Herbal Medicine for Colitis and Crohn's Disease - All Forums

Pulsatillae Root (白头翁)

Sun, 06 May 2012 09:35:55 +0000

Latin:
Radix Pulsatillae

Origin:
Chinese pulsatilla root is the root of the perennial plant Pulsatilla chinensis (Bunge) Regel, of the Ranunculaceae family. Native to East Asia, it is grown from east Siberia to Inner Mongolia, the northeast and north of China. A related herb, Pulsatilla nigricans, is native to northern Europe and England. This wild plant grows in sunny meadows, pastures, and fields.

The flowers are hermaphrodite (have both male and female organs) and are pollinated by insects. A crown of leaves forms on the ground, from which a single flower grows in March and May. The stem reaches a height of about 10-40 cm and has downy hairs that grow on it. The flower is colored blue violet.

The root is harvested in spring. When used, remove leaves and residual flower stems and fibrous roots from the roots, retaining the white tassels at the root heads, dry them in the sun and use when raw.

Also called Anemone Root, Wood Anemone, Wild-flower Root, Pasque Flower Root.

Properties:
Bitter in flavor, cold in nature, it is related to the large intestine channel.

Functions:
Clears away heat to expel toxic substances, removes heat from the blood and arrests diarrhea.

The plant was used medicinally during ancient times as an external remedy for ulcers and eye inflammation. During the 19th century, European physicians had noted pulsatilla's use in the treatment of melancholy, swelling of the knees, and nervous system disorders.

Applications:
1. For treating dysentery with bloody stools due to toxic heat:

This herb can be used alone or in combination with Chinese goldthread rhizome (Rhizoma Coptidis), cork tree bark (Cortex Phellodendri) and ash bark (Cortex Fraxini), e.g., Baitouweng Tang. In recent years, it has produced good results in the treatment of bacillary dysentery and amoebic dysentery.

2. For treating vaginal itching and malaria:

A) Vaginal itching (trichomonal vaginitis):

This herb is decocted together with ash bark (Cortex Fraxini) for external washing.

(B) Malaria:

It is used with Chinese thorowax root (Radix Bupleuri), skullcap root (Radix Scutellariae) and betel nuts.

Dosage and Administration:
6-15 g.

Decoct the ingredients for drinking. Use an adequate amount externally.

Cautions on Use:
This herb should be avoided by anyone who suffers from diarrhea due to cold of the insufficiency type.

When chewed, a caustic substance contained in the plant burns the tongue and throat. When applied topically, it may cause blisters on the skin.

Reference Materials:
Shen Nong's Herbal Classic : "To treat pyrexial malaria, mania, chills and fever, masses in the abdomen, goiter, etc."

"Eliminating blood stasis, killing pain and healing incised wounds."

On Drug Properties : "Abdominal pain, dysentery with bloody stools, toothache, ... general arthralgia."

Toxic or Side Effects:

Modern Researches:
The plant contains lactones protoanemonin, saponins, anemone camphor, tannins, and a volatile oil. It is antispasmodic and antibacterial and acts on the nervous system.

The fresh herb is a cardiac and nervous sedative, producing a hypnotic state with a diminution of the senses followed by a paralizing action.

A constituent similar to digitalis can be extracted from the whole herb with the roots removed. This is cardiotonic.

The Chinese pulsatilla root has clear antimicrobial effects on Staphylococcus aureus, Bacillus pyocyaneus, Bacillus subtilis and salmonella. Its decoction and the saponin contained therein can resist amoebae to a marked degree. This herb has notable results in killing Trichomonas vaginalis. It also has a mild inhibitory effect on influenza virus.

The root is anodyne, anti-inflammatory, antispasmodic, astringent and sedative. The root is an effective cure for bacterial and amoebic dysentery. It is also used in the treatment of malaria, epistaxis and haemorrhoids and is used externally to treat trichomonas vaginitis.

Shanzhuyu Fructus Corni (山茱萸)

Sun, 22 Apr 2012 01:32:13 +0000

Latin Name:
Fructus Corni

Properties:
sour, slightly warm

Channels entered:
Kidney, Liver

Text in which first appeared:
Divine Husbandman’s Classic of the Materia Medica

Actions and Indications:
Stabilizes the Kidneys and retains the essence: for leakage of fluids due to weak essence with such symptoms as excessive urination, incontinence, spermatorrhea, and excessive sweating

Stops excessive sweating and supports that which has collapsed: for excessive sweating, especially in cases of devastated yang and collapsed qi, as in shock.

Tonifies and augments the Liver and Kidneys: for Liver and Kidney deficiency with such symtptoms as lighheadedness, dizziness, sore and weak lower back and knees, or impotence. This herb both tonifies the essence and assists the yang.

Stabilizes the menses and stops bleeding: for deficiency patterns of excessive uterine bleeding and prolonged menstruation. It has only a weak effect on the bleeding.

Major Combinations:
With Fructus Rosae Laevigate (jin ying zi) for spermatorrhea or premature ejaculation.

With Os Draconis (long gu), Concha Ostreae (mu li), Radix Lateralis Carmichaeli Preparata (fu zi), and Radix Ginseng (ren shen) for profuse sweating due to devastated yang.

Radix Astragali Membranacei (huang qi) and Radix Codonopsitis Pilosulae (dang shen) for spontaneous sweating usually resulting from yang or qi deficiency.

With Radix Angelicae Sinensis (dang gui) and Radix Rehmanniae Glutinosae Conquitae (shu di huang) for night sweats due to yin deficiency.

With Fructus Schisandrae Chinensis (wu wei zi) for spermatorrhea, abnormal sweating, palpitations, and shortness of breath due to yin and yang deficiency of both the Liver and Kidneys.

With Radix Rehmanniae Glutinosae Conquitae (shu di huang) and Radix Dioscoreae Oppositae (shan yao) for urinary frequency (during the day and night), dizziness, tinnitus, lower back pain, and other symptoms associated with Kidney deficiency. Add GElatinum Cornu Cervi (bu jiao jiao) and Fructus Psoraleae Corylifoliae (bug u zhi) for impotence and premature ejaculation due to Kidney yang deficiency.

With Os Sepiae seu Sepiellae (hai piao xiao), Radix Rubiae Cordifoliae (qian cao gen), and charred Fibra Stipulae Trachycarpi (zong lu tan) for thin, pale, profuse uterine bleeding that either gushes or continually trickles out due to instability of the penetrating vessel.

With Cortex Eucommiae Ulmoidis (du zhong) and Radix et Caulils Jixueteng (ji xue teng) for hypertension due to Liver and Kidney deficiency.

Cautions and Contraindications:
Contraindicated in cases with painful and difficult urination or those with damp- heat. According to some traditional sources, this herb antagonizes Radix Platycodi Grandiflori (jie geng), Radix Ledebouriellae Divaricatae (fang ji). See Toxicity below.

Major Known Ingredients:
verbanalin, saponins, morroniside, 7- o- methylmorroniside, loganin, cornusiin A and B, ursolic acid, tannin, vitamin A

Pharmacological & Clinical Research:
Antibiotic effect: Decoctions of Fructus Corni Officinalis (shan zhu yu) have shown an in vitro inhibitory effect and lowered blood pressure with little effect on serum glucose.

Toxicity:
This herb has very low toxicity. When given to various animals no signs of toxicity were noted except increased congestion of the gastic mucosa. It had no effect on rabbit conjunctiva. Fructus Corni Officinalis (shan zhu yu) also has a very low incidence of side effects and is a mild parasympathomimetic.

Ophiopogon Root (麦门冬)

Thu, 19 Apr 2012 02:35:29 +0000

Ophiopogon Root

Other Common Names
Ophiopogon

Pharmaceutical Latin
Radix Ophiopononis

Pinyin
Mai Men Dong

Atmospheric Energy
Cold

Taste
Sweet and bitter

Organ Meridian Systems
Lung, Heart and Stomach

Part Used and Form
Tuberous root

Primary Functions
Provide cooling Yin to the Heart, Lungs and Stomach, to promote production of body fluids, to clear heat in the heart and relieve irritability, to relieve dry cough, dry mouth and tongue, and to moisten the bowels

Qualities
This herb is very similar in its actions to wild Asparagus root, a close relative. It is primarily used as a Yin tonic, and especially as a Yin tonic to the heart and lung. It is excellent for moistening any dryness in the body. Being a cold herb, it can cool down hot symptoms and relieve Yin deficiency conditions such as Yin-deficiency insomnia and irritability, especially when blended with herbs such as fresh Rehmannia, Asparagus root and Coptis.

It is a great herb for people who experience hot, dry lungs. Smokers and people exposed to smoke, smog, desert heat and dust will benefit from a daily dose of this herb. Singers and public speakers will find that Ophiopogon moistens the throat and vocal cords, improving vocal quality. It helps relieve sticky sputum For dry throat and lungs, Ophiopogon can be combined with herbs such as Fritillaria, Asparagus root, Glehnia and fresh Rehmannia.

When blended with Dong Gui and Cistanche, Ophiopogon is very useful for relieving dry-type constipation.

The Taoists perceived an even deeper level of purpose for consuming the this herb. They considered Ophiopogon a major Shen tonic herb. Like Asparagus root, it was considered extremely valuable for mastering one's own heart. It is found in a wide number of Taoist formulas. By cooling down the heat in the heart it helps to steady the emotions and control the mind. Combine with major Shen developing tonics such as wild Ginseng, Ganoderma, and Asparagus root, etc.

Ophiopogon root is an ingredient in an extremely popular tonic preparation called Formula for Restoring Pulse Beating, which consists of relatively equal parts of Panax Ginseng, Ophiopogon root and Schizandra fruit. This formula is famous for quickly rebuilding energy in those that have experienced trauma or surgery and for those recovering from illness.

Primary Combinations
Combine with:

1. Glehnia root, Asparagus root, Raw Rehmannia to tonify Lung yin
2. Glehnia root, Asparagus root, Raw Rehmannia and Fritillary bulb to treat dry cough due to Lung yin deficiency
3. Raw Rehmannia, Zizyphus seed and Coptis to treat irritability and insomnia due to pathogenic heat entering the heart

Varieties and Grading
Most Ophiopogon available in Asia is of similar quality. But fresher Ophiopogon, which is gummier and more pliable is better than stiff, hard, dry tubers.

Contraindications
Use moderately in cases of cold, deficient Spleen resulting in diarrhea.

Order Series # 1 and Series # 2 (60 days supply)

Mon, 12 Mar 2012 12:07:04 +0000

Order IBD Recovery Capsule Series # 1 and Series # 2 (60 days supply)

To order the following medicine for 66 days of treatment as listed below:

Series # 1. Intestine Appeasing Powder with
Series # 2:Intestine Appeasing Capsule,
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Order One-Month Supply of IBD Recovery Capsule Series # 1 & Series # 6

Mon, 12 Mar 2012 12:03:54 +0000

Order One-month Supply of IBD Recovery Capsule Series # 1 & Series # 6

This combination is used for effectively treating ulcerative colitis, Crohn's disease, chronic colitis, radiation proctitis, irritable bowel syndrome. Patients are advised to contact us for details before ordering it.

To order the following medicine for 30 days of treatment as listed below:

Series # 1. Intestine Appeasing Powder with
Series # 6: IBD Recovery Capsule Series,
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The costs total USD 190.00, international air shipping charges included. Please click the "Buy Now" button below to place an order:

Order IBD Recovery Capsule Series # 1 & Series # 6

Mon, 12 Mar 2012 11:59:26 +0000

Order Two-Month Supply of IBD Recovery Capsule Series # 1 & Series # 6

To order the following medicine for 60 days of treatment as listed below:

Serie # 1. Intestine Appeasing Powder with
Series # 6: IBD Recovery Capsule Series,
Packed up together in powder form / 150 packs / for 60 days

The costs total USD 299.00, international air shipping charges included. Please click the "Buy Now" button below to plance an order:

Scientists Discover Anti-Inflammatory Polyphenols in Apple Peels

Fri, 03 Feb 2012 02:41:11 +0000

Here's another reason why "an apple a day keeps the doctor away" -- according to new research findings published in the Journal of Leukocyte Biology, oral ingestion of apple polyphenols (antioxidants found in apple peels) can suppress T cell activation to prevent colitis in mice. This study is the first to show a role for T cells in polyphenol-mediated protection against an autoimmune disease and could lead to new therapies and treatments for people with disorders related to bowel inflammation, such as ulcerative colitis, Crohn's disease and colitis-associated colorectal cancer.

Many people with colitis use some form of dietary supplement to complement conventional therapies, but most of the information on the health effects of complementary medicine remains anecdotal. Also, little is known about exactly how these therapies work, if they work at all," said David W. Pascual, Ph.D., a researcher involved in the work from the Department of Immunology and Infectious Diseases at Montana State University in Bozeman, Montana. "Our results show that a natural product found in apple peels can suppress colonic inflammation by antagonizing inflammatory T cells to enhance resistance against autoimmune disease."

To make this discovery, scientists used a chemically induced model of colitis with Dextran sulfate sodium (DSS), researchers administered an oral placebo to one group of mice, and the other group of mice was given an oral dose of apple polyphenols every day during the course of the disease. Results showed that mice treated orally with apple polyphenols were protected from colitis. Importantly, scientists also found that the treated mice had fewer activated T cells in their colons. In mice lacking T cells, apple polyphenols were unable to protect against colitis or suppress proinflammatory cytokine expression, indicating apple polyphenols protect against colitis via the suppression of T cell activation and/or recruitment.

"It appears that the old adage rings true in more ways than one," said John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology, "In addition to the obvious health benefits of the nutrients and fiber in fruits and vegetables, this study indicates that even something as relatively common as the apple contains other healthy ingredients that can have serious therapeutic value."

Individualised Treatment for Crohn’s Disease Right Closer to Gene Mapping

Fri, 03 Feb 2012 02:38:41 +0000

Scientists have discovered three new locations for Crohn's Disease genes by means of novel gene mapping approach.

The complex genetic and environmental causes of Crohn's Disease (CD) have long been difficult to untangle. CD, a type of Inflammatory Bowel Disease that affects about 100 to 150 people per 100,000 in Europe, is characterised by inflammation in the gastrointestinal tract. Even though twin and family studies suggest a high heritability for CD of 50-60%, so far the locations of much of the genetic information implicated in this chronic disease have remained elusive.

Now, three newly identified gene regions on chromosome 16 have filled in some of the missing gaps, as well as showing that different patients carry different sets of faulty genes. Published today in the American Journal of Human Genetics, the findings could pave the way for personalised treatment and also lead to improved understanding of how complex diseases are inherited.

Dr Nikolas Maniatis, senior author from the UCL Research Department of Genetics, Evolution and Environment, said: "This paper shows how personalised medicine could work and also help to separate out patients. For example, just as there are many different types of cancer with different underlying genes, it seems that there are also mutations in different genes for different types of Crohn's Disease."

The research team used UK data provided by the Wellcome Trust Case Control Consortium (WTCCC), which includes genetic information of 1698 CD patients. The team's results were also replicated using independent US data provided by the American National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which contains genetic information of 813 patients with CD.

Instead of comparing lots of genomic sites, one at a time, across the entire genome, the team instead looked at segments of DNA, each of which contains many variable sites. They used a mapping technique based on refined genetic maps that have the ability to show how stretches of DNA have been passed down together through the generations. By taking this into account when analysing genetic information from patients with CD the team were able to localise the faulty genes.

Dr Maniatis said: "This project essentially maps the most likely location of faulty sites for Crohn's Disease in the genome. By combining several pieces of information together, our technique lets us increase the power of our analysis."

Applying their technique on chromosome 16, which has long been known to harbour NOD2, an important gene for CD, the team indentified three novel genes, called CYLD, IRF8 and CDH1/CDH3, associated with CD and involved with inflammation and immune dysregulation in the body. Although these genes have different functions, all three are implicated in pathways involved in CD.

Dr Maniatis said: "These are very exciting times, as we can use these genetic maps to pinpoint where the causal sites of Crohn's Disease are located. Although it has been shown in the past that a proportion of patients suffering from Crohn's Disease do not carry the NOD2 mutations, up until now no other genes on chromosome 16 have been published in genome-wide analyses."

Professor Dallas Swallow, collaborator and co-author, also from the UCL Research Department of Genetics, Evolution & Environment, said: "This research will complement the work of those examining cellular and molecular changes, and ultimately lead to more personalised strategies for treatment. The next step is to search the rest of the genome.

"Importantly the work also shows that this method will allow more information to be derived from the valuable datasets collected by organisations such as the Wellcome Trust. This method can also be used to analyse other complex disorders, allowing us to make similar progress on other diseases, such as diabetes and Parkinson's disease."

Read more: Individualised Treatment for Crohn’s Disease Right Closer to Gene Mapping | MedIndia http://www.medindia.net/news/Individuali...z1lHa92ge5

How Cholera Bacterium Gains a Foothold in the Gut

Fri, 03 Feb 2012 02:35:47 +0000

A team of biologists at the University of York has made an important advance in our understanding of the way cholera attacks the body. The discovery could help scientists target treatments for the globally significant intestinal disease which kills more than 100,000 people every year.

The disease is caused by the bacterium Vibrio cholerae, which is able to colonise the intestine usually after consumption of contaminated water or food. Once infection is established, the bacterium secretes a toxin that causes watery diarrhea and ultimately death if not treated rapidly. Colonisation of the intestine is difficult for incoming bacteria as they have to be highly competitive to gain a foothold among the trillions of other bacteria already in situ.

Scientists at York, led by Dr. Gavin Thomas in the University's Department of Biology, have investigated one of the important routes that V. cholera uses to gain this foothold. To be able to grow in the intestine the bacterium harvests and then eats a sugar, called sialic acid, that is present on the surface of our gut cells.

Collaborators of the York group at the University of Delaware, USA, led by Professor Fidelma Boyd, had shown previously that eating sialic acid was important for the survival of V. cholerae in animal models, but the mechanism by which the bacteria recognise and take up the sialic was unknown.

The York research, funded by the Biotechnology and Biological Sciences Research Council (BBSRC), demonstrates that the pathogen uses a particular kind of transporter called a TRAP transporter to recognise sialic acid and take it up into the cell. The transporter has particular properties that are suited to scavenging the small amount of available sialic acid. The research also provided some important basic information about how TRAP transporters work in general.

The leader of the research in York, Dr. Gavin Thomas, said: "This work continues our discoveries of how bacteria that grow in our body exploit sialic acid for their survival and help us to take forward our efforts to design chemicals to inhibit these processes in different bacterial pathogens."

Quality of Colonoscopy Reporting Assessed in New Study

Fri, 03 Feb 2012 02:34:23 +0000

The quality of colonoscopy reporting in daily clinical practice has been assessed by researchers in the Netherlands. They also evaluated the quality of colonoscopy performance.

They found that colonoscopy reporting varied significantly in clinical practice. Colonoscopy performance met the suggested standards, however, considerable variability between endoscopy departments was found. Researchers concluded that the results of the study underline the importance of the implementation of quality indicators and guidelines, and that by continuous monitoring of quality parameters, the quality of both colonoscopy reporting and colonoscopy performance can easily be improved. The study appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Quality assurance in endoscopy has become an important topic in recent decades. The implementation of colorectal cancer screening has driven a significant portion of these quality initiatives in colonoscopy. Suggested quality indicators for colonoscopy include, among others, cecal intubation rate, adenoma detection rate (ADR), and withdrawal time. Without complete and accurate reporting of colonoscopy parameters, continuous quality assurance is meaningless because deficits in service and quality improvements over time cannot be identified. By determining underlying reasons for quality deficits, specific training and education projects can be implemented to achieve the maximum benefit from colonoscopic procedures.

"Studies of quality indicators focus to a great extent on single quality indicators and often show the results of quality assurance in nondaily clinical practice, such as screening programs and study settings, where endoscopists were aware of the quality audit or were obliged to complete automated colonoscopy reporting systems. Less is known about the compliance with colonoscopy reporting and performance in daily clinical practice," said study lead author Vincent de Jonge, MSc, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. "Our study examined both reporting and performance in daily practice. We found that reporting varied significantly in clinical practice and that while performance met the suggested standards, there was considerable variability between endoscopy departments."

Methods
This study took place in the daily clinical practice of 12 endoscopy departments in the Netherlands (six teaching hospitals and six general hospitals). At the time of the study, there was no comprehensive quality assurance program either nationwide or at any of the endoscopy departments individually, although over the past 15 years, the Dutch Society of Gastroenterologists has put in place and maintained a quality audit system for endoscopy units. This system requires that endoscopy units and their staff undergo a thorough quality audit every five years according to a fixed format by trained external auditors from the Dutch Society. The audit focuses on, for example, organizational aspects of the units, case mix, number of endoscopy procedures performed, waiting lists, and complication registration, but not on specific performance indicators of individual endoscopists such as those investigated in this study (i.e., cecal intubation rate and ADR). The staff of each participating endoscopy department was informed about the study protocol and parameters of interest, and ethical approval was obtained from each institutional review board. During the study period, colonoscopies and colonoscopy reporting were performed according to local protocols.

A total of 4,800 colonoscopy reports were included covering scheduled colonoscopies on 4,738 patients. Reports were reviewed by hand. Quality of reporting was assessed by using the American Society for Gastrointestinal Endoscopy criteria for colonoscopy reporting. Quality of colonoscopy performance was evaluated by using cecal intubation rate and ADR.

Results
The 4,800 colonoscopies were performed by 116 endoscopists: 70 percent by gastroenterologists, 16 percent by gastroenterology fellows, 10 percent by internists, 3 percent by nurse-endoscopists, and 1 percent by surgeons. The mean age of the patients was 59 years old and 47 percent were male. Reports contained information on indication, sedation practice, and extent of the procedure in more than 90 percent. Only 62 percent of the reports mentioned the quality of bowel preparation (range between departments was 7 to 100 percent). Photographic documentation of the cecal landmarks was present in 71 percent (range was 22 to 97 percent). The adjusted cecal intubation rate was 92 percent (range was 84 to 97 percent) and the ADR was 24 percent (range was 13 to 32 percent).

The researchers concluded that overall, the quality of colonoscopy reporting was high, although significant variability existed. This variance suggests that, with a relatively small amount of effort, the quality of reporting can be improved significantly. This may be achieved with the widespread introduction of computerized image storage and endoscopy reporting, and also has the potential to be cost-saving compared with handwritten or dictated reports. The overall quality of colonoscopy performance reached international standards, although remarkable variability between endoscopy departments was found. By continuous quality monitoring and disclosure of results, the overall quality of performance can be further improved. This study emphasizes that national guidelines for both colonoscopy performance and reporting parameters are needed to set common targets for the quality of colonoscopy, thereby improving uniformity in daily clinical practice of both colonoscopy reporting and colonoscopy performance.

In an accompanying editorial, David A. Johnson, MD, FACG, FASGE, Department of Internal Medicine Gastroenterology Division, Eastern VA Medical School, Norfolk, Virginia, states, "The results of this study highlight several important points. First, there is clearly room for significant improvement, both for reporting and performance of colonoscopy. Second, despite the use of the quality metrics, there was not consistent use nor was there any improvement even when the endoscopists knew that they were being evaluated. This suggests that the process perhaps needs to be better standardized via an electronic report with required fields. What the study does not address is whether this information was to be used in feedback to the individual endoscopists as part of a quality improvement program, which clearly should be the intent of comparative metrics."

Source-Eurekalert

Treating Crohn's disease

Thu, 02 Feb 2012 01:41:24 +0000

Your treatment plan

If you are diagnosed with Crohn’s disease, your care team will draw up a treatment plan for you. There are three goals in your treatment plan:

1. treat the active disease, in order to resolve your symptoms
2. prevent your symptoms returning with maintenance therapy
3. treat any returning symptoms with relapse therapy

Steroids

Steroids are a type of hormone medication. Hormones are groups of powerful chemicals that have a wide range of effects on the body. One such effect is to reduce inflammation.

Steroids are usually only used to treat the active disease because their long-term use is associated with a range of adverse side effects.

Budesonide and prednisolone are two steroids that are often used to treat Crohn’s disease.

Budesonide
Budesonide is usually the first steroid that is prescribed to help control the symptoms of Crohn’s disease.

If you take budesonide on a short-term basis (fewer than 12 weeks) you may experience the following side effects:

. acne
. swelling of the face
. swelling of the hands, arms, feet and legs due to a build-up of fluids (oedema)
. mood changes, such as feeling irritable or anxious
. insomnia
. indigestion

If you take budesonide for more than 12 weeks, you may experience the following side effects:

. thinning of the bones (osteoporosis)
. increased vulnerability to infection
. cataracts (a type of eye condition)
. muscle cramps and stiffness

If you need to take budesonide for more than 12 weeks, you may be given vitamin D and calcium supplements to help protect against the effects of osteoporosis. Both of these supplements help to strengthen the bone.

Due to your increased vulnerability to infections, you should avoid close contact with people who are known to have infections, particularly those with chickenpox, measles and shingles.

You should not suddenly stop taking budesonide because doing so can cause adverse effects. When you no longer need to take your medication, your dose will be gradually reduced over time.

Prednisolone
Prednisolone is used in cases where budesonide proves ineffective, or where your symptoms are moderate to severe.

Prednisolone has the same type of short-term and long-term side effects as budesonide. In addition, prednisolone has been known to cause mental health problems in an estimated 5% of people.

These include:

. feeling depressed and thinking about suicide
. feeling very excited and happy
. experiencing sudden and severe mood changes (happy one minute, very depressed the next)
. feeling anxious
. having problems thinking clearly and feeling particularly confused
. memory loss
. hallucinations (seeing and hearing things that are not real)

If you experience any of these symptoms, contact your GP as soon as possible because your dose may need to be adjusted.

The advice outlined above about avoiding people with infections and not suddenly stopping your prescribed dose also applies to prednisolone.

Aminosalicylates

Sulfasalazine
Sulfasalazine belongs to a group of medicines called aminosalicylates. Aminosalicylates are known to reduce inflammation inside the colon.

Sulfasalazine can be used as an alternative to steroids to treat mild cases of Crohn’s disease.

Depending on exactly where the inflammation is occurring, you may be given sulfasalazine in tablet form or as a suppository. A suppository is a capsule that you insert into your anus (back passage).

Common side effects of sulfasalazine include:

. headache
. nausea
. abdominal pain
. diarrhoea

If side effects become particularly troublesome, you should tell your GP as the dose used may need to be adjusted.
Immunosuppressants

Immunosuppressants are a type of medication to suppress the activities of the immune system in order to help reduce inflammation on a long-term basis.

Immunosuppressants are used in maintenance therapy and in combination with steroids when a person has a relapse of symptoms.

Two immunosuppressants that are widely used for treating Crohn’s disease are azathioprine and mercaptopurine.

Azathioprine
Depending on the severity of your symptoms, you may be given azathioprine in tablet form or as an injection.

Common side effects of azathioprine include:

. increased vulnerability to infection
. bleeding and bruising more easily

Due to your increased vulnerability to infection, you should avoid people with a known chickenpox or shingles infection.

Less common side effects of azathioprine include:

. headaches
. shortness of breath and dizziness when exercising
. nausea
. vomiting

Mercaptopurine

Mercaptopurine was originally developed to treat leukaemia (cancer of the blood cells), but it has since proved effective in the treatment of Crohn’s disease.

As mercaptopurine is given in tablet form, its side effects are not as severe as those associated with other forms of chemotherapy treatment.

Common side effects of mercaptopurine include:

. nausea
. vomiting

Less common side effects of mercaptopurine include:

. loss of appetite
. feeling tired, breathless and weak, which is caused by a drop in the number of red blood cells (anaemia)

Mercaptopurine can also temporarily affect the quality of a woman’s eggs and a man’s sperm, which could increase the risk of birth defects. It is therefore very important to use effective contraception if you are sexually active and you are taking mercaptopurine.

Biological therapies
Biological therapies are a new type of medication. They are created using naturally occurring biological substances, such as antibodies and enzymes.

There are currently two biological therapies licensed for use in England:

. infliximab
. adalimumab

Each medication is discussed in more depth below.

Infliximab
Infliximab is usually only recommended in severe cases of Crohn’s disease that have not responded to steroid and immunosuppressant treatments, and where the person is unsuitable for surgery.

For example, if a person has had previous surgery to remove a section of bowel, removing more of the bowel could result in a loss of digestive function. Alternatively, a person may be in too poor a state of health to withstand the effects of surgery.

Infliximab works by targeting the tumour necrosis factor (TNF) antibodies that are responsible for much of the inflammation that is associated with Crohn’s disease.

Infliximab is given through a drip in your arm over the course of two hours. This is known as an infusion.

Depending on how well your symptoms respond to treatment, you may only require one infusion, or you may have three infusions that are given every eight weeks.

Around one person in four has an allergic reaction to infliximab and experiences symptoms such as:

. joint and muscle pain
. itchy skin
. high temperature
. rash
. swelling of the hands and/or lips
. problems swallowing
. headaches

Symptoms can range from mild to severe and they usually develop in the first two hours after the infusion has finished.

However, in a minority of cases, people have experienced a delayed allergic reaction days, or even weeks, after an infusion. If you begin to experience the symptoms listed above after having infliximab, you should seek immediate medical assistance.

Due to the significant risk of having a severe allergic reaction (one in four), your health will be carefully monitored after your first infusion and, if necessary, powerful anti-allergy medication, such as intravenous steroids, may be used.

There have been several cases where infliximab has reactivated a previously dormant tuberculosis (TB) infection. Therefore, it may not be suitable for you if you have a previous history of TB. Infliximab is also not recommended for people with a history of heart disease.

Infliximab will also make you more vulnerable to infection so you should avoid contact with people who have a known chickenpox or shingles infection.

You should report any symptoms of a possible infection, such as coughs, a high temperature or a sore throat, to your GP.

Adalimumab
Another biological therapy available for people with severe Crohn's disease is a medication called adalimumab. Adalimumab works in a similar way to infliximab by targeting TNF antibodies.

Adalimumab is given by injection and most people will need to have an injection every two weeks. Your GP or practice nurse will be able to teach you how to administer the injections yourself at home.

Like infliximab, adalimumab will make you more vulnerable to infection, so if you are taking it you should avoid contact with people with chickenpox or shingles and always report any symptoms of a possible infection to your GP.

Adalimumab can cause reactivation of the hepatitis B virus in people who were previously infected. If you know you have previously been infected with hepatitis B, you should inform your GP because adalimumab may not be suitable for you.

Common side effects of adalimumab include:

. pain, swelling, redness and itching at the site of the injection
. headache
. abdominal (tummy) pain
. nausea (feeling sick)
. vomiting (being sick)
. skin rash
. muscle, joint and bone pain
. respiratory tract infections, such as colds, a runny nose and pneumonia (lung infection)

Surgery
Surgery is often required when the symptoms of Crohn’s disease cannot be controlled using medication alone. An estimated 80% of people with Crohn’s disease will require surgery at some point in their life.

Surgery cannot cure Crohn’s disease, but it can provide long periods of remission, often lasting several years. During surgery, the inflamed section of the digestive system is removed and the remaining part is reattached.

Relieve Crohn's Disease Naturally

Sun, 15 Jan 2012 01:37:51 +0000

(NaturalNews) Crohn's Disease is an inflammation that can affect any portion of the digestive tract. Approximately 50% of all incidences of Crohn's Disease affect the last part of the small intestine. The typical onset of Crohn's is in early adulthood. Some with Crohn's Disease will experience periods of remission and others with Crohn's Disease will experience continuous symptoms. To date, there is no known cure for Crohn's Disease. There are many pharmaceutical drugs available for control of moderate to severe symptoms. But while these drugs may offer limited relief, there are natural alternative methods for relieving symptoms that are much more effective and less toxic to the human body.

There are various ideas about the causes of Crohn's Disease – none have proven conclusive. The most popular theory is that Crohn's Disease occurs when the body's immune system reacts to an invading bacteria or virus by creating an ongoing inflammation. People who suffer with Crohn's Disease often have abnormalities within their immune systems. It has yet to be determined whether these abnormalities are the cause of Crohn's or a result, however.

The chief symptom of Crohn's Disease is abdominal pain that is usually in the lower right part of the abdomen. Another main symptom is diarrhea. The inflammation causes the pain and also causes the intestines to empty frequently (diarrhea is a result of this). Other symptoms include rectal bleeding, weight loss, and fever. The rectal bleeding can often be severe enough to lead to anemia. If children have Crohn's Disease they may experience stunted growth and delayed development.

A common complication of Crohn's Disease is a blockage of the intestine. This blockage happens because the disease will lead to a thickening of the intestinal walls. Scar tissue will build up and this will narrow the intestinal passage. Another complication is ulcers that form in the intestines and move into surrounding tissues such as the bladder, vagina, rectum, and anus. These tunneling ulcers are called fistulas and they often become infected. Treatment for fistulas varies from medication to removing portions of the infected intestine surgically. Often the infections return after surgery, however.

The best way to relieve symptoms of Crohn's Disease is to improve one's diet. The bottom line is that Crohn's Disease is a direct result of consuming a bad diet. To experience better health, changes in diet must be made.

These changes include eliminating all sugar, processed foods, soda pops (and fruit juices), and grains. Also include probiotics in the diet to improve symptoms. L-glutamine supplementation has been shown to lead to improvements in people with Crohn's Disease, ulcerative colitis, and irritable bowel syndrome. There was also some recent research in Japan that revealed that flax oil may help relieve symptoms of Crohn's Disease.

Source: http://www.healingdaily.com/conditi...

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Hypnotherapy Helps Crohn's Disease

Sun, 15 Jan 2012 01:36:59 +0000

(NaturalNews) Hypnotherapy has long been used to help people cope with stress. No matter what the source of stress is, hypnosis is a relaxation technique that calms the mind and body into a deeper state of relaxation. Research has shown that when stress is a contributing factor in a physical or physiological situation, hypnotherapy helps reduce symptoms associated with that ailment. Studies show that hypnotherapy is very beneficial in treating people with Crohn's disease.

Crohn's disease is an inflammatory bowel disease. It affects about 2 to 7 in 100,000 people. The disease can be quite debilitating and sometimes life threatening when symptoms are not controlled. It causes the digestive tract to inflame and can cause severe abdominal pain, malnutrition, and diarrhea. Unfortunately, there is no known cure for Crohn's disease. Instead, symptoms must be treated, for example with hypnotherapy, and people with the disease can live a long life with their symptoms under control. According to the Mayo Clinic, stress does not cause Crohn's disease, but it can cause symptoms to worsen or cause a flare up.

According to the University of Maryland Medical Center, there is no way to prevent Crohn's disease, but managing the symptoms is possible through diet, lifestyle changes, and alternative therapies. The main goal is to prevent flare-ups and to remain in remission as long as possible. People with Crohn's disease have reported that stress makes their symptoms worsen. Relaxation techniques are very helpful in reducing the symptoms of Crohn's disease. The University of Maryland Medical Center also promotes the use of hypnotherapy because studies have been shown that it improves immune function, decreases stress, increases relaxation, and eases feelings of anxiety.

A study conducted in Europe included 266 participants with Crohn's disease. The researchers found that hypnotherapy and psychotherapy improve the treatment of the disease. The study found that emotional conflicts such as stress, depression, and anorexia effect the transgression of the disease. Relaxation techniques used in hypnotherapy and psychotherapy were found to give patients greater control over their symptoms.

More research is finding that there are links between stress and physiological diseases. There is a direct link between emotional stress and Crohn's disease flare-ups. Alternative therapy such as hypnotherapy, psychotherapy, yoga, and meditation has been shown to improve the overall well-being of Crohn's disease sufferers. Since there is no known cure for Crohn's disease, alternative therapies are highly suggested to help people control their flare-ups and remain in remission. Hypnotherapy promotes relaxation and puts the Crohn's disease sufferer in control of their symptoms in a safe and natural way.

Sources

Crohn's disease. Mayo Clinic. Retrieved August 21, 2009 from http://www.mayoclinic.com/health/cr...

Crohn's disease. (2008). University of Maryland Medical Center. Retrieved August 21, 2009 from http://www.umm.edu/altmed/articles/...

Feiereis, H. (1984). Hypnotherapy/Psychotherapy and Crohn's disease. Langenbecks Arch Chir, 364, 407-411.

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FDA Finally Admits That Drugs for Crohn's Disease and Arthritis May Promote Cancer

Sun, 15 Jan 2012 01:35:46 +0000

(NaturalNews) The FDA has ordered makers of drugs for a variety of inflammatory diseases to add a "black box warning" about an increased risk of cancer in children and adolescents.

A black box warning is the most severe warning that the FDA can place on a product without withdrawing it from the market.

The FDA began analyzing the drugs, known as tumor necrosis factor (TNF) blockers, when reports emerged that dozens of children had developed cancer while taking the drugs. TNF blockers are used to treat inflammatory and autoimmune diseases such as Crohn's disease and rheumatoid arthritis. They include adalimumab (marketed as Humira), certolizumab pegol (marketed as Cimzia), etanercept (marketed as Enbrel), golimumab (marketed as Simponi) and infliximab (marketed as Remicade.

"FDA announced that it has completed its analysis of TNF blockers and has concluded that there is an increased risk of lymphoma and other cancers associated with the use of these drugs in children and adolescents," spokesperson Crystal Rice said . "This new safety information is now being added to the boxed warning for these products."

The drugs already carry warnings about the risk of fungal infections and other side effects.

Since people with the inflammatory diseases that TNF blockers treat are already at an increased risk of cancer, those who take the drugs are at particularly high risk.

"It's good to have this information out there," said Patience White of the Arthritis Foundation. "It gives people with arthritis an opportunity to go to their doctor and talk about the risk/benefits."

The FDA advises all patients currently taking TNF blockers that the drugs may increase their risk of lymphoma, leukemia and other cancers; may worsen pre-psoriasis; and may increase the risk of psoriasis. Such patients should watch for cancer warning signs such as swollen lymph nodes in the neck, underarms or groin; unexpected weight loss or fatigue; or easy bruising or bleeding. Any such symptoms should be discussed with a doctor. Patients should not stop or change prescription drugs without consulting a physician first.

Sources for this story include: health.usnews.com.

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Probiotic could treat Crohn's, colitis and colon cancer

Sun, 15 Jan 2012 01:34:59 +0000

(NaturalNews) Some of the most miserable and painful chronic diseases known to humankind involve inflammation in the bowel. Crohn's disease and ulcerative colitis are two of these relapsing conditions. They affect more than a million people in the United States and cause weight loss, diarrhea, sometimes excruciating abdominal pain and cramping and gastrointestinal bleeding.

Mainstream medicine treats these ills, which involve ongoing tissue inflammation that alters the functioning of the intestine, with a host of immune suppressive drugs including steroids. Unfortunately, these Big Pharma side-effect laden solutions are not totally effective and patients relapse.

But now there's new hope on the horizon for a drug-free, totally safe treatment could even turn out to be a cure: a probiotic.

Probiotics are live microorganisms (in most cases, bacteria) that are much like the beneficial microorganisms found in the healthy human gut. Also known as "friendly bacteria" or "good bacteria", foods like yogurt and kefir contain probiotics. They can be taken as supplements, too.

Northwestern Medicine researchers have genetically tweaked a version of a common probiotic found in yogurt and cheese and a new animal study shows it is an effective treatment for inflammatory bowel diseases such as Crohn's and ulcerative colitis. What's more, the scientists think the probiotic may be useful in treating colon cancer, another disease triggered by inflammation, as well.

The Northwestern team deleted a gene in the probiotic Lactobacillus acidophilus and fed this version of the probiotic to mice with two different models of colitis. After about 2 weeks of treatment, the new probiotic strain had virtually eliminated colon inflammation in the animals. Moreover, it halted progression of the disease by 95 percent. The results of the study were just published in the Proceedings of the National Academy of Sciences.

"This opens brand new avenues to treat various autoimmune diseases of the gut, including inflammatory bowel disease and colon cancer, all which can be triggered by imbalanced inflammatory immune responses," said Mansour Mohamadzadeh, associate professor of medicine at Northwestern University Feinberg School of Medicine and lead investigator of the study, in a statement to the media. He also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

In the study, the modified Lactobacillus acidophilus was found to calm over stimulated immune cells in the gut by mobilizing messenger immune cells, called dendritic cells. These dendritic cells then enhanced the production of other functional immune cells, known as regulatory T-cells. The result? A healthy new balance was achieved in the intestine and systemic inflammation was soothed away.

"They essentially calm everything down and restore it to normal," Dr. Mohamadzadeh explained. The next step will be a trial testing the new form of Lactobacillus acidophilus in humans. Dr. Mohamadzadeh and his colleagues at the Lurie Cancer Center are also researching the new Lactobacillus acidophilus as a possible treatment for colon cancer.

Editor's note: NaturalNews is opposed to the use of animals in medical experiments that expose them to harm. We present these findings in protest of the way in which they were acquired.

For more information:
http://www.ncbi.nlm.nih.gov/pubmed/...
http://www.naturalnews.com/probioti...

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Beat Crohn's disease naturally

Sun, 15 Jan 2012 01:34:04 +0000

(NaturalNews) Crohn`s disease is an inflammatory disease of the intestines that can affect any part of the digestive system from mouth to anus. It primarily causes abdominal pain and diarrhea (which may be bloody if inflammation is at its worst). This syndrome may also cause complications outside the gastrointestinal tract such as arthritis, eczema, fatigue and lack of concentration. Natural lifestyle solutions exist for preventing and reversing this crippling disease.

Crohn`s disease is considered an auto-immune disease where the body`s immune system attacks the tissues of the digestive system. Environmental factors play a large role as evidenced by a higher incidence of the disease in western industrialized nations compared to other parts of the world.

The immune system is characterized by 2 major regions: Innate immunity and adaptive immunity. Innate immunity provides immediate defense against pathogens and is characterized by t-cell formation. Adaptive immunity is considered a `learned immunity` and is what provides long-lasting immune defense through antibody formation. Researchers have shown that Crohn`s is an innate immune deficiency. Chronic inflammation with this disorder is caused by the adaptive immunity trying to compensate for the reduced function of the innate immune system.

Crohn`s disease appears to be associated with anti-yeast antibodies. Mannon is a component of the yeast organism`s cell wall. Individuals with Crohn`s tend to have lower levels of lectin binding proteins that bind mannan and help expel it from the body. Due to the lowered lectin levels and the insufficient innate immune system, individuals with Crohn`s very often develop anti-yeast antibodies. This overproduction of anti-yeast antibodies triggers an inflammatory response that damages the gut lining.

Individuals with Crohn`s disease should avoid all yeast products and other common allergens. The most common food allergens to avoid include gluten containing grains such as wheat, barley, rye, oats, kamut, & spelt. Soy products, different nuts (such as peanuts), eggs, and heavy proteins are often not tolerated well. Some individuals struggle with nightshade vegetables such as eggplant, tomatoes, & potatoes.

An anti-inflammatory diet and lifestyle are critical for full recovery from this condition. Anti-inflammatory foods help to modulate the immune system and give it a more accurate pair of eyes so as to not over-inflame when stimulated. To effectively de-inflame it is key to completely avoid man-made foods, sugars, and food allergens as listed above. The long chain omega 3 fatty acids EPA and DHA powerfully de-inflame the body by restoring natural balance to the lipid wall of the cell membrane.

Other great anti-inflammatory foods include coconut products, berries, and non-denatured, whey protein from grass-fed cows and goats. This protein source is also loaded with L-glutamine and enhances cellular glutathione stores which are both necessary for rebuilding the gut and de-inflaming the body. Anti-inflammatory herbs such as turmeric, ginger, boswellia, cinnamon, rosemary, & oregano among others should be used as much as possible.

Dysbiosis is a common feature in individuals with auto-immune disease. Naturally fermented foods such as red cabbage sauerkraut, kimchi, & coconut kefir are phenomenal foods for restoring healthy gut bacteria. Additionally, a high quality probiotic supplement with 50+ billion microorganisms should be consumed regularly.

A balanced immune response in the body is also dependent upon healthy vitamin D levels. Vitamin D helps the body recognize between foreign and self proteins. This reduces inflammation and auto-immune reactions. Healthy Vitamin D levels also stimulate natural Killer cells and macrophages that destroy antagonistic microbes & other pathogens. Healthy Vitamin D3 levels should be between 60-100 ng/ml. Be sure to get tested and supplement if necessary.

http://www.naturalnews.com/030475_i...
http://en.wikipedia.org/wiki/Crohn'...
http://en.wikipedia.org/wiki/Anti_s...

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F.D.A. Approves Drug for Intestinal Disease

Sun, 15 Jan 2012 01:33:22 +0000

Tysabri, a treatment for multiple sclerosis made by Biogen Idec and Elan, received regulatory approval on Monday for use among patients with a severe intestinal disorder.

The Food and Drug Administration approved Tysabri for use in patients with moderate to severe Crohn's disease who do not respond to more conventional drugs, like Humira, which is made by Abbott Laboratories.

The approval represents a comeback for Tysabri, which was temporarily pulled from the market in 2005 after three patients using the drug developed a rare nervous system disorder called multifocal leukoencephalopathy.

The F.D.A. allowed the drug back on the market the following year, but only under a restricted distribution program. The drug is used by more than 12,000 multiple sclerosis patients in the United States, according to Biogen, with no new reports of the fatal disorder.

Government officials said Tuesday that Crohn's disease patients would have to enroll in a similar distribution program for Tysabri. Patients must undergo an educational program on the drug's risks and can receive the injectable drug only from a select group of physicians.

About 500,000 people in the United States have Crohn's, which usually causes diarrhea, fever and internal bleeding. There is no known cure.

Biogen said distribution of Tysabri for Crohn's patients would begin by the end of next month. Biogen said it hoped to expand Tysabri's market to 100,000 patients by 2010, which would give the drug annual sales of $670 million.

The drug is expected to compete with Remicade, the leading Crohn's treatment, made by Johnson & Johnson.

Shares of Biogen Idec rose 96 cents to $59.98. Shares of Elan fell 4 cents to $24.85 in after-hours trading, after rising 13 cents, to $24.89.

New Possible Source for Crohn's Disease Found

Thu, 22 Dec 2011 01:33:32 +0000

A new gene has been linked to the appearance and development of Crohn's disease, an illness that affects around 500,000 people in North America each year. The gene, dubbed Atg16L1, increases the chances of the carrier developing the disease considerably, but it is not a direct cause. In fact, more than 30 areas in the human DNA are thought to be responsible for increased risks of Crohn's disease developing. Scientists at the Washington University School of Medicine in St. Louis say that finding all of these areas is essential in developing new, better treatments in the future.

Until now, doctors believed that this inherited disease evolved due to malfunctions of the immune systems, which was thought to attack some healthy cells in the gut, causing ulcerations and swelling. But a new study on lab mice showed that the Paneth cells, responsible for immune protection in some portions of the small intestine, lose their ability to develop a suited immune response to threats after the Atg16L1 gene mutates. According to Ken Cadwell, Ph.D., a postdoctoral student working in the study, "When they have less Atg16L1, the Paneth cells survive, but their ability to secrete granules is significantly impaired."

Herbert W. "Skip" Virgin, M.D., Ph.D., head of the Department of Pathology and Immunology at the Washington University says that outside, environmental factors are also crucial in determining the underlying causes of Crohn's disease. Following his study, new questions were raised concerning the degree at which Paneth cells affect the development of the disease and how other mutant genes affect the Paneth cells. The only certain result is that these cells indeed predispose a person to Crohn's disease.

Ellen Li, M.D., Ph.D., and Thaddeus Stappenbeck, M.D., Ph.D., co-authors and practitioners at Barnes-Jewish Hospital, gathered samples from patients they operated on over the years, in an attempt to discover all gene mutations that favor the appearance of the disease. The presence and concentration of the Atg16L1 gene was, in Virgin's own words, strikingly similar to that of the same gene in lab mice the researchers had under scrutiny during the study. This proves without a doubt that indeed the gene plays some role in the development of Crohn's disease and scientists are now trying to determine what this role is exactly.

10 Herbs and Vitamins That Are Good for Your Gut

Thu, 22 Dec 2011 01:32:45 +0000

Life with Crohn's disease is often about figuring out what you can and can't eat. Find out how you may be able to compensate for any nutritional deficiencies with these key supplements and herbal remedies.

1. Probiotics, or “good bacteria,” are popping up in all sorts of food products because they’re thought to play a positive role in digestion. For example, says Everyday Health Crohn’s disease expert Bret Lashner, MD, a gastroenterologist in practice at the Cleveland Clinic in Ohio, “There’s a probiotic called VSL#3 that has been shown to be possibly helpful in preventing pouchitis recurrence.” Pouchitis, an inflammation of the lining of a surgically created pouch, can occur in people who have had part of their colon removed.

2.

Probiotics for maintenance of remission in ulcerative colitis

Thu, 22 Dec 2011 01:24:13 +0000

BACKGROUND:
Ulcerative colitis is a chronic relapsing disease characterised by diffuse mucosal inflammation limited to the colon. Current maintenance treatments have multiple adverse events and an effective treatment with minimal adverse events is desired. Several studies have demonstrated the importance of intestinal flora in the pathogenesis of ulcerative colitis. It has been suggested that modifying the bacterial flora with probiotics may attenuate the inflammatory process and prevent relapses in ulcerative colitis.

OBJECTIVES:
The primary objectives were to determine the efficacy and safety of probiotics for the maintenance of remission in ulcerative colitis.

SEARCH METHODS:
The Cochrane Central Register of Controlled Tials (CENTRAL), MEDLINE (1966 to July 2011), EMBASE (1974 to July 2011), CINAHL (1982 to July 2011) and the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group Specialised Trial Register were searched. Manufacturers of probiotics were contacted to identify any unpublished trials. References of trials were also searched for any additional trials.

SELECTION CRITERIA:
Randomised controlled trials (RCTs) that compared probiotics against placebo or any other intervention for the maintenance of remission in ulcerative colitis were eligible for inclusion.

DATA COLLECTION AND ANALYSIS:
Data extraction and assessment of methodological quality of included studies were independently performed by two authors. The main outcome measure was the occurrence of clinical or endoscopic relapse.
MAIN RESULTS:

Four studies (n = 587) met the inclusion criteria and were included in the review. Three trials compared probiotics to mesalazine and one trial compared probiotics with placebo. The studies ranged in length from 3 to 12 months. The risk of bias was high in two studies due to incomplete outcome data and lack of blinding. The methods used for allocation concealment were unclear for all four studies. There was no statistically significant difference between probiotics and mesalazine for maintenance of remission in UC. Relapse was reported in 40.1% of patients in the probiotics group compared to 34.1% of patients in the mesalazine group (3 studies; 555 patients: OR 1.33; 95% CI 0.94 to 1.90 ; I(2) = 11%). There was no statistically significant difference in the incidence of adverse events. Twenty-six per cent of patients in the probiotics group experienced at least one adverse event compared to 24% of patients in the mesalazine group (2 studies; 430 patients OR 1.21; 95% CI 0.80 to 1.84; I(2) =27%). Adverse events reported in the mesalazine-controlled studies include diarrhea, mucous secretion, bloody stools, abdominal pain, flatulence and distension, nausea and vomiting and headache. A small placebo controlled trial (n = 32) found no statistically significant difference in efficacy. Seventy-five per cent of probiotic patients relapsed at one year compared to 92% of placebo patients (OR 0.27; 95% CI 0.03 to 2.68). Adverse events reported in the placebo-controlled study include flatulence, abdominal bloating and pain, changes in faecal consistency, arthralgia, sacroiliitis, tiredness, incontinence, stress, oral blisters, eye dryness, headache, dizziness, influenza, gastroenteritis, cystitis and pneumonia.

AUTHORS' CONCLUSIONS:
Given the relatively small number of patients in the pooled analysis, the small number of events and the high risk and unclear risk of bias in the included studies, there is insufficient evidence to make conclusions about the efficacy of probiotics for maintenance of remission in UC. There is a lack of well-designed RCTs in this area and further research is needed.