Impact of environmental and dietary factors on the course of inflammatory bowel disease

Besides their possible effects on the development of inflammatory bowel disease(IBD),some environmental factors can modulate the clinical course of both ulcerative colitis(UC) and Crohn's disease(CD).This review is mainly devoted to describing the current knowledge of the impact of some of these factors on the outcome of IBD,with special emphasis on smoking and diet.Although the impact of smoking on the susceptibility to develop CD and UC is firmly established,its influence on the clinical course of both diseases is still debatable.In CD,active smoking is a risk factor for postoperative recurrence.Beyond this clinical setting,smoking cessation seems to be advantageous in those CD patients who were smokers at disease diagnosis,while smoking resumption may be of benefit in ex-smokers with resistant UC.The role of dietary habits on the development of IBD is far from being well established.Also,food intolerances are very frequent,but usually inconsistent among IBD patients,and therefore no general dietary recommendations can be made in these patients.In general,IBD patients should eat a diet as varied as possible.Regarding the possible therapeutic role of some dietary components in IBD,lessons should be drawn from the investigation of the primary therapeutic effect of enteral nutrition in CD.Low-fat diets seem to be particularly useful.Also,some lipid sources,such as olive oil,medium-chain triglycerides,and perhaps omega-3 fatty acids,might have a therapeutic effect.Fermentable fiber may have a role in preventing relapses in inactive UC.

CONCERNING THE RELATION OF TOBACCOGLYCOPROTEIN TO BUERGER'S DISEASE

Objective To comprehend the reiation of tobacco glycoprotein (TGP) to Buerger,s disease.Metbods TGP was isolated from crude tobacco leaves by basic immunologic techniques. Serum anti- TGPantibodies were tested by Western blot analysis in 11 patients with Buerger,s disease, 15 healthy male smokers and11 nonsmoking healthy male subjects. Results 1. TGP is a dark brown protein of molecular weight 14000. It maybe a subunit of some high molecular weight protein, and exists in crude tobacco leaves. 2. Western blot analysisshowed that 81.81% of patients with Buerger’s disease (9/11), 33.33% of healthy smokers (5/15) and 27.27% ofhealthy nonsmokers (3/11) had serum anti- TGP antibodies. There was significant dtherence between patientswith Buerger,s disease and two control groups (P<0.05), and no signilicant dtherence between both control groups(P>0.05). Conclusion TGP does play an important role in the pathogenesis of Buerger’s disease. As anti - TGPantibodies are also found in some control subjects, it is speculated that other etiologic factors might coordinatelycontribute to the specifc vascular response to TGP in susceptible subjects.

Age,smoking and overweight contribute to the development of intestinal metaplasia of the cardia

AIM:To assess the role of Helicobacter pylori(H.pylori),gastroesophageal reflux disease(GERD),age,smoking and body weight on the development of intestinal metaplasia of the gastric cardia(IMC).METHODS:Two hundred and seventeen patients scheduled for esophagogastroduodenoscopy were enrolled in this study.Endoscopic biopsies from the esophagus,gastroesophageal junction and stomach were evaluated for inflammation,the presence of H.pylori and intestinal metaplasia.The correlation of these factors with the presence of IMC was assessed using logistic regression.RESULTS:IMC was observed in 42% of the patients.Patient age,smoking habit and body mass index(BMI) were found as potential contributors to IMC.The risk of developing IMC can be predicted in theory by combining these factors according to the following formula:Risk of IMC = a + s-2B where a = 2,…6 decade of age,s = 0 for non-smokers or ex-smokers,1 for < 10 cigarettes/d,2 for > 10 cigarettes/d and B = 0 for BMI < 25 kg/m2(BMI < 27 kg/m2 in females),1 for BMI > 25 kg/m2(BMI > 27 kg/m2 in females).Among potential factors associated with IMC,H.pylori had borderline signif icance(P = 0.07),while GERD showed no signif icance.CONCLUSION:Age,smoking and BMI are potential factors associated with IMC,while H.pylori and GERD show no significant association.IMC can be predicted in theory by logistic regression analysis.