Inflammatory Bowel Diseases Clinical Trial
Official title:
Impact of Different Dietary IgGs on the Pathogenesis of Inflammatory Bowel Disease
Identify the association between certain food IgGs (Wheat, rice, broad beans, cow milk, eggs, chicken and beef) and the immunological response in patients with IBD
Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis and
Crohn disease. Ulcerative colitis and Crohn disease have distinct pathologic and clinical
characteristics but their pathogenesis remains poorly understood.
In 2015, an estimated 1.3% of US adults (3 million) reported being diagnosed with IBD (either
Crohn's disease or ulcerative colitis). This was a large increase from 1999 (0.9% or 2
million adults).The incidence and prevalence of Crohn disease and ulcerative colitis (UC)
appear to be lower in Asia and the Middle East , however, in some newly industrialized
countries in Africa, Asia, and South America, the incidence of IBD has been rising.
Ulcerative colitis is a chronic inflammatory condition characterized by relapsing and
remitting episodes of inflammation limited to the mucosal layer of the colon. It almost
invariably involves the rectum and typically extends in a proximal and continuous fashion to
involve other portions of the colon.
Crohn disease is characterized by transmural inflammation and by skip lesions. The transmural
inflammatory nature of Crohn disease may lead to fibrosis and strictures, and to obstructive
clinical presentations that are not typically seen in ulcerative colitis. The transmural
inflammation more commonly results in sinus tracts, giving rise to microperforations and
fistulae.
Food antigens are thought to trigger an immunologic response resulting in the development of
IBD. However, specific pathogenic antigens have not been identified. While studies attempting
to associate specific diets with the development of IBD have had inconsistent results, the
data suggest that a "Western" style diet (processed, fried, and sugary foods) is associated
with an increased risk of developing Crohn disease, and possibly ulcerative colitis.
To date, studies concerning food intolerance in IBD have largely focused on classic food
allergies based on IgE mediated antibody responses. The levels of total or food-specific IgEs
have been observed to be increased in the sera of IBD patients, and IgE-mediated food
allergies are more frequent in IBD patients than in those without IBDs. Nevertheless,
reactions mediated by food specific IgGs, featuring a more delayed response following
exposure to a particular antigen, are also expected to contribute to adverse reactions in
IBD, and food-specific IgGs help physicians identify the candidate food for elimination in
IBD patients. Furthermore, IgG-mediated adverse reactions have also been reported to be
involved in some cases of food hypersensitivity.
Elimination diet can help in the remission of the disease. An elimination diet involves
removing a food from the diet for a period of time and seeing whether symptoms resolve during
that time. In patients receiving enteral nutrition, it involves introducing one new food at a
time to identify foods that precipitate IBD symptoms. Many patients can identify foods that
they believe may precipitate or worsen their disease and it is reasonable for them to avoid
such foods. Using an elimination diet to identify at-risk foods may decrease the possibility
of a "flare" of IBD.
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