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Inflammatory Bowel Disease Linked to Prevalence of Neurological Disorder

January 21st, 2011

Inflammatory bowel disease (IBD) has been linked to an increased risk for subsequent neurological disorders, new research suggests.

Initial 2-year results from an ongoing study that will be presented May 1 at the American Academy of Neurology’s 59th Annual Meeting, in Boston, Massachusetts, showed individuals with IBD were 4 times more likely to develop neuromuscular conditions (including carpal tunnel syndrome and small fiber neuropathy) and 6 times more likely to have sensorimotor polyneuropathy (PN) compared with individuals with other types of gastric conditions.

“Based on these initial results, we believe IBD itself is directly related to the neuropathy and that neuropathy in these patients is much more common than we previously thought,” the study’s principal investigator, Francisco De Assis Gondim, MD, PhD, from the Federal University in Ceara, Brazil, told Medscape.

Women at Greater Risk for Neuromuscular Complications

Although the link between IBD and neurologic disease has been reported before, most of the studies have been small, retrospective case series. In 2005 (Gondim FA et al. Brain. 2005;128:867-879), Dr. Gondim and colleagues also reported the association in a case series of 33 patients with IBD and PN as well as a literature analysis, At the time, this was the largest study and provided the most convincing evidence of the link between IBD and peripheral neuropathy to date.

The initial aim of the current cohort study, said Dr. Gondim, was to determine the prevalence of IBD-associated neurologic disease. To do this, investigators compared 103 individuals with IBD

37 with Crohn’s disease (CD) and 66 with ulcerative colitis (UC)

with 51 control subjects who had other gastric disorders, including dyspepsia, gastritis, and irritable bowel syndrome (IBS).

All subjects received a standard neurological evaluation, including vibration assessment, electromyography, screening for common causes of neuropathy, including possible vitamin B12 deficiency, diabetes, glucose intolerance, and hypothyroidism. They also underwent a neurological workup that included neuroimaging.

Headache was the most commonly reported neurological complaint and had a similar prevalence in all 3 study groups

48.6% in CD patients, 56.9% in the UC group, and 56.9% among controls.

However, the investigators report neuromuscular diseases, including parasthesias and SFN, were much more likely to occur in UC and CD patients compared with the control group.

Carpal tunnel syndrome was 4 times more prevalent in the UC group, and SP was more than 6 times more common in IBD patients, affecting 21% of subjects in the UC and CD groups.

In addition, said Dr. Gondim, the study also showed that neuromuscular complications in general and carpal tunnel syndrome in particular were much more common in women.

A Good Start

“Compared with the control group, the IBD group had a much higher prevalence of neuropathy. In spite of the fact that some of the IBD patients had [neuropathy] risk factors, there were a substantial number who did not, which leads us to conclude there is a direct relationship between IBD and neuropathy,” said Dr. Gondim.

Whether this is due to an immune-mediated phenomenon, an undetected vitamin deficiency, or some other mechanism is not clear, he said. However, the link between IBD and neuropathy is something clinicians need to be aware of, since neuromuscular disease is a common IBD complication that is frequently misdiagnosed as a rheumatological disorder.

The investigators intend to follow study participants for at least another 3 years, with the aim of gaining a better understanding of the natural history of neurological complications in IBD patients.

In the future, Dr. Gondim also hopes to launch a larger, long-term, multicenter cohort study in IBD patients who are neurologically competent at study outset to confirm the link between IBD and neuropathy and better characterize patients who are at risk for neurological complications.

“There’s a lot of work still to do, but this is a good start,” he said.

American Academy of Neurology 59th Annual Meeting: Abstract S16.005. April 28

May 5, 2007

Dr. Perlmutter’s comment:

This is breathtaking that this would be considered breaking news. Please see

BrainRecovery.com which I published 7 years ago. Complementary based physicians have long recognized that inflammation, like that in inflammatory bowel disease, is systemic and therefore affects other organ systems like the nervous system. It’s time for gastroenterologists to talk to neurologists.

Intestinal Inflammation Linked To Systemic Chromosome Damage

June 7th, 2009

From ScienceDaily.com:

UCLA scientists have linked for the first time intestinal inflammation with systemic chromosome damage in mice, a finding that may lead to the early identification and treatment of human inflammatory disorders, some of which increase risk for several types of cancer.

Researchers found that local intestinal inflammation induced DNA damage to lymphocytes of the peripheral blood circulating throughout the body. This means that chromosome damage was not limited to the intestine, but involved tissues of the body distant from the site of inflammation. The team found single- and double-strand DNA breaks in the blood, and chromosome damage in peripheral blood indicating systemic genetic damage.

Inflammatory diseases have been linked to some lymphomas and abdominal, liver and colorectal cancers, said Robert Schiestl, a professor of pathology, radiation oncology and environmental health sciences and a Jonsson Cancer Center scientist. If inflammation can be found early – before any symptoms arise – and the diseases treated immediately, it may prevent the damage that eventually leads to these cancers, he said. The study appears in the June 1, 2009, edition of Cancer Research.

“This was not known before, that intestinal inflammation causes damage that can be found throughout the body,” said Schiestl, the study’s senior author. “This may help explain how inflammation leads to these cancers.”

Conditions that cause intestinal inflammation include Crohn’s disease, inflammatory bowel disease, ulcerative colitis and Celiac disease. About 1.4 million people in the United States and 2.2 million Europeans currently suffer from inflammatory bowel diseases and incidence worldwide is increasing, Schiestl said.

The chromosome damage in the peripheral circulating blood could be used as a biomarker to identify those with intestinal inflammation before they show any symptoms or suffer any distress. In the study, the chromosome damage could be detected in the blood before the onset of colitis in the mouse models the team studied, which were engineered to develop the inflammatory disorder, said Aya Westbrook, a graduate student of the UCLA Molecular Toxicology Interdepartmental Program and first author of the paper. She also noted that the severity of the disease correlated with higher levels of chromosome damage in the blood.

Dr. Jonathan Braun, professor and chairman of the Department of Pathology and Laboratory Medicine at UCLA and a study author, said the chromosome damage may be the “earliest detectable indicator” of intestinal inflammatory diseases.

“Patients come to us with abdominal complaints and we can’t tell if they are inflammatory, obstructive or a bacterial overgrowth,” said Braun, who also is a researcher at UCLA’s Jonsson Cancer Center. “At present, the only way to diagnose the patients is to do full endoscopic examinations, which are both invasive and expensive. ”

In principle, Braun said, this biomarker blood test could replace the invasive endoscopic exam and allow physicians to identify smoldering inflammatory disease before it becomes full blown.

“This may give us the opportunity to ward off the disease early and avoid the subsequent organ damage,” Braun said. “This could change the natural history of these diseases.”

Treating these diseases early would not only bring patients relief, it could prevent the cancers that might have developed later, Braun said.

“We know that prolonged exposure to intestinal inflammatory disease leads to greatly increased risk of cancer,” he said. “If we can reduce the inflammation, we may be able to prevent the cancer.”

UCLA researchers have launched a clinical trial to confirm their findings in humans, Schiestl said. They’re focusing on patients with Crohn’s disease and ulcerative colitis.

“This discovery may give us an opportunity to test new strategies to treat smoldering disease, which we’ve never been able to identify before,” Schiestl said. “We may be able to test new drugs to see which are best at treating early inflammatory disease.”

The research also may uncover why some patients with inflammatory disease develop cancers, while others may have chronic inflammatory disorders for decades and never develop cancer. There may be molecular mechanisms at work that protect some patients and not others. If those mechanisms could be found, it could lead to tests that can predict which patients with intestinal inflammatory diseases are predisposed to cancer.

Diet of worms can cure bowel disease

November 7th, 2007

From New Scientist

Regular doses of worms really do rid people of inflammatory bowel disease. The first trials of the treatment have been a success, and a drinkable concoction containing thousands of pig whipworm eggs could soon be launched in Europe.

At the moment the concoction cannot be stored for long, so doctors or hospitals would have to prepare fresh batches of the eggs for their patients. But a new German company called BioCure, whose sister company BioMonde sells leeches and maggots for treating wounds, hopes it will soon solve the storage problem.

It plans to launch a product called TSO, short for Trichuris suis ova. Chief executive Detlev Goj says the company will apply for approval by the European Agency for the Evaluation of Medicinal Products as soon as the product is ready.

The pig whipworm was chosen as it does not survive very long in people. Patients would have to take TSO around twice a month. The human whipworm, which infects half a billion people, can occasionally cause problems such as anaemia.

The latest trials, carried out in the US, involved 100 people with ulcerative colitis and 100 with Crohn’s disease, both incurable and potentially serious diseases collectively known as inflammatory bowel disease.

Remission rate

In many of the volunteers the symptoms of IBD, such as abdominal pain, bleeding and diarrhoea, disappeared. The remission rate was 50 per cent for ulcerative colitis and 70 per cent for Crohn’s, says gastroenterologist Joel Weinstock of the University of Iowa, who devised the treatment.

“A lot of researchers couldn’t believe this treatment was effective, but people are always sceptical when confronted with new ideas,” Weinstock says. He will announce the results in May at a conference in New Orleans, and full details will soon be published. “With our new impressive results, we can come out of the closet,” he says.

The trials follow the success of a pilot study, revealed by New Scientist in 1999. Weinstock came up with the idea of using worms to treat IBD after noticing that the sharp rise in the disease over the past 50 years in western countries coincided with a fall in infections by parasites such as roundworms and human whipworms. IBD is still rare in developing countries where parasitic infections remain common.

Weinstock’s theory is that our immune systems have evolved to cope with the presence of such parasites, and can become overactive without them