epithelial cell (IEC) lines, iii) adults with Crohn’s disease. We
examined the possible effect of serum vitamin D levels on the course of IBD and also the
possible role of ethnicity in our paediatric and adult populations that were treated with
EEN but also in our general adult population.
Results
Chapter II: 56 paediatric patients with Crohn’s disesase were followed up for 5 years.
57% of patients achieved remission after 6 weeks of EEN. Achievement of clinical
remission within 6 weeks of EEN was significantly associated with a longer time to
relapse and to treatment escalation. VitD deficiency was common; and those patients who
were deficient were significantly more likely to require corticosteroids and also needed
thiopurines sooner.
Chapter III: CD58 was expressed in the IEC isolated from IBD patients and healthy
controls. EN down-regulated the expression of CD58 on IEC lines.
Chapter IV: 22 adult patients with Crohn’s disease with a mean age of 30.8 years were
given EEN and followed up for a mean time of 1.9 years. 22.7% of patients went into
clinical remission and 77.3% experienced a clinical response. By the end of follow up
63.6% (14/22) of patients had clinically relapsed and 36.4% required surgery during their
follow up. There was no difference between South Asian and Caucasian patients in the
disease outcomes after administration of EEN.
Chapter V: Bangladeshis were more often vitamin D deficient than white Caucasian
patients; however vitamin D status was not associated with the course of IBD.
Bangladeshis developed perianal disease and required thiopurines earlier in their disease
course. Bangladeshi patients with UC had more extensive disease.
Conclusions: EEN, when successful, improves the long term outcome of Crohn’s disease
in children, possibly in part, by down-regulating CD58 on the IEC. VitD deficiency may
influence the clinical course of IBD; however our results were contradictory between
children and adults and significantly limited by the assessment of the vitamin D level at a
single time point. | en_US |
dc.language.iso | en | en_US |
dc.publisher | Queen Mary University of London | en_US |
dc.rights | The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author | |
dc.subject | Gastroenterology | en_US |
dc.subject | inflammatory bowel disease | en_US |
dc.subject | IBD | en_US |
dc.subject | Crohn’s disease | en_US |
dc.subject | exclusive enteral nutrition | en_US |
dc.title | NUTRIENT EFFECTS IN INFLAMMATORY BOWEL DISEASE | en_US |
dc.type | Thesis | en_US |