Category Archives: Inflammatory bowel disease : Part 2

Prebiotics for inflammatory bowel disease: Changes in microbial flora (Part 1)

Research in all areas continues and at this time it is difficult to assign a specific explanation for features of abnormal mucin (genetic or environmental effects of bacteria) and altered permeability (genetic or effect of bacteria). A leading contender of environmental triggers is the effect of commensal bacteria . Combined with the loss of tolerance to such ordinary bacteria, there is a hyperimmune response leading to a cell-mediated cytokine cascade through a T helper 1 response in CD and a predominantly humoral or T helper 2 response in UC. Continue reading

Prebiotics for inflammatory bowel disease

dietary therapyThe role of diet in inflammatory bowel disease (IBD) has been difficult to elucidate, but may be relevant to both pathogenesis and treatment. Current emphasis on dietary therapy examines the role of anti-inflammatory molecules or food additives that promote putatively beneficial bacteria. These nutrients include prebiotics, defined by Gibson and Roberfroid as “a nondigestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon and thus improves host health”. Continue reading

Patient nonadherence to medication in inflammatory bowel disease (Part 3)

relationship with patientsYou probably won’t remember the results of the “simple bivariate generalized estimating equations analyses” that “active disease, longer duration of disease, scheduling another appointment, consulting another health professional, prescribed steroids, and higher discordance on well-being were associated with decreased risks of overall nonadherence to medication”. What I will remember, however, is that there are:

•    Sophisticated measures to predict who will and who will not be adherent;

•    Ways of assessing discordance between the patient and physician; and

•    Sophisticated psychosocial measures that can be used to evaluate, for example, patient stress. Continue reading

Patient nonadherence to medication in inflammatory bowel disease (Part 2)

Sometimes patients do not adhere to the treatment regimen for unintentional reasons. As Maida Sewitch and her colleagues point out, “a new model of patient adherence has been proposed in which effective patient-physician dialogue is central to promoting patient adherence”. Psychosocial factors may contribute not only to patient nonadherence but also to physicians’ and patients’ health-related perceptions. These findings are also in keeping with the health psychology literature, which emphasizes the importance of stress and social support on the adoption of lifestyle changes. Continue reading

Patient nonadherence to medication in inflammatory bowel disease (Part 1)

nonadherence with medicationDr Sewitch and colleagues at the University of Montreal and McGill University undertook a prospective study that provided evidence for the important relationship between patient-physician discordance and patient nonadherence with medication for inflammatory bowel disease (IBD).

There are various theories of adherence (the term “compliance” is no longer politically correct!). The authors’ analyses support the communication theory of adherence, which purports that adherence depends on an effective patient-physician dialogue. “Patient-physician discordance” is defined as the difference between patient and physician evaluations of health-related information. Continue reading

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