Inflammatory bowel disease (IBD) is a chronic disorder thought to be caused by enteric inflammation in a genetically susceptible host. Although the pathogenesis of IBD is largely unknown, it is widely accepted that dietary components play an important role. Human and animal-based studies have explored the role of various dietary components such as meat, artificial sweeteners and food additives in causing enteric inflammation. Several diets have also been studied in patients with IBD, specifically their role in the induction or maintenance of remission. The most well-studied of these include exclusive enteral nutrition and specific carbohydrate diet. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols), typically prescribed for patients with irritable bowel syndrome, has also been studied in a specific subgroup of patients with IBD. In this review, we describe the current evidence on how various dietary components can induce enteric and colonic inflammation, and the clinical–epidemiological evidence exploring their role in predisposing to or protecting against the development of IBD. We also discuss several special diets and how they affect clinical outcomes in IBD patients. Based on the available evidence, we provide guidance for patients and clinicians managing IBD regarding the best practice in dietary modifications.
1 September 2021 in Clinical and Experimental Gastroenterology
Overview: The purpose of this review is to introduce options for dietary therapies and supplements for the treatment of irritable bowel syndrome (IBS). IBS is a common condition with heterogeneity in pathogenesis and clinical presentation. Current treatment options are targeted at symptom relief with medications. Patients naturally pursue dietary modifications when dealing with symptoms. Dietary therapy for IBS has been poorly studied in the past; however, newer evidence suggests the use of certain diets, such as the low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet, as an intervention in patients with IBS for symptom improvement. Exclusion strategies are frequently tried, such as gluten restriction or lactose avoidance, but lack quality evidence behind their use. Additionally, supplements, such as fiber, probiotics, and peppermint oil, have also been used for IBS with more recent data suggesting the use of these supplements with specific caveats.
Immune checkpoint inhibitors (ICIs) are important immunotherapeutic tools with known potential for adverse events (immune-related adverse events [irAEs]) in the gastrointestinal system. Although ICI-induced colitis and diarrhea are well documented, irAEs localized to the stomach are less frequently described. The management of most irAEs is suspension of ICI therapy and immune suppression. In rare cases of ICI-induced gastritis, treatment strategies of immune suppression have been scarcely described. To our knowledge, there have been no reported cases of severe ICI-induced gastritis leading to fistula formation. This case report describes a patient with isolated ICI-induced gastritis leading to an ulcer with gastrocolic fistula and his treatment course.
Foreign body ingestion is an under-recognized hazard in adults, especially in the elderly where it may lead to significant morbidity and even mortality. We present the case of an elderly patient who ingested her denture without any reported symptoms. After early recognition, endoscopic retrieval of the item was performed. We provide support for endoscopy as a safe and effective intervention for removing ingested foreign bodies in the geriatric population.