Stuart McLean

It is a chronic relapsing inflammatory

disorder of the large bowel
 Rectalbleeding
 Diarrhoea with blood and mucous

 Tenesmus

 Abdominal pain

 Anorexia

 Raised temperature
Immunologically mediated

Genetic influences

Environmental influences
 Tragnone et al 1995 Dietary habits as risk factors
for inflammatory bowel disease. Eur J Gastroenterol
Hepatol. Jan;7(1):47-51.

 Reif et al 1997 Pre-illness dietary factors in

inflammatory bowel disease. Gut. Jun;40(6):754-60.

 Sakamoto et al 2005 Dietary risk factors for

inflammatory bowel disease: a multicenter case-
control study in Japan. Inflamm Bowel Dis.
Feb;11(2):154-63.
Jowett et al 2004 Influence of dietary factors on
the clinical course of ulcerative Colitis: a
prospective cohort study. Gut Oct; 53: 1479 - 1484.

Magee et al 2005 Associations between diet and

disease activity in ulcerative colitis patients using
a novel method of data analysis. Nutr J. Feb 10;4:7
 Antigen - bacterial, viral, protazoal?

Intestinal epithelium 'Leaky' enterocytes

M - cells Ulcer

Lipids in plasma membrane

Phospholipase A
Macrophage CD-4
cell Free fatty acid
Activated Activated
macrophage CD-4 cell

NF - kB IL - 4 cyclooxygenase-1 2,5-lipoxygenase

TNF - alpha IL - 1 IL - 8

Th - 2 Prostaglandins Leucotrines
Adhesion molecules predominates
(ICAM-1, E-Selectin) in UC
Mast
cells
Systemic manifestations To the bowel Leading to Prostaglandins
of leading to degranulation Production of from
malaise / fever Inflammation of neutrophols cytokines cyclooxygenase-2 LTB-4

I N F L A M M A T I O N
adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.
 Patient Details First Visit Oct 07 Advice / Outcome
Treatment
Male: 34, BMI 24 Prev. azathioprine Rx 3 wks pred 15 mg
10 yr hist. Stable 150mg om stopped Chamomile 25 More relaxed, sleep
last 5 yrs platelets Tormentil 25 better, n. sweats,
Vib opulus 25 Freq loose stools,
Diet: meat, proc. Colitis returned Symph fol. 25 no blood.
Foods, wine, coffee within month. 5 ml tds 300ml -Torm +Agrimonia,
F&V, Omega-3
Rx Predsol enema calendula
didn’t work Lamberts Tumeric
Lifestyle: Self-
employ Acidophilus 10 3 Months no pred.
Stress, poor Bloody stool 6x d, Stools loose 1-
sleep Abdom. Cramps, Diet: Add fish and 2x/day
Fatigue, night cooked veg. -Agrim + Hydrastis
Medication: sweats, work Rooibosh + -FOS 1 tsp
Prednisalone 40mg limited, v. anxious Chamomile tea
om Self Rx bland diet freely 5 Months feeling
Dipentum 1g tds well
Stools normal
Rx tea ( treating
other issues)
 Constituents – Curcumin one of the main
constituents
 Action - anti-inflammatory action on the
enzymes 5-lipoxygenase and cycloxegenase
(Ammon et al 1993. Mechanism of antiinflammatory actions of
curcumin and boswellic acids. J Ethnopharmacol. Mar;38(2-
3):113-9.).
 inhibit nuclear factor kappa B (NF-Kb) (Singh
and Aggarwal (1995 ). Activation of transcription factor NF-kappa
B is suppressed by curcumin (diferuloylmethane) J Biol Chem.
Oct 20;270(42):2 4995-5000).
 Curcumin maintenance therapy for ulcerative
colitis: randomized, multicenter, double-blind,
placebo-controlled trial. (Hanai et al 2006 Clin
Gastroenterol Hepatol Dec; 4(12): 1502-6. )
 Constituents

 Phenolic compounds – flavonoids –

apigenin, quercetin, patuetin, luteolin
and their glycosides.
 Essential oil – terpenoids – alpha-
bisabolol and azulenes
 Actions – Antioxidant, antimocrobial,
antiinflammatory, antispasmotic and
anxiolytic. ( McKay and Blumberg (2006) Phytother Res
Jul; 20 (7): 519-30 )

 Chamazuline showed inhibition of the

formation of leucotrine B 4 (LTB4) through
antioxidant activity of 5-lipoxygenase, (Safayhi
et al 1994 Planta Med. Oct;60(5):410-3. ).
 complex interaction of constituents including
the polysaccarides - acemannan and
mannose

 Theaction upon colonic tissue is thought to

be due to binding of the polysaccarides to
receptor sites lining the colon, thereby
enhancing mucosal barrier function (Vazquez et
al 1996 J Ethnopharmacol 55(1): 69-71)
 In vitro

Anti-inflammatory effects of Aloe vera gel in

human colorectal mucosa ( Langmead et al 2004
Aliment Pharmacol Ther 19; 521 – 527)
Anti-inflammatory - interleuken-8 (IL-8)
 Randomized, double-blind, placebo-
controlled trial of oral Aloe vera gel for active
ulcerative colitis. ( Langmead et al 2004 Aliment
Pharmacol Ther 19; 739 – 747)

4 week trial – 44 patients with mild to moderate

colitis.
histological disease activity.
 Antigen - bacterial, viral, protazoal?

Intestinal epithelium 'Leaky' enterocytes

M - cells Ulcer

Lipids in plasma membrane

Phospholipase A
Macrophage CD-4
cell Free fatty acid
Activated Activated
macrophage CD-4 cell

NF - kB IL - 4 cyclooxygenase-1 2,5-lipoxygenase

TNF - alpha IL - 1 IL - 8

Th - 2 Prostaglandins Leucotrines
Adhesion molecules predominates
(ICAM-1, E-Selectin) in UC
Mast
cells
Systemic manifestations To the bowel Leading to Prostaglandins
of leading to degranulation Production of from
malaise / fever Inflammation of neutrophols cytokines cyclooxygenase-2 LTB-4

I N F L A M M A T I O N
adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.
 Number of factors associated with UC
 Small number of studies that
demonstrate effectiveness of herbs
 Need for more studies