Calcium, a trace mineral plays an important role in build and maintain
strong bones and teeth, found abundantly in meat, poultry, fish, nut,
seeds, bean, etc. As we age, calcium is absorbed less effectively.
1. Osteoporosis: vitamin D and calcium
Osteoporosis is a bone disease that predisposes to fractures. Sufficient intake of calcium
and vitamin D is recommended for prevention and treatment. According to
the study of 28,406 respondents aged 50 or older to the 2009 Canadian
Community Health Survey (CCHS)--Healthy Aging, found that
In 2009, 19.2% of women and 3.4% of men aged 50 or older reported having
been diagnosed with osteoporosis; the 2004 rates were similar. Age, sex
and household income were associated with the probability of reporting
osteoporosis. In 2004, based on dietary and supplement intake, 45% to
69% of the population aged 50 or older had inadequate intake of calcium, and 54% to 66% had inadequate intake of vitamin D(1).
2. Vitamin D3, calcium and reduced risk of fractures and falls
According to the study by the research team of Dr. Cranney A, in most trials, the effects of vitamin D and calcium could not be separated. Vitamin D(3) (>700 IU/day) with calcium
supplementation compared to placebo has a small beneficial effect on
BMD, and reduces the risk of fractures and falls although benefit may be
confined to specific subgroups. Vitamin D intake above current dietary
reference intakes was not reported to be associated with an increased
risk of adverse events. However, most trials of higher doses of vitamin D
were not adequately designed to assess long-term harms(2).
3. Vitamin D, calcium and the importance of other vitamins
Osteoporosis is a major health disorder
associated with an increased risk of fracture. Nutrition is among the
modifiable factors that influence the risk of osteoporosis and fracture.
Calcium and vitamin D play important roles in improving bone mineral density and reducing the risk of fracture. According to the study by American University of Beirut, deficiencies in vitamins C, E, and K are also associated with compromised bone health; this effect may be modified by smoking, estrogen use or hormonal therapy after menopause, calcium intake, and vitamin D(3).
4. Calcium, dairy products, and bone health in children and young adults
In the review of Medline (National Library of Medicine, Bethesda, MD)
search conducted for studies published on the relationship between milk,
dairy products, or calcium intake and bone
mineralization or fracture risk in children and young adults (1-25
years) yielded 58 studies: 22 cross-sectional studies; 13 retrospective
studies; 10 longitudinal prospective studies; and 13 randomized,
controlled trials found to ne supported of nutrition guidelines focused
specifically on increasing milk or other dairy product intake for
promoting child and adolescent bone mineralization(4).
5. The dosage of calcium and life style risks
According to the study by Aarhus University, secondary hyperparathyroidism caused by calcium and vitamin D insufficiency may reduce bone mass and strength and increase fracture risk and should be avoided. Since calcium
supplementation has been associated with an increased risk of
cardiovascular complications and renal stones, the dose should be
tailored to the habitual daily calcium
intake. Lifestyle-related risk factors (smoking, alcohol consumption,
lack of physical activity and low body weight) should be addressed. The
antifracture efficacy of antiresorptive and anabolic treatment for
osteoporosis has not been documented in larger randomized controlled
studies(5).
6. Calcium and Physiology and cell biology of acupuncture
In the article presenting a novel model of acupuncture physiology based on cellular calcium activation by an acoustic shear wave (ASW) generated by the mechanical movement of the needle with an acupuncture needle was driven by a piezoelectric transducer at 100 Hz or below, showed that the cell
level, the ASW activated intracellular Ca(2+) transients and
oscillations in fibroblasts and endothelial, ventricular myocytes and
neuronal PC-12 cells along with frequency-amplitude tuning and memory capabilities. In contrast with traditional acupuncture models, the signal source is
derived from the total acoustic energy. ASW signaling makes use of the
anisotropy of elasticity of tissues as its waveguides for transmission
and that cell activation is not based on the nervous system(6).
7. Calcium and cell physiology
According to the study by the University of Florida, in excitable cells,
the coordination of changing Ca(2+) concentrations at global (cellular)
and well-defined subcellular spaces through the course of membrane
depolarization can now be conceptualized in the context of disease
processes such as cardiac arrhythmogenesis. The spatial and temporal
dimensions of Ca(2+) signaling are similarly important in non-excitable cells, such as endothelial and epithelial cells,
to regulate multiple signaling pathways that participate in organ
homeostasis as well as cellular organization and essential secretory
processes(7).
8. Calcium and S100 proteins
S100 proteins play a crucial role in multiple important biological processes in vertebrate organisms acting predominantly as calcium signal transmitters.According to the study by the Polish Academy of Sciences, after four Ca(2+) ions bind, it undergoes a dramatic conformational
change, resulting in exposure, in each of its two identical subunits, a
large hydrophobic cleft that binds to target proteins. It has been shown
that abnormal expression of S100A1 is strongly correlated with a number
of severe human diseases: cardiomyopathy and neurodegenerative
disorders(8).
9. Calcium and aluminum salt
Most humans living in industrialized societies are routinely exposed to
bioavailable aluminum salts in the form of additives-in
commercially-prepared foods, alum-clarified drinking water, certain
pharmaceuticals, sunscreens, and other topical applications. Minute
amounts of this aluminum are absorbed into the circulation. Trace
aluminum levels cross the blood-brain barrier and progressively
accumulate in large pyramidal neurons of the hippocampus, cortex, and
other brain regions vulnerable in Alzheimer's disease. According to the study by the St George Hospital Campus, intraneuronal aluminum interferes with Ca2+ metabolism in the aged brain
and describes a way to test this hypothesis. This paper reviews: 1)
major changes that occur in brain Ca2+ homeostasis and Ca2+ signaling,
subtly with aging and more overtly in Alzheimer's disease; and 2)
evidence from the scientific literature that aluminum causes these same
changes in neurons(9).
10. calcium
and aluminum in Neurodegenerative disorders
Both calcium
and aluminum have been implicated in the cell damage and death that
occurs in several neurodegenerative disorders including Alzheimer's
disease (AD). In the study to examine the effects of experimentally elevated intraneuronal levels of aluminum ([Al]i) and/or calcium
([Ca2+]i) on neuronal degeneration and antigenic alterations in the
microtubule-associated protein tau in cell cultures of rat hippocampus
and human cerebral cortex, showed that Exposure of cultures to Al3+ alone (200 microM) for up to 6 d did not
result in neuronal degeneration. Neurons exposed to the divalent cation
ionophore A23187 degenerated within 4 h when Ca2+ was present in the
culture medium whether or not Al3+ was present. Measurements of [Ca2+]i
using the calcium
indicator dye fura-2 demonstrated a direct relationship between
increased [Ca2+]i and neuronal degeneration. In contrast, neurons did
not degenerate when exposed to A23187 in the presence of Al3+ and the
absence of Ca2+, despite a 10-fold elevation in [Al]i as measured by
laser microprobe mass spectrometry. Calcium
influx, but not aluminum influx, elicited antigenic changes in tau
similar to those seen in AD neurofibrillary tangles. Neurons exposed to
glutamate in the presence of Al3+ but in the absence of Ca2+ were not
vulnerable to injury. Finally, increased [Al]i occurred in neurons that
degenerated as the result of exposure to glutamate indicating that
aluminum associates with degenerating neurons(10).
11. Neuronal calcium homeostasis in the aging nervous system
Maintenance of the cellular calcium homeostasis plays an important role for neuronal cell function and interneuronal cell to cell communication. Therefore, alterations of the neuronal Ca2+ homeostasis may play a
crucial role for brain aging in general and for age-related deficits in
cognitive functions particularly.
Numerous studies indicate various disturbances of the Ca2+ homeostasis
on different levels like Ca2+ channel properties, 45Ca2+ uptake, or Ca2+
binding proteins. Investigations on alterations of the free
intracellular calcium
concentration ([Ca2+]i) in presynaptic synaptosomal preparations led to
inconsistent results reporting increased or unchanged [Ca2+]i in aged
animals, according to the Central Institute of Mental Health, Dept. Psychopharmacology(11).
12. Disruption of calcium homeostasis and Alzheimer's disease (AD)
Oligomerization, conformational changes, and the consequent
neurodegeneration of Alzheimer's β-amyloid protein (AβP) play crucial
roles in the pathogenesis of Alzheimer's disease (AD). Mounting evidence
suggests that oligomeric AβPs cause the disruption of calcium homeostasis, eventually leading to neuronal death, according to the School of Pharmaceutical Sciences, Kyushu University of Health and Welfare(12).
13. BK Channels in Cardiovascular Diseases and Aging
Aging is a major risk factor for cardiovascular diseases, one of the
main world-wide causes of death. Several structural and functional
changes occur in the cardiovascular system during the aging process and
the mechanisms. BK channels are transmembrane proteins that play a key role in many
physiological processes, including regulation of vascular tone.In vascular smooth muscle cells,
BK opening and the consequent efflux of potassium (K(+)) leads to
membrane hyperpolarization, which is followed by the closure of
voltage-dependent Ca(2+) channels, reduction of Ca(2+) entry and
vasodilatation. BK regulates nitric oxide-mediated vasodilatation and
thus is crucial for normal endothelial function(13).
14. Ca(2+) waves regulate blood vessel tone and vasomotion
Agonist-stimulated smooth muscle Ca(2+) waves regulate blood vessel tone and vasomotion.The Pharmacology, and Therapeutics, University of British Columbia, present a first report of endothelin-1 stimulated waves of Ca(2+) depletion from the sarcoplasmic reticulum of vascular smooth muscle cells using a calsequestrin-targeted Ca(2+) indicator and confirmed that these waves are due to regenerative Ca(2+)-induced Ca(2+) release by the receptors for inositol 1,4,5-trisphosphate(14).
15. Calcium ion channel blockers on sperm fertilization
In the stduy to evaluate the effects of calcium ion (Ca2+) channel blockers on male fertility potential, showed that therapeutic administrations of calcium
antagonists for hypertension control cause reversible male infertility
associated with an IVF failure. A mechanism of inhibition of sperm
fertilizing potential through insertion of lipophilic calcium ion antagonists into the lipid bilayer of the sperm plasma membrane is consistent with our in vitro studies(15).
16. Ca(2+)and enzymes
The processes of excitation-contraction (EC) coupling consume large
amounts of energy that need to be replenished by oxidative
phosphorylation in mitochondria. Since Ca(2+) activates key enzymes
of the Krebs cycle in the mitochondrial matrix, it is important to
understand the mechanisms and kinetics of mitochondrial Ca(2+) uptake to
delineate how in cardiac myocytes, energy supply is efficiently matched
to demand. According to the study by Universitätsklinikum des Saarlandes, defects in EC coupling that occur in heart failure disrupt
SR-mitochondrial Ca(2+) crosstalk and may cause energetic deficit and
oxidative stress, both factors that are thought to be causally involved
in the initiation and progression of the disease(16).
17. Calcium and blood clotting
In the study of corn-soybean meal diet fortified with minerals and vitamins (but not
vitamin K) was fed to pigs, levels of Ca and P were achieved by adjusting the
amounts of dicalcium phosphate and ground limestone in the diet by the University of Kentucky, showed that in blood clotting, Prothrombin and whole blood clotting
times were increased (P less than .01) in pigs fed high Ca without
vitamin K but were normal in pigs fed high Ca with added vitamin K.
Similar trends in clotting
times occurred in a second experiment. A third experiment was conducted
to determine whether the addition of vitamin K could reverse the
hemorrhagic condition induced by feeding high dietary Ca for 28 d(17).
18. Calcium in follicle-stimulating hormone signal transduction in Sertoli cells
Sertoli cells play a pivotal role in regulation and maintenance of spermatogenesis. Sertoli cells are hormonally regulated by follicle-stimulating hormone (FSH) acting upon a G-protein-linked cell
surface FSH receptor. FSH increases intracellular cyclic AMP but the
involvement of other signal transduction mechanisms including
intracellular calcium in FSH action are not proven. In the study of freshly isolated rat Sertoli cells for the measurement of cytosolic free ionized calcium levels by dual-wavelength fluorescence spectrophotometry using the calcium-sensitive fluorescent dye Fura2-AM, showed that
cyclic AMP may mediate the FSH-induced rise in cytosolic calcium. The FSH-induced rise in cytosolic calcium required extracellular calcium and was abolished by calcium channel blockers specific for dihydropyridine (verapamil, nicardipine), nonvoltage-gated (ruthenium red) or all calcium channels (cobalt). Thus FSH action on Sertoli cells involves a specific, rapid, and sustained increase in cytosolic calcium which requires extracellular calcium and involves both dihydropyridine-sensitive, voltage-gated calcium channels and voltage-independent, receptor-gated calcium channels in the plasma membranes of rat Sertoli cells(18).
19. Long-term dialysis with low-calcium solution (1.0 mmol/L) in CAPD and hyperparathyroidism
In the prospective, randomized, controlled multicenter study to compare the effects of low-calcium (LCa, dialysate calcium 1.0 mmol/L) versus standard-calcium dialysate solution (SCa, dialysate calcium 1.75 mmol/L) on bone mineral metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients over 2 years of treatment with Calcium
carbonate (CaCO3) was given as oral phosphate binder to maintain serum
phosphate < 2.0 mmol/L. If hypercalcemia supervened, CaCO3 was
exchanged stepwise for aluminium hydroxide (Al(OH)3), until
normocalcemia was obtained. Patients received calcitriol (0.25
microgram/day per os) if parathyroid hormone (PTH) exceeded the upper limit of normal by a factor of 2 or more, showed that In CAPD patients low-calcium dialysate solutions can be used successfully over prolonged periods of time with stable control of serum calcium. The risk of hypercalcemia resulting from calcium-containing
phosphate binders and the need to use aluminum-containing phosphate
binders is markedly diminished. However, there is a certain risk that
severe secondary hyperparathyroidism with long-term LCa therapy will
develop, even if normocalcemia is maintained(19).
20. Calcium absorption and hemodialysis
In the study of paired calcium absorption tests done before and after 12-13 weeks of 20,000 IU weekly cholecalciferol supplementation in 30 participants with stage 5 CKD on hemodialysis, calcium absorption was tested with a standardized meal containing 300 mg calcium carbonate intrinsically labeled with (45)Ca; 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured. found that patients with stage 5 CKD on hemodialysis had very low calcium absorption values at baseline, and cholecalciferol supplementation that raised 25(OH)D levels to 50 ng/ml had no effect on calcium absorption(20).
21. Calcium and Vitamin D intake of smokers
In the study conducted by the Geneva University Hospital, Geneva, Switzerland.to determine differences in dietary calcium and vitamin D intakes between female never, former and current smokers of a total of 2319 women resident in Geneva, Switzerland between 1993 and 1997, showed that Female current smokers have lower dietary intakes of calcium and vitamin D than never smokers(21).
22. Calcium and vitamin D nutrition and bone disease of the elderly
Osteoporosis, a systemic skeletal disease characterized by a low bone
mass, is a major public health problem in EC member states because of
the high incidence of fragility fractures, especially hip and vertebral
fracture. According to the study by, The two nutrients essential for bone health are calcium and vitamin D. Reduced supplies of calcium are associated with a reduced bone mass and osteoporosis, whereas a chronic and severe vitamin D deficiency
leads to osteomalacia, a metabolic bone disease characterized by a
decreased mineralization of bone. Vitamin D insufficiency, the
preclinical phase of vitamin D deficiency, is most commonly found in the elderly. The major causes of vitamin D deficiency
and insufficiency are decreased renal hydroxylation of vitamin D, poor
nutrition, scarce exposition to sunlight and a decline in the synthesis
of vitamin D in the skin(22).
23. Calcium deficiency reduces circulating levels of FGF23
Fibroblast growth factor (FGF)-23 is probably the most important regulator of serum phosphate and calcitriol (1,25(OH)2D3) levels. Fibroblast growth factor (FGF) 23 inhibits calcitriol production, which could exacerbate calcium deficiency or hypocalcemia unless calcium itself modulates FGF23 in this setting. According to the stduy by the IMIBIC, Hospital Universitario Reina Sofia, indicated that In parathyroidectomized rats, an increase in dietary calcium for 10 days increased serum calcium, with an associated increase in FGF23, decrease in calcitriol, and no change in phosphorus. Also in parathyroidectomized rats, FGF23 increased significantly 6 hours after administration of calcium gluconate. Taken together, these results suggest that hypocalcemia reduces the circulating concentrations of FGF23(23).
24. Calcium in pregnancy.
Significant transplacental calcium transfer occurs during pregnancy,
especially during the last trimester, to meet the demands of the
rapidly mineralizing fetal skeleton. Similarly, there is an obligate
loss of calcium in the breast milk during lactation. Both these result in considerable stress on the bone mineral homeostasis in the mother. According to the study by Dr. E. V. Kalyani Medical Centre, during pregnancy, increased intestinal absorption of calcium from the gut mainly due to higher generation of calcitriol (1,25 dihydroxy vitamin D) helps in maintaining maternal calcium
levels. On the other hand, during lactation, the main compensatory
mechanism is skeletal resorption due to increased generation of
parathormone related peptide (PTHrP) from the breast. Previous studies
suggest that in spite of considerable changes in bone mineral metabolism
during pregnancy, parity and lactation are not significantly associated with future risk for osteoporosis(24).
25. Calcium & vitamin D supplementation in women with PCOS
In the study to evaluate the efficacy of calcium
& vitamin D supplementation in infertile women suffering from
polycystic ovary syndrome (PCOS), and to assess levels of 25-hydroxy
vitamin D in these patients, showed that the positive effects of calcium
& vitamin D supplementation on weight loss, follicle maturation,
menstrual regularity, and improvement of hyperandrogenism, in infertile
women(25).
26. Calcium-vitamin D and metformin on polycystic ovary syndrome
In thye study to to evaluate the effects of calcium-vitamin D and metformin on the menstrual cycle and ovulation in patients with polycystic ovary syndrome (PCOS), in atotal of 60 infertile PCOS patients were enrolled in a randomized clinical trial
and divided into three equal groups. Group 1 received 1,000 mg of calcium
and 400 IU of vitamin D per day, orally. Group 2 received the same as
Group 1, plus 1,500 mg/day of metformin. Group 3 received 1,500 mg/day
of metformin. The patients were treated for 3 months and followed up for
a further 3 months, showed that the effects of metformin and calcium-vitamin
D in regulating the menstrual cycle suggest that they could also be
effective for the treatment of anovulation and oligomenorrhea, with
possible consequences for pregnancy rates in PCOS patients(26).
27. Calcium metabolism & hypercalcemia in adults
Calcium is essential for many metabolic process, including nerve function, muscle contraction, and blood clotting. According to the study by University of Padua, School of Medicine, Calcium
metabolism mainly depends on the activity of parathyroid hormone (PTH). Its secretion is strictly controlled by the ionized serum calcium levels through a negative feed-back, which is achieved by the activation of calcium-sensing
receptors (CaSRs) mainly expressed on the surface of the parathyroid
cells. The PTH receptor in bone and kidney is now referred as PTHR1. The
balance of PTH, calcitonin, and vitamin D has long been considered the
main regulator of calcium metabolism, Uncontrolled hypercalcemia
may cause renal impairment, both temporary (alteration of renal tubular
function) and progressive (relapsing nephrolithiasis), leading to a
progressive loss of renal function, as well as severe bone diseases, and
heart damages. Advances in the understanding of all actors of calcium homeostasis will be crucial, having several practical consequences in the treatment and prevention of hypercalcemia(27).
28. Calcium and prostate cancer
A high calcium intake, mainly from dairy products, may increase prostate cancer risk by lowering concentrations of 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], a hormone thought to protect against prostate cancer.According to the study by the Harvard School of Public Health, men who consumed >600 mg Ca/d from skim milk had lower plasma
1,25(OH)(2)D(3) concentrations than did those consuming < or =150 mg
Ca/d [71 compared with 85 pmol/L (30.06 compared with 35.64 pg/mL); P =
0.005]. Compared with men consuming < or =0.5 daily servings of dairy
products, those consuming >2.5 servings had a multivariate relative
risk of prostate cancer
of 1.34 (95% CI: 1.04, 1.71) after adjustment for baseline age, body
mass index, smoking, exercise, and randomized treatment assignment in
the original placebo-controlled trial. Compared with men consuming <
or =150 mg Ca/d from dairy products, men consuming >600 mg/d had a
32% higher risk of prostate cancer (95% CI: 1.08, 1.63)(28).
29. calcium and vitamin D and Colon cancer
In the study to investigate whether a high intake of calcium, vitamin D, or dairy products may protect against colon cancer, the authors analyzed data from a prospective cohort study of 35,216 Iowa women aged 55-69 years without a history of cancer who completed a dietary questionnaire in 1986, by the showed that adjusted for age, intakes of calcium and vitamin D were significantly inversely associated with the risk of colon cancer(29).
30. Calcium protect against ischemic heart disease
In the study to investigate whether greater intakes of calcium,
vitamin D, or milk products may protect against ischemic heart disease
mortality, the authors analyzed data from a prospective cohort study of
34,486 postmenopausal Iowa women 55-69 years old and without a history
of ischemic heart disease who completed a dietary questionnaire in 1986, showed that
a higher intake of calcium,
but not of vitamin D or milk products, is associated with reduced
ischemic heart disease mortality in postmenopausal women, and reduced
risk may be achievable whether the higher intake of calcium is attained by diet, supplements, or both(30).
31. Long term intake of dietary and supplemental calcium and cardiovascular disease
In the study to investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease, by the Section of Orthopedics, Uppsala University,showed that High intakes of calcium in women are associated with higher death rates from all causes and cardiovascular disease but not from stroke(31).
32. Health risks and benefits from calcium and vitamin D supplementation
In the study to examines the health benefits and risks of calcium and vitamin D supplementation using WHI data, with emphasis on fractures, cardiovascular disease, cancer, and total mortality by the Fred Hutchinson Cancer Research Center, Seattle, indicated that among women not taking personal calcium or vitamin D supplements at baseline, the hazard ratio [HR] for hip fracture occurrence in the CT following 5 or more years of calcium
and vitamin D supplementation versus placebo was 0.62 (95 % confidence
interval (CI), 0.38-1.00). In combined analyses of CT and OS data, the
corresponding HR was 0.65 (95 % CI, 0.44-0.98). Supplementation effects
were not apparent on the risks of myocardial infarction, coronary heart
disease, total heart disease, stroke, overall cardiovascular disease,
colorectal cancer, or total mortality, while evidence for a reduction in breast cancer risk and total invasive cancer risk among calcium plus vitamin D users was only suggestive(32).
33. Supplemental calcium and colorectal neoplasia
In the study to investigate whether supplemental oral calcium has a suppressant effect on colonic mucosal ornithine decarboxylase (ODC) and tyrosine kinase activities in patients with adenomatous polyps or a history of adenomatous polyps and whether this is affected by age, found that there is an age-related increase in basal rectal mucosal ODC activity in patients with adenomatous polyps which can be suppressed with calcium supplementation p.o., suggesting a role for dietary calcium in the chemoprevention of colorectal neoplasia(33).
34. Calcium and recurrent colorectal adenomas
In a randomized, double-blind trial of the effect of supplementation with
calcium carbonate on the recurrence of colorectal adenomas of 930 subjects (mean age, 61 years; 72 percent men) with a recent history
of colorectal adenomas to receive either calcium carbonate (3 g [1200
mg of elemental calcium] daily) or placebo, with follow-up colonoscopies
one and four years after the qualifying examinationby the New England Journal of medicine, found that Calcium supplementation is associated with a significant — though
moderate — reduction in the risk of recurrent colorectal adenomas(34).
35. Intake of calcium and vitamin D and breast cancer
In the study to evaluate the
total calcium and vitamin D intake in relation to breast cancer
incidence among 10 578 premenopausal and 20 909 postmenopausal women 45
years or older who were free of cancer and cardiovascular disease at
baseline in the Women's Health Study, showed that t
higher intakes of calcium and vitamin D may be associated with a lower
risk of developing premenopausal breast cancer. The likely apparent
protection in premenopausal women may be more pronounced for more
aggressive breast tumors(35).
36. Intravenous calcium and hyperkalemia
Digoxin is an inhibitor of the sodium-potassium ATPase. In overdose, hyperkalemia is common. In the review of the charts of all adult patients diagnosed with digoxin toxicity
in a large teaching hospital over 17.5 years with the main outcome measures
were frequency of life-threatening dysrhythmia within 1 h of calcium administration, and mortality rate in patients who did vs. patients who did not receive intravenous calcium, showed that among digoxin-intoxicated humans, intravenous calcium does not seem to cause malignant dysrhythmias or increase mortality. We found no support for the historical belief that calcium administration is contraindicated in digoxin-toxic patients(36).
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22106784
(2) http://www.ncbi.nlm.nih.gov/pubmed/18088161
(3) http://www.ncbi.nlm.nih.gov/pubmed/21967159
(4) http://www.ncbi.nlm.nih.gov/pubmed/15741380
(5) http://www.ncbi.nlm.nih.gov/pubmed/23329464
(6) http://www.ncbi.nlm.nih.gov/pubmed/21796340
(7) http://www.ncbi.nlm.nih.gov/pubmed/15821159
(8) http://www.ncbi.nlm.nih.gov/pubmed/23351007
(9) http://www.ncbi.nlm.nih.gov/pubmed/22330830
(10) http://www.ncbi.nlm.nih.gov/pubmed/8448655
(11) http://www.ncbi.nlm.nih.gov/pubmed/7997060
(12) http://www.ncbi.nlm.nih.gov/pubmed/21547225
(13) http://www.ncbi.nlm.nih.gov/pubmed/23423545
(14) http://www.ncbi.nlm.nih.gov/pubmed/23408969
(15) http://www.ncbi.nlm.nih.gov/pubmed/8062958
(16) http://www.ncbi.nlm.nih.gov/pubmed/23417042
(17) http://www.ncbi.nlm.nih.gov/pubmed/2016194
(18) http://www.ncbi.nlm.nih.gov/pubmed/1748649
(19) http://www.ncbi.nlm.nih.gov/pubmed/8761540
(20) http://www.ncbi.nlm.nih.gov/pubmed/23411428
(21) http://www.ncbi.nlm.nih.gov/pubmed/11002379
(22) http://www.ncbi.nlm.nih.gov/pubmed/11683549
(23) http://www.ncbi.nlm.nih.gov/pubmed/22581996
(24) http://www.ncbi.nlm.nih.gov/pubmed/22629499
(25) http://www.ncbi.nlm.nih.gov/pubmed/22500844
(26) http://www.ncbi.nlm.nih.gov/pubmed/19574176
(27) http://www.ncbi.nlm.nih.gov/pubmed/21756230
(28) http://www.ncbi.nlm.nih.gov/pubmed/11566656
(29) http://www.ncbi.nlm.nih.gov/pubmed/8333412
(30) http://www.ncbi.nlm.nih.gov/pubmed/9921960
(31) http://www.ncbi.nlm.nih.gov/pubmed/23403980
(32) http://www.ncbi.nlm.nih.gov/pubmed/23208074
(33) http://www.ncbi.nlm.nih.gov/pubmed/1711410
(34) http://www.nejm.org/doi/full/10.1056/NEJM199901143400204
(35) http://archinte.jamanetwork.com/article.aspx?articleid=486844
(36) http://www.ncbi.nlm.nih.gov/pubmed/19201134
Friday, February 22, 2013
Monday, February 18, 2013
Dietary Mineral - Boron
Boron, a vital trace mineral found abundantly in Almond, Red Apple, Apricots, Avocado, Banana, Red kidneyBeans, etc., is necessary for the normal growth
and health of the body. Boric acid has antiseptic and antiviral
activity. Its aqueous solutions have been used as mouth-washes,
eye-drops, skin lotions and cosmetics(1).
1. Boron and Osteoporosis
Osteoporosis and low bone mineral density affect millions of Americans. According to the study by Orlando Health, the majority of adults in North America have insufficient intake of vitamin D and calcium along with inadequate exercise. Physicians are aware that vitamin D, calcium and exercise are essential for maintenance of bone health. Physicians are less likely to be aware that dietary insufficiencies of magnesium, silicon, Vitamin K, and boron are also widely prevalent, and each of these essential nutrients is an important contributor to bone health(2). Other in the study to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis of 45 postmenopausal women over 47 years of age, the preliminary results suggest the existence of a significant difference (p < 0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis(2a).
2. Dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women
In the study to to examine the effects of aluminum, magnesium, and boron on major mineral metabolism in postmenopausal women, conducted by the Grand Forks Human Nutrition Research Center, showed that boron supplementation markedly reduced the urinary excretion of calcium and magnesium; the depression seemed more marked when dietary magnesium was low. Boron supplementation depressed the urinary excretion of phosphorus by the low-magnesium, but not by the adequate-magnesium, women. Boron supplementation markedly elevated the serum concentrations of 17 beta-estradiol and testosterone; the elevation seemed more marked when dietary magnesium was low(3). Other study found that increase in dietary intake of B from 0.25 to 3.25 mg/d has been reported to increase plasma oestradiol and testosterone and decrease urinary Ca excretion in postmenopausal women. Changing B intake from 0.33 to 3.33 mg/d had no effect on minerals, steroids or crosslinks. However, the LBD (low-B diet) appeared to induce hyperabsorption of Ca since positive Ca balances were found in combination with elevated urinary Ca excretion. This phenomenon may have inhibited or obscured any effect of B(3a).
3. Plasma boron and the effects of boron supplementation in males
In the study to examine the effect of boron supplementation in 10 male bodybuilders, who (aged 20 to 26) were given a 2.5-mg boron supplement, with nine male bodybuilders (aged 21 to 27) were given a placebo for 7 weeks. Plasma total and free testosterone, plasma boron, lean body mass, and strength measurements were determined on day 1 and day 49, found that bBoth groups demonstrated significant increases in total testosterone (p < 0.01), lean body mass (p < 0.01), and one repetition maximum (RM) squat (p < 0.001) and one RM bench press (p < 0.01). The findings suggest that 7 weeks of bodybuilding can increase total testosterone, lean body mass, and strength in lesser-trained bodybuilders, but boron supplementation affects these variables not at all(4).
4. Boron supplementation on lean body mass, plasma testosterone levels
In the study to evaluate the effect of boron supplementation in 19 male bodybuilders ages 20-27 years. Ten were given a 2.5-mg boron supplement while 9 were given a placebo every day for 7 weeks. Plasma total and free testosterone, plasma boron, lean body mass, and strength measurements were determined on Days 1 and 49, found that 7 weeks of bodybuilding can increase total testosterone, lean body mass, and strength in lesser trained bodybuilders, and that boron supplementation had no effect on these measures(5).
5. Boron and Fertility
In the study to investigate the consequences of exposure to three levels of boric acid on male rats reproduction, fertility, and progeny outcome, with emphasis on testicular DNA level and quality, by Ain Shams University, showed that the impact of boric acid exposure at dose 250 mg on male rats fertility was translated into increases in pre-implantation loss with a resulting decrease in the number of live fetuses/ litter. In addition to the significant alteration of biochemical measurements, observed at dose 250 mg, administration of boric acid at 500 mg caused testicular atrophy, severe damage of spermatogenesis, spermiation failure and significant reduction of Mg and Zn testicular levels. None of the male rats, treated with 500 mg/kg bwt, could impregnate untreated females, suggesting the occurrence of definitive loss of fertility(5a).
6. Dietary Boron and aging
Total boron concentrations in Drosophila changed during development and aging. In the study of mouses conducted by Masonic Medical Research Laboratory, found that Adding excess dietary boron during the adult stage decreased the median life span by 69% at 0.01 M sodium borate and by 21% at 0.001 M sodium borate. Lower concentrations gave small but significant increases in life span. Supplementing a very low boron diet with 0.00025 M sodium borate improved life span by 9.5%. The boron contents of young and old mouse tissues were similar to those of Drosophila and human samples. Boron supplements of 4.3 and 21.6 ppm in the drinking water, however, did not significantly change the life span of old mice fed a diet containing 31.1 ppm boron(6).
7. Boron and hormonal regulation and cognitive function
in the study to review the scientific evidence of some studies on boron including expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing, found that there was a lack of systematic study on the safety and effectiveness of boron in humans. However, based on popular use and supportive scientific data, nine indications are discussed in this review: hormone regulation, improving cognitive function, osteoarthritis, osteoporosis, vaginitis (topical), bodybuilding aid (increasing testosterone), menopausal symptoms, prevention of blood clotting (coagulation effects), and psoriasis (topical). Although studies assessing the use of boron for osteoarthritis and osteoporosis are in preliminary stages, reports are promising. There is conflicting evidence to support the use of boron in hormonal regulation and cognitive function. Future randomized controlled trials are warranted. There is fair negative evidence regarding the use of boron as an anticoagulant, a bodybuilding aid, for menopausal symptoms, or for psoriasis. Excessive use may be harmful, and caution is advised(7).
8. Boron nutrition for brain and psychological function
Certain stuies indicated that Boron (B) nutriture has been related to bone, mineral and lipid metabolism, energy utilization, and immune function. In the study to consider possible relationships between B nutriture and brain and psychological function, indicated that assessments of brain electrical activity in both animals and humans found that B deprivation results in decreased brain electrical activity similar to that observed in nonspecific malnutrition. Assessments of cognitive and psychomotor function in humans found that B deprivation results in poorer performance on tasks of motor speed and dexterity, attention, and short-term memory. However, little support was found for anecdotal reports that supplementation with physiologic amounts of B helps alleviate the somatic and psychological symptoms of menopause. Parallels between nutritional and toxicological effects of B on brain and psychological function are presented, and possible biological mechanisms for dietary effects are reviewed. Findings support the hypothesis that B nutriture is important for brain and psychological function in humans(8).
9. Dietary boron and Magnessium
In the study with human volunteers conducted to test the hypothesis that naturally occurring inadequate intakes of magnesium induce negative magnesium balance and undesirable changes in calcium metabolism variables, and that these changes are influenced by dietary boron, indicated that consuming an ordinary diet deficient in magnesium, resulting in negative magnesium balance, can affect calcium, potassium, and cholesterol metabolism. Dietary boron did not have an obvious effect on the response to magnesium deprivation(9).
10. 2-aminoethoxydiphenyl borate (2-APB) and ORAI1
In the study to assess the influence of Orai1(ORAI calcium release-activated calcium modulator 1) intervention on mouse airway epithelium reactions in vivo and in vitro, found that administration of 2-aminoethoxydiphenyl borate (2-APB) into the nostrils suppressed Orai1 expression in nasal and tracheal mucosa of treated mice compared with that in control mice and restrained the mediators in nasal lavage fluid, bronchoalveolar lavage fluid, and airway mucosa of treated groups compared with those in control groups. Similarly, the 2-APB intervention also alleviated Orai1 and the production of the mediators in culture supernatant and cultured airway epithelium under allergic conditions(10).
11. Boronic acid and Antimalarials
The high rate of mortality due to malaria and the worldwide distribution of parasite resistance to the commonly used antimalarial drugs chloroquine and pyrimethamine emphasize the urgent need for the development of new antimalarial drugs. According to the study to test Proteasome inhibitor bortezomib (Velcade: [(1R)-3-methyl-1-[[(2S)-1-oxo-3-phenyl-2-[(pyrazinylcarbonyl) amino]propyl]amino]butyl] boronic acid), which has been approved for treatment of patients with multiple myeloma, and a second boronate analog Z-Leu-Leu-Leu-B(OH)2 (ZL3B), against four different strains of P. falciparum (3D7, HB3, W2 and Dd2) by University of Connecticut Health Center, found that the identification of bortezomib and its analog as potent antimalarial drugs will set the stage for the advancement of this class of compounds, either alone or in combination therapy, for treatment of malaria, and emphasize the need for large-scale screens to identify new antimalarials within the library of clinically approved compounds(11).
12. Boron and parasites
In the study of Balb/c mice fed either a low-B (0.2 microg B/g), marginal (2.0 microg B/g), or control (12.0 microg B/g) diet and to explore whether low dietary B would: 1) alter survival or reproduction of Heligmosomoides bakeri (Nematoda); 2) modify the resulting cytokine response to this parasitic infection; or 3) influence liver mineral concentrations in the infected host, showed that parasite survival and cytokine and inflammatory responses are modified by dietary B intake but indicates that a GI nematode infection alters liver mineral concentrations(12).
13. Boronic acids and Candida albicans
In the study of the inhibition of the beta-carbonic anhydrases (CAs, EC 4.2.1.1) from the pathogenic fungi Cryptococcus neoformans (Can2) and Candida albicans (Nce103) with a series of aromatic, arylalkenyl- and arylalkylboronic acids, found that the host human enzymes CA I and II were also effectively inhibited by these boronic acids. The B(OH)(2) moiety is thus a new zinc-binding group for designing effective inhibitors of the alpha- and beta-CAs.
14. Bortezomib and antibody-mediated diseases (lupus-like disease)
In the study of The proteasome inhibitor bortezomib depletes plasma cells and protects mice with lupus-like disease from nephritis conducted by Nikolaus Fiebiger-Center of Molecular Medicine, University Hospital Erlangen, found that treatment with bortezomib depleted plasma cells producing antibodies to double-stranded DNA, eliminated autoantibody production, ameliorated glomerulonephritis and prolonged survival of two mouse strains with lupus-like disease, NZB/W F1 and MRL/lpr mice. Hence, the elimination of autoreactive plasma cells by proteasome inhibitors might represent a new treatment strategy for antibody-mediated diseases(14). Other study showed that the proteasome inhibitor bortezomib, approved for the treatment of multiple myeloma, efficiently depletes short- and long-lived plasma cells and ameliorates lupus nephritis in mouse models. These novel therapies may improve the future treatment of SLE and other antibody-mediated diseases(14a).
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Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
For over 100 healthy recipes, http://diseases-researches.blogspot.ca/p/blog-page_17.html
ources
(1) http://chemicalland21.com/industrialchem/inorganic/BORIC%20ACID.htm
(2) http://www.ncbi.nlm.nih.gov/pubmed/22523525
(2a) http://www.ncbi.nlm.nih.gov/pubmed/22524104
(3) http://www.ncbi.nlm.nih.gov/pubmed/3678698
(3a) http://www.ncbi.nlm.nih.gov/pubmed/8329361
(4) http://www.ncbi.nlm.nih.gov/pubmed/7889885
(5) http://www.ncbi.nlm.nih.gov/pubmed/8508192
(5a) http://www.ncbi.nlm.nih.gov/pubmed/23301826
(6) http://www.ncbi.nlm.nih.gov/pubmed/7889879
(7) http://www.ncbi.nlm.nih.gov/pubmed/22433045
(8) http://www.ncbi.nlm.nih.gov/pubmed/10050926
(9) http://www.ncbi.nlm.nih.gov/pubmed/15724868
(10) http://www.ncbi.nlm.nih.gov/pubmed/22289729
(11) http://www.ncbi.nlm.nih.gov/pubmed/17956613
(12) http://www.ncbi.nlm.nih.gov/pubmed/17709446
(13) http://www.ncbi.nlm.nih.gov/pubmed/19375309
(14) http://www.ncbi.nlm.nih.gov/pubmed/18542049
(14a) http://www.ncbi.nlm.nih.gov/pubmed/19224224
1. Boron and Osteoporosis
Osteoporosis and low bone mineral density affect millions of Americans. According to the study by Orlando Health, the majority of adults in North America have insufficient intake of vitamin D and calcium along with inadequate exercise. Physicians are aware that vitamin D, calcium and exercise are essential for maintenance of bone health. Physicians are less likely to be aware that dietary insufficiencies of magnesium, silicon, Vitamin K, and boron are also widely prevalent, and each of these essential nutrients is an important contributor to bone health(2). Other in the study to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis of 45 postmenopausal women over 47 years of age, the preliminary results suggest the existence of a significant difference (p < 0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis(2a).
2. Dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women
In the study to to examine the effects of aluminum, magnesium, and boron on major mineral metabolism in postmenopausal women, conducted by the Grand Forks Human Nutrition Research Center, showed that boron supplementation markedly reduced the urinary excretion of calcium and magnesium; the depression seemed more marked when dietary magnesium was low. Boron supplementation depressed the urinary excretion of phosphorus by the low-magnesium, but not by the adequate-magnesium, women. Boron supplementation markedly elevated the serum concentrations of 17 beta-estradiol and testosterone; the elevation seemed more marked when dietary magnesium was low(3). Other study found that increase in dietary intake of B from 0.25 to 3.25 mg/d has been reported to increase plasma oestradiol and testosterone and decrease urinary Ca excretion in postmenopausal women. Changing B intake from 0.33 to 3.33 mg/d had no effect on minerals, steroids or crosslinks. However, the LBD (low-B diet) appeared to induce hyperabsorption of Ca since positive Ca balances were found in combination with elevated urinary Ca excretion. This phenomenon may have inhibited or obscured any effect of B(3a).
3. Plasma boron and the effects of boron supplementation in males
In the study to examine the effect of boron supplementation in 10 male bodybuilders, who (aged 20 to 26) were given a 2.5-mg boron supplement, with nine male bodybuilders (aged 21 to 27) were given a placebo for 7 weeks. Plasma total and free testosterone, plasma boron, lean body mass, and strength measurements were determined on day 1 and day 49, found that bBoth groups demonstrated significant increases in total testosterone (p < 0.01), lean body mass (p < 0.01), and one repetition maximum (RM) squat (p < 0.001) and one RM bench press (p < 0.01). The findings suggest that 7 weeks of bodybuilding can increase total testosterone, lean body mass, and strength in lesser-trained bodybuilders, but boron supplementation affects these variables not at all(4).
4. Boron supplementation on lean body mass, plasma testosterone levels
In the study to evaluate the effect of boron supplementation in 19 male bodybuilders ages 20-27 years. Ten were given a 2.5-mg boron supplement while 9 were given a placebo every day for 7 weeks. Plasma total and free testosterone, plasma boron, lean body mass, and strength measurements were determined on Days 1 and 49, found that 7 weeks of bodybuilding can increase total testosterone, lean body mass, and strength in lesser trained bodybuilders, and that boron supplementation had no effect on these measures(5).
5. Boron and Fertility
In the study to investigate the consequences of exposure to three levels of boric acid on male rats reproduction, fertility, and progeny outcome, with emphasis on testicular DNA level and quality, by Ain Shams University, showed that the impact of boric acid exposure at dose 250 mg on male rats fertility was translated into increases in pre-implantation loss with a resulting decrease in the number of live fetuses/ litter. In addition to the significant alteration of biochemical measurements, observed at dose 250 mg, administration of boric acid at 500 mg caused testicular atrophy, severe damage of spermatogenesis, spermiation failure and significant reduction of Mg and Zn testicular levels. None of the male rats, treated with 500 mg/kg bwt, could impregnate untreated females, suggesting the occurrence of definitive loss of fertility(5a).
6. Dietary Boron and aging
Total boron concentrations in Drosophila changed during development and aging. In the study of mouses conducted by Masonic Medical Research Laboratory, found that Adding excess dietary boron during the adult stage decreased the median life span by 69% at 0.01 M sodium borate and by 21% at 0.001 M sodium borate. Lower concentrations gave small but significant increases in life span. Supplementing a very low boron diet with 0.00025 M sodium borate improved life span by 9.5%. The boron contents of young and old mouse tissues were similar to those of Drosophila and human samples. Boron supplements of 4.3 and 21.6 ppm in the drinking water, however, did not significantly change the life span of old mice fed a diet containing 31.1 ppm boron(6).
7. Boron and hormonal regulation and cognitive function
in the study to review the scientific evidence of some studies on boron including expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing, found that there was a lack of systematic study on the safety and effectiveness of boron in humans. However, based on popular use and supportive scientific data, nine indications are discussed in this review: hormone regulation, improving cognitive function, osteoarthritis, osteoporosis, vaginitis (topical), bodybuilding aid (increasing testosterone), menopausal symptoms, prevention of blood clotting (coagulation effects), and psoriasis (topical). Although studies assessing the use of boron for osteoarthritis and osteoporosis are in preliminary stages, reports are promising. There is conflicting evidence to support the use of boron in hormonal regulation and cognitive function. Future randomized controlled trials are warranted. There is fair negative evidence regarding the use of boron as an anticoagulant, a bodybuilding aid, for menopausal symptoms, or for psoriasis. Excessive use may be harmful, and caution is advised(7).
8. Boron nutrition for brain and psychological function
Certain stuies indicated that Boron (B) nutriture has been related to bone, mineral and lipid metabolism, energy utilization, and immune function. In the study to consider possible relationships between B nutriture and brain and psychological function, indicated that assessments of brain electrical activity in both animals and humans found that B deprivation results in decreased brain electrical activity similar to that observed in nonspecific malnutrition. Assessments of cognitive and psychomotor function in humans found that B deprivation results in poorer performance on tasks of motor speed and dexterity, attention, and short-term memory. However, little support was found for anecdotal reports that supplementation with physiologic amounts of B helps alleviate the somatic and psychological symptoms of menopause. Parallels between nutritional and toxicological effects of B on brain and psychological function are presented, and possible biological mechanisms for dietary effects are reviewed. Findings support the hypothesis that B nutriture is important for brain and psychological function in humans(8).
9. Dietary boron and Magnessium
In the study with human volunteers conducted to test the hypothesis that naturally occurring inadequate intakes of magnesium induce negative magnesium balance and undesirable changes in calcium metabolism variables, and that these changes are influenced by dietary boron, indicated that consuming an ordinary diet deficient in magnesium, resulting in negative magnesium balance, can affect calcium, potassium, and cholesterol metabolism. Dietary boron did not have an obvious effect on the response to magnesium deprivation(9).
10. 2-aminoethoxydiphenyl borate (2-APB) and ORAI1
In the study to assess the influence of Orai1(ORAI calcium release-activated calcium modulator 1) intervention on mouse airway epithelium reactions in vivo and in vitro, found that administration of 2-aminoethoxydiphenyl borate (2-APB) into the nostrils suppressed Orai1 expression in nasal and tracheal mucosa of treated mice compared with that in control mice and restrained the mediators in nasal lavage fluid, bronchoalveolar lavage fluid, and airway mucosa of treated groups compared with those in control groups. Similarly, the 2-APB intervention also alleviated Orai1 and the production of the mediators in culture supernatant and cultured airway epithelium under allergic conditions(10).
11. Boronic acid and Antimalarials
The high rate of mortality due to malaria and the worldwide distribution of parasite resistance to the commonly used antimalarial drugs chloroquine and pyrimethamine emphasize the urgent need for the development of new antimalarial drugs. According to the study to test Proteasome inhibitor bortezomib (Velcade: [(1R)-3-methyl-1-[[(2S)-1-oxo-3-phenyl-2-[(pyrazinylcarbonyl) amino]propyl]amino]butyl] boronic acid), which has been approved for treatment of patients with multiple myeloma, and a second boronate analog Z-Leu-Leu-Leu-B(OH)2 (ZL3B), against four different strains of P. falciparum (3D7, HB3, W2 and Dd2) by University of Connecticut Health Center, found that the identification of bortezomib and its analog as potent antimalarial drugs will set the stage for the advancement of this class of compounds, either alone or in combination therapy, for treatment of malaria, and emphasize the need for large-scale screens to identify new antimalarials within the library of clinically approved compounds(11).
12. Boron and parasites
In the study of Balb/c mice fed either a low-B (0.2 microg B/g), marginal (2.0 microg B/g), or control (12.0 microg B/g) diet and to explore whether low dietary B would: 1) alter survival or reproduction of Heligmosomoides bakeri (Nematoda); 2) modify the resulting cytokine response to this parasitic infection; or 3) influence liver mineral concentrations in the infected host, showed that parasite survival and cytokine and inflammatory responses are modified by dietary B intake but indicates that a GI nematode infection alters liver mineral concentrations(12).
13. Boronic acids and Candida albicans
In the study of the inhibition of the beta-carbonic anhydrases (CAs, EC 4.2.1.1) from the pathogenic fungi Cryptococcus neoformans (Can2) and Candida albicans (Nce103) with a series of aromatic, arylalkenyl- and arylalkylboronic acids, found that the host human enzymes CA I and II were also effectively inhibited by these boronic acids. The B(OH)(2) moiety is thus a new zinc-binding group for designing effective inhibitors of the alpha- and beta-CAs.
14. Bortezomib and antibody-mediated diseases (lupus-like disease)
In the study of The proteasome inhibitor bortezomib depletes plasma cells and protects mice with lupus-like disease from nephritis conducted by Nikolaus Fiebiger-Center of Molecular Medicine, University Hospital Erlangen, found that treatment with bortezomib depleted plasma cells producing antibodies to double-stranded DNA, eliminated autoantibody production, ameliorated glomerulonephritis and prolonged survival of two mouse strains with lupus-like disease, NZB/W F1 and MRL/lpr mice. Hence, the elimination of autoreactive plasma cells by proteasome inhibitors might represent a new treatment strategy for antibody-mediated diseases(14). Other study showed that the proteasome inhibitor bortezomib, approved for the treatment of multiple myeloma, efficiently depletes short- and long-lived plasma cells and ameliorates lupus nephritis in mouse models. These novel therapies may improve the future treatment of SLE and other antibody-mediated diseases(14a).
Natural Remedies for Dementia Memory Loss Reversal
Guarantee to Stop Progression and Reverse Memory Loss in Alzheimer and Dementia with step by step instructions through Scientific Studies within 2 Months or your Money back
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
For over 100 healthy recipes, http://diseases-researches.blogspot.ca/p/blog-page_17.html
ources
(1) http://chemicalland21.com/industrialchem/inorganic/BORIC%20ACID.htm
(2) http://www.ncbi.nlm.nih.gov/pubmed/22523525
(2a) http://www.ncbi.nlm.nih.gov/pubmed/22524104
(3) http://www.ncbi.nlm.nih.gov/pubmed/3678698
(3a) http://www.ncbi.nlm.nih.gov/pubmed/8329361
(4) http://www.ncbi.nlm.nih.gov/pubmed/7889885
(5) http://www.ncbi.nlm.nih.gov/pubmed/8508192
(5a) http://www.ncbi.nlm.nih.gov/pubmed/23301826
(6) http://www.ncbi.nlm.nih.gov/pubmed/7889879
(7) http://www.ncbi.nlm.nih.gov/pubmed/22433045
(8) http://www.ncbi.nlm.nih.gov/pubmed/10050926
(9) http://www.ncbi.nlm.nih.gov/pubmed/15724868
(10) http://www.ncbi.nlm.nih.gov/pubmed/22289729
(11) http://www.ncbi.nlm.nih.gov/pubmed/17956613
(12) http://www.ncbi.nlm.nih.gov/pubmed/17709446
(13) http://www.ncbi.nlm.nih.gov/pubmed/19375309
(14) http://www.ncbi.nlm.nih.gov/pubmed/18542049
(14a) http://www.ncbi.nlm.nih.gov/pubmed/19224224
Wednesday, February 13, 2013
Enteritis
Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis
is an increasing problem, as more patients receive radiotherapy as part
of their cancer therapy and as the long-term survival of these patients
improves(a). Other study indicated that acute radiation enteritis
is almost inevitable in the curative treatment of malignant tumors of
the abdomen and pelvic area. It is frequently a self-limiting disorder
of intestinal function associated with reversible mucosal changes of the
intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Types of Entertitis
1. Campylobacter enteritis (Campylobacter jejuni)
Campylobacter enteritis is the commonest form of infective diarrhoea in most developed countries of the world. According to the statistic from Wales laboratory, the an annual incidence of about 85/100,000, but the true rate is probably nearer 1100/100,000. Most infections are sporadic and believed to be foodborne; large outbreaks are infrequent and mostly as a result of the consumption of raw milk or unchlorinated water. Raw meats and animal products, notably broiler chickens, are the main source of campylobacters in food(c). Other indicated that Cross-contamination and improper handling and cooking of foods of animal origin account for the majority of disease. Hygienic measures must be applied in order to reduce the incidence of campylobacteriosis in humans(b).
2. E. coli enteritis (E. coli)
In an age cross sectional cohort analysis of 340 0-47 month old children and newborn cohort analysis of 144 newborns to determine the diarrheogenic Escherichia coli incidence in Santa Julia, a low socioeconomic community in Santiago, Chile, between December 1986 and February 1990, showed thatthe age cross sectional cohort had 1178 episodes of diarrhea and the newborn cohort had 674 episodes. No difference in the isolation rate of enteroaggregative E. coli existed between cases and controls. Since most households in Santa Julia have access to potable water (68%) and an indoor toilet (64%), food contamination were likely the vehicles of E. coli transmission because more than 50% of households do not have a refrigerator(e). Other in the review of the outbreak of E. coli O142 K86 H34, the enteritis of adults and children are due to enteroinvasive (EIEC) and enterotoxigenic (ETEC) strains, suggested that routine search for EPEC is suggested in cases of infantile enteritis in hospitals and other institutions(f).
3. Clostridium perfringens enteritis
Clostridium perfringens is an important anaerobic pathogen causing foodborne and non-foodborne gastrointestinal diseases in humans and animals. This pathogen is also the more common Clostridium species associated with bacteraemia. We report on a fatal case of C. perfringens infection in an adult with type 2 diabetes(g).
4. Staphylococcal enteritis (Food poisioning)
The disease is as reslt of eating or drinking substances contaminated with staph enterotoxin. The enterotoxins are fast acting, sometimes causing illness within one to six hours. Patients typically experience nausea, vomiting, stomach cramps, and diarrhea(h).
5. Radiation enteritis
Radiation therapy may damage the lining of the intestines (bowels) and cause inflammation.
The clinicopathologic features of radiation enteritis are reviewed in 44 children receiving whole abdominal radiation therapy between 1961-1972 at the Institut Gustave-Roussy. Five of 14 long-term survivors (36%) developed severe delayed radiation injury with small bowel obstruction, occurring within 2 months after completion of irradiation. All had previously had acute radiation reaction during therapy, according to the study by Dr. Donaldson SS and the research team(i).
6. Salmonella enteritis
Salmonella enterica and Campylobacter spp. cause a considerable number of human illnesses each year, and the vast majority of cases are foodborne(j). Other study indicated thatthe most common disease syndromes caused by Salmonella serotypes in humans, typhoid fever and enteritis, can be modeled using Salmonella enterica serotype Typhimurium infections in mice and calves, respectively(k).
7. Shigella enteritis
Shigella species cause bacillary dysentery in humans by invasion, intracellular multiplication, spread to adjacent cells, and induction of brisk inflammatory responses in the intestinal epithelium(l). According to the study, in August 2002, an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5-6 August 2002. The estimated primary attack rate was 9.97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16.49%)(m).
8. Etc.
I. Symptoms
1. Abdomen Pain, diahrrea and fever
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(1).
2. Post-infectious fatigue and abdominal symptoms
Some patients with Severity of Giardia infection after treatment may be experience Post-infectious fatigue and abdominal symptoms. According to the study by Haukeland University Hospital, Protracted and severe giardiasis seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the Giardia infection(2).
3. Bloating, Iron and vitamin deficiency
Patient with Campylobacter jejuni enteritis may be experioence with symptoms of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies.
There is a report of a young woman with no previous gastrointestinal complaints who was initially diagnosed with postinfective irritable bowel syndrome (IBS) after a confirmed case of Campylobacter jejuni enteritis. However, because of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies(3).
4. Hematochezia
Hematochezia is defined as a condition of passing fresh blood through the anus and in or with stools. In most cases it is caused by the bleeding of lower gastrointestine.
5. Dizziness
Patient with cryptogenic multifocal ulcerous stenosing enteritis, may be experiencerecurrent colicky abdominal pain and dizziness(4).
6. Acute intestinal obstruction or perforation
Although Acute intestinal obstruction or perforationare rare in patient with enteritis. There is a report of a case of a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis(5).
7. Constipation
There is a report of a case of mucosal Eosinophilic gastroenteris (EG) presenting as constipation and abdominal pain in a 43 year old female. EG should be considered in the differential diagnosis of patients presenting with constipation and abdominal pain and can easily be diagnosed with mucosal biopsies and treated with steroid therapy(5a).
8. Others
Patients may be also experience to symptoms of loss of appetite, dehydration, vomiting, thirst, change in stool pattern, high CRP and leucocytosisetc, etc(5b).
II. Causes and Risk factors
A. Causes
1. Radiation-induced enteritis
Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. According to the study by Fovárosi Onkormányzat Uzsoki Utcai Kórház Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145, during the radiotherapy of tumors in the minor pelvis and abdomen intestinal inflammation of different degree may occur even if special attention is paid. Irradiation to the minor pelvis causes in half of the cases radiation induced acute enteritis, whereas in 25% chronic enteritis and colitis will develop(6).
2. Virus
Certain virus can induce entertitis including Cytomegalovirus and Norovirus. The Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries, according to the study to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis by Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey, indicated that NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%)(7).
3. Bacteria
Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract, according to the study by Universidad de Barcelona, Barcelona, España(8).
4. Crohn's disease
Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology(9). Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel, according to the study by, there is a report of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. Laboratory tests indicated iron-deficiency anemia. There was no evidence of bleeding on esophagogastroduodenoscopic and colonofiberscopic examination. With capsule endoscopy, multiple mucosal ulcers were visualized in the jejunoileal area. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis(10).
5. Medication such as proton pump inhibitors
Gastric acid is a defense mechanism against gastrointestinal infections caused by ingested bacteria. According to the study by Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain, gastric acid suppression induced by proton pump inhibitors (PPIs) but not H2RAs is associated with an increased risk of Campylobacter and Salmonella GE(11).
6. Drugs
There is a report of a 25-year-old woman who was hospitalized repeatedly during a 5-year period due to abdominal pain, change in stool pattern, high CRP and leucocytosis. A thorough interview revealed a recreational use of cocaine, and diary recordings confirmed the association between her abdominal pain and cocaine use(12).
B. Risk Factors
1. Intestinal illness
People who have a family memeber with intestinal illness are at increased risk to develop gastroenteritis.In the study to evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection, showed that Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p < 0.01)(13).
2. Undercooked ground meat and foods
Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection(14).
3. Environmental risk
Campylobacter is a common cause of bacterial gastro-enteritis characterized by multiple environmental sources and transmission pathways. According to the study, regional characteristics associated with an increased regional risk of campylobacteriosis, for at least some geographical units, were high ruminant density, high poultry density, high population density, and presence of a large poultry slaughterhouse, whereas a reduction in risk was associated with a lower percentage of people with diplomas, a lower level of precipitation, and warmer temperature. Two clusters of elevated residual risk were observed, with different location and size depending on the geographical unit used(15).
4. Biologically plausible risk
In the study to to evaluate whether the increase in incidence of campylobacteriosis observed in humans in Norway from 1995 to 2001 was statistically significant and whether different biologically plausible risk factors were associated with the incidence of campylobacteriosis in the different counties in Norway, found that treated water was a protective factor against Campylobacter infections in humans with an IRR of 0.78 per percentage increase in people supplied. Campylobacter infections did not appear to be clustered in any particular county in Norway(16).
5. Immune dysfunction
Immune system is responsible in fighting against invasion of bacteria and virus. Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS)(17).
6. Aging
Elderly are more susceptible to bacterial and virus infection and inflammation, as a result of weakened immune system.
7. Etc.
II. Diseases associated to Entetitis
1. Functional gastrointestinal disorders (PI-FGID)
A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). According to the study by the University of Bergen, Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations suggesting a possible immunological abnormality in these conditions(18).
2. Small bowel perforation
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(19).
3. Severe intraluminal hemorrhage
There is a report of 4 9-month-old Simmental male calves were presented with a history of sudden death. The necropsy and microscopic findings allowed a diagnosis of enteritis and severe intraluminal hemorrhage with blood clots in the jejunum, suggestive of jejunal hemorrhage syndrome, according to the study by Institute of Veterinary Medicine Belgrade(20).
4. Chronic and recurrent occlusion events and multiple small intestinal ulcers
Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel. According to the study by Seoul Paik Hospital, Inje University, College of Medicine Seoul, there is a case of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis. Cryptogenic multifocal ulcerous stenosing enteritis should be considered in cases of chronic or recurrent occlusion events and multiple small intestinal ulcers and strictures of unknown origin(21).
5. Hypereosinophilic syndrome
Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide(21a).
6. Systemic lupus erythematosus
There is a reprot of a 38-year-old Persian Iranian woman admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis, according to the study by Tehran University of Medical Sciences(21b)
III. Complications
1. Chronic fatigue syndrome
A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. In the study to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection, showed that in a total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis(22).
2. Irritable bowel syndrome and chronic fatigue
Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications. In the study to estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis, indicated that Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness.This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic(23).
3. Arthritis symptoms
According to the London Kidney Research Unit, Division of Nephrology, London Health Sciences Centre, Acute bacterial gastroenteritis necessitating medical attention was associated with a higher risk of arthritic symptoms, but not arthritic medications, up to 4 yrs afterwards(24).
4. Risk of pregnancy-related hypertension
In the study to evaluate the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water, by the University of Western Ontario, London, indicated that of 148 eligible pregnancies, antenatal audits with blood pressure data were available for 135. PRH was detected in 20.7% pregnancies, of which 6.7% were chronic hypertension and 14.1% gestational hypertension. Although nonsignificant, we observed a consistent trend toward higher rates of PRH and mean arterial pressure, particularly prior to 20 weeks gestation, among women who reported symptomatic gastroenteritis compared to asymptomatic women. BP should be monitored closely in women after exposure to contaminated water(25).
5. Diabetes mellitus
Ingestion of Escherichia coli O157:H7 can cause a spectrum of acute illness, ranging from overt hemolytic-uremic syndrome (HUS), to gastroenteritis with bloody diarrhea, to no symptoms. According to the study by the University of Western Ontario, survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection. However, less severe forms of infection, such as E. coli O157:H7 gastroenteritis without overt HUS, do not appear to result in an increased risk of type 2 diabetes(26).
6. Hypertension, Renal impairment, and Self reported cardiovascular disease
In the study to evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter, showed that Gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter was associated with an increased risk for hypertension, renal impairment, and self reported cardiovascular disease. Annual monitoring of blood pressure and periodic monitoring of renal function may be warranted for individuals who experience E coli O157:H7 gastroenteritis(27).
Other study also indicated that acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection(28).
7. Celiac disease
According to the study by the McMaster University Medical Centre, CD should be considered in the differential diagnosis of persistent IBS-like symptoms after an episode of infectious gastroenteritis(29).
8. Seizures and even GE encephalopathy
In the study to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections of a data of a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009, found that Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode(29a).
9. Dehydration
According to the Department of Pediatrics, CHU Sainte-Justine, From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001)(29b).
10. Etc.
III. Misdiagnosis and diagnosis
A. Misdiagnosis
1. Primary NK/T cell lymphoma
Primary natural killer (NK) cell like T cell lymphoma of the terminal ileum is extremely rare. It most frequently occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. NK/T cell lymphoma involving gastrointestinal tract has characteristic endoscopic features of Inflammatory bowel disease. According to the study by the Hallym University College of Medicine, there is a case of primary NK/T cell lymphoma misdiagnosed as Behcet's enteritis of the terminal ileum colonoscopically and complicated by cecal bleeding and perforation(30).
2. Acute appendicitis
Acute appendicitis is the most common cause of urgent surgery in children. Bacterial enteritis limited to the ileocecal region appears to be responsible for an appreciable number of unnecessary appendectomies. On the other hand, diagnostic errors in appendicitis may delay early appendectomy and result in the formation of appendiceal mass(31).
3. Acute abdomen pain
Enteritis cystica profunda, an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The third case of enteritis cystica profunda in children is presented with special emphasis on diagnosis and treatment. This rare entity may mimic acute abdomen and should be kept in mind in the differential diagnosis(32).
4. Others
Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. According to the study by, there is a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone(33).
B. Diagnosis
Diagnosis is depending to the underlined causes of the diseases
1. Stool culture
The aim of the test is to identify the bacteria and virus which cause the diseases. According to the study of "New methods for detection of campylobacters in stool samples in comparison to culture" by the University Hospital, Frankfurt/Main, current detection in stools is done essentially by culture on selective and nonselective media with filtration. These methods were compared to 2 molecular biology methods, an in-house real-time PCR and a multiplex PCR named Seeplex Diarrhea ACE Detection, and 3 immunoenzymatic methods, Premier Campy, RidaScreen Campylobacter, and ImmunoCard Stat!Campy. Out of 242 stool specimens tested, 23 (9.5%) fulfilled the positivity criteria, i.e., they were positive by one or both culture methods or, in case of a negative culture, by a positive molecular method and a positive immunoenzymatic method. The striking feature of this study is the low sensitivity of culture, in the range of 60%, in contrast to immunoenzymatic and molecular tests(34).
2. [13]C-acetate breath test
[13C]acetate breath test is the measure of gastric emptying of the liquid phase both in liquid and semisolid test meals by simultaneous radioscintigraphy.There is a report of eosinophilic enteritis in which the (13)C-acetate breath test was effective(35).
IV. Preventions
A. The do and do not's list
In case of entertitis outbreak
A.1. The article by All Refer.com health(36) suggested the followings
1. Always wash hands after using the toilet and before eating or preparing food or drink.
2. You may also clean your hands with a 60% alcohol based product.
3. Avoid drinking from unknown sources, such as streams and outdoor wells, without boiling the water first.
4. Use only clean utensils for eating or handling foods, especially when handling eggs and poultry.
5. Cook food completely and properly.Store food appropriately in coolers.
A.2. Others according to the article of Viral Gastroenteritis by National Digestive Diseases Information Clearinghouse (NDDIC)(37) the following may increase the risk of virural entertitis
1. Touching contaminated surfaces or objects and then touching their mouths.
2. Sharing food, drink, or eating utensils with infected people
3. Eating foods that are contaminated with the virus, such as oysters from contaminated waters
4. Swallowing airborne particles that contain viruses.
B. Diet ot prevent Enteritis
1. Probiotic
Oral administration of a probiotic preparation was shown to be effective in preventing the recurrence of chronic pouchitis in a classic double-blind, placebo-controlled trial. According to the study by the East Carolina University, Greenville, dysbiosis, a condition of microbial imbalance, has been implicated in the pathogenesis of inflammatory bowel disease. Rather than administering antibiotics to treat the microflora with each relapse of pouchitis, the emphasis was placed on preventing chronic flare-ups by administering probiotics to correct dysbiosis. In addition, the choice of bacteria, optimal dose, and timing of administration have yet to be determined. Finally, the mechanisms by which probiotics provide their beneficial effects remain unresolved(38).
2. Green tea
In the study to investigate the Green tea's repair fasting-induced mucosal damage in rat intestine, showed that use of green tea was associated with a significant increase in total plasma antioxidants (P < 0.001), and mucosal SOD (P < 0.001), catalase (P = 0.006) and GPx (P = 0.017), but a significant decrease in MPO activity (P < 0.001). Green tea reverses the fasting-induced damage to the intestinal mucosa by its antioxidant and anti-inflammatory effect(39).
3. Origanum vulgaris and Allium sativum
According to the study to investigate the efficacy of Virbamix PE (Virbac SA, France) an appetite enhancer and feed flavouring material containing plant extracts of Origanum vulgaris and Allium sativum, added to the feed at one single dose in the control of proliferative enteropathy (PE) in weaning pigs, in comparison to reference treatment with tiamulin (Tiamutine 6.5 Premix/Ceva Animal Health) group and a negative control group indicated that administration of Virbamix PE was found to be effective for the control of PE, as shown by the reduction of prevalence of Lawsonia intracellularis in the intestine at the end of the treatment period, as determined by PCR method comparatively with the T1 group, while no significant difference was found between T2 and T3 groups. The diarrhoea score (DS) was significantly higher (P < 0.05) in the control group in comparison with T2 and T3 groups. However, no significant differences were noticed between T2 and T3 groups during the treatment period (P > 0.05)(40).
4. Etc.
C. Phytochemicals to prevent Enteritis
1. Genistein
Genistein, a principal soy isoflavone, has been identified as a protein kinase inhibitor that possesses immunosuppressive and anti-inflammatory properties. According to the study by the Louisiana State University School of Medicine, Genistein, at low doses, also appeared to attenuate immunohistochemical staining for inducible nitric oxide synthase (iNOS) and nitrotyrosine. The beneficial effects of genistein were not apparent at doses above 0.1 mg/kg. Genistein also inhibited LPS-induced nitrite production by cultured macrophages and protected against LPS-induced necrosis despite its ability to cause apoptosis. These results indicate that genistein displayed mild anti-inflammatory properties which may, in part, involve an attenuation of nitric oxide release via inducible nitric oxide synthase, and the formation of peroxynitrite(41).
2. Resveratrol and curcumin
In the study to investigate the potential anti-inflammatory and immunomodulatory mechanisms of the above mentioned compounds in a murine model of hyper-acute Th1-type ileitis following peroral infection with Toxoplasma gondii conducted by the Charité-Universitätsmedizin Berlin, indicated that Oral treatment with Resveratrol, Curcumin or Simvastatin ameliorates acute small intestinal inflammation by down-regulating Th1-type immune responses and prevents bacterial translocation by maintaining gut barrier function. These findings provide novel and potential prophylaxis and treatment options of patients with inflammatory bowel diseases(42).
3. Beta-carotene
Beta-carotene is known as a potent free radical quencher and antioxidant. According to the study conducted by the B'nai Zion Medical Center, Haifa, Israel, the result demonstrate the effectiveness of beta-carotene in a rat model as a prophylactic dietary measure in reducing the effects of acid-induced enteritis and raise the possibility that patients with Crohn's disease may benefit from the consumption of natural beta-carotene(43).
D. Antioxidants to prevent Enteritis
1. Melatonin
In the study to tests the hypothesis that "the intake of melatonin can minimize the morphological features of cell damage associated with radiation enteritis", conducted by the Assuit University, Assuit, Egypt, found that Administration of melatonin prior to irradiation can protect the intestine against X-rays destructive effects, i.e. radiation enteritis(44).
2. Cu/Zn-superoxide dismutase (SOD1)
In the study to analyze the therapeutic value of Cu/Zn-superoxide dismutase (SOD1) supplementation in an experimental model of radiation-induced intestinal inflammation and explore its mechanistic effects, showed that Treatment with SOD1 decreases oxidative stress and adhesion molecule upregulation in response to abdominal irradiation. This is associated with an attenuation of the radiation-induced intestinal inflammatory response(45).
3. Vitamin A
Vitamin is a free radical scavenger. It emhances the immune system in fighting against forming of free radicals and foreign invasion. In the study to examine Serum retinol, retinyl palmitate, and total vitamin A concentrations, and jejunoileal morphology in neonatal calves infected with Cryptosporidium parvum, showed that
Cryptosporidium parvum infection was associated with significant (P < or = 0.05) reduction in postadministration serum retinol, retinyl palmitate, and total vitamin A concentrations in calves of groups 2, 3, and 4. Cryptosporidium parvum infection caused significant (P < or = 0.05) reduction in villus height. Decreased villus height, villus blunting and fusion, and attenuation of the intestinal mucosa were associated with reduced absorption of vitamin A, as indicated by lower peak postadministration retinyl palmitate concentration in C parvum-infected calves(46).
4. Vitamin E
In the study to the effects of a nonenzymatic oxygen radical scavenger (vitamin E) and an exogenous PGE1 analog known to increase mucosal blood flow (misoprostol) on acute radiation enteritis in rats, showed that ionizing radiation reduces in vivo intestinal fluid absorption without significant changes in histologic or morphometric appearance. Treatment with vitamin E, but not misoprostol, protects gastrointestinal mucosa against radiation-induced absorptive injury(47). Other study showed that selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury may have some beneficial effects against irradiation-induced intestinal injury(48).
V. Treatments
A. In conventional medicine perspective
Treatment depending to the underlined causes of the diseases.
Beside taking certain steps in relieving the symptoms of the patients by providing short-lived and general supportive care(49), such as
Oral rehydration therapy for older children and adults:
Intravenous fluids for severe dehydration
Clear liquid diet
BRAT diet (i.e. bananas, rice, applesauce, toast)
But according to the study by the Christiana Care Health System, probiotics reduce diarrheal duration from a number of etiologies.
Professional nursing practice based on evidence and clinical expertise
supports a diet-containing probiotics to manage acute diarrhea. Dietary limitations included in the BRAT (bananas, rice, applesauce, and toast) diet recommended by many nurses need to be reexamined in light of the newest evidence(48a).
Medications for nausea and vomiting:
Medications for diarrhea:
Atibiotic used are depending to types infectous organism, including Ciprofloxacin (Cipro), Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX), Ceftriaxone (Rocephin) Cefotaxime (Claforan) Vancomycin (Vancocin, Lyphocin, etc., but side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
According to the study by Enterics laboratory, US Army Research Unit, Nairobi, in screening of the 651 patients screened, the highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin(49a).
A.2. Viral entertitis
There is no specific treatment for viral entertistis as antibiotic are not helpful in treating the diseasse. Make sure you are vaccinate against certain virus in a specific season.
According to the study by Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, clinical effective rate of Novalac AD in infantile rotavirus enteritis was 100%. All 20 subjects stool turned normal and systemic symptoms disappeared after treatment, with 17 within 48 h (85%,17/20) and 3 within 72 h (15%, 3/20)(50).
A.3. Radiation-induced enteritis
Radiation-induced enteritis van be prevented, according to the University Hospital Mannheim, Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach(50a).
According to the study the Provincial Hospital affiliated to Shandong University, in the evaluation of the effect of actovegin (Nycomed, deproteinized hemoderivative of calf blood injection) on intestinal mucosa in rats with acute radiation enteritis, and observe the changes of expression of apoptosis-related bcl-2/bax genes, showed that Actovegin accelerates the recovery of the acute radiation-injured intestinal mucosal epithelium by decreasing apoptosis via down-regulation of the expression of activating apoptosis protein bax and up-regulation of inhibiting apoptosis protein bcl-2(51).
B. In herbal medicine perspective
1. Psidium guajava L (Guava)
In the study to observe the clinical effect of olium Psidium guajava (PG) in treating infantile rotaviral enteritis in Sixty-two patients of rotaviral enteritis randomly divided into the treated group treated with PG and the control group treated with Gegen Qinlian decoction, showed that The rate of recovery in 3 days of the treated group was 87.1%, significantly higher than that of the control group (58.1%, P < 0.05). The time of ceasing diarrhea of the treated group (25.1 +/- 9.5 hr) was significantly shorter than that of the control group (38.7 +/- 15.2 hr, P < 0.01)(52).
2. Gastritis-granule and Wei-Mei-Su
According to the study by Dr. Pu CS., In the group treated with granule-gastritis, the effective rate for CP was 81.3% (26/32), and the improvement rates of the symptoms and histopathological lesion were 87.5% (28/32) and 40.6% (13/32) respectively. In the group treated with Wei-Mei-Su as the control group, the figures were 25%, 40% and 10% respectively. These differences were statistically significant (P less than 0.01-0.000). The results showed that the effect of granule-gastritis on chronic gastritis infected with CP was better than that of Wei-Mei-Su(53).
3. Etc.
C. In traditonal Chinese medicine perspective
1. Qiwei baizhu powder
Sixty cases of rotaviral enteritis treated with Qiwei Baizhu Powder (QWBZP) revealed a better efficacy than that treated with Oral Rehydration solution (ORS, chi 2 = 6.07, P < 0.05), according to the study by the Hunan Academy of Traditional Chinese Medicine(54).
2. Jiechang Mixture (JCM)
In the study to evaluate the therapeutic effect and mechanism of Jiechang Mixture (JCM) in treating infantile mycotic enteritis, showed that the time of stool forming, diarrhea relieving and fungi vanishing in the treated group were significantly shorter than those in the control group (P < 0.01), and JCM also showed a better effect in improving clinical symptoms and signs of patients than the control. Results of experimental study showed that JCM could abate the ink evacuation of small intestine in mice. The fungi inhibitory test suggested that Candida albicans was susceptible to JCM(55).
3. Zhixie buye mixture
In the study to observe the therapeutic effect of Zhixie Buye mixture (ZXBYM) on infantile diarrhea patient with mild and middle degree of dehydration, indicated that the ZXBYM is an effective mixture in the treatment of diarrhea with dehydration. It has a good prospect of development and application(56).
4. Fu-zheng qu-xie
In the study of the of fu-zheng qu-xie on gastric disease infected with Campylobacter pyloridis] by Jiangsu Provincial Hospital of TCM, pointed out that the principle of Chinese herbal medicine treatment of gastric disease by campylobacter pyloridis was fu-zheng qu-xie. Fu-zheng was achieved by Astragalus membranaceus, Atractylodes macrocephala and Paeonia lactiflora, whereas qu-xie by Taraxacum monogolicum and Oldenlandia diffusa. Chinese herbal medicine for fu-zheng played an important role in modulating immune function. Qu-xie was directly disinfective and indirectly anti-bacterial. Chinese herbal medicine combined with western drugs will decrease the side effects and enhance the curative effect at the same time(57).
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(24) http://www.ncbi.nlm.nih.gov/pubmed/15923490
(25) http://www.ncbi.nlm.nih.gov/pubmed/19180135
(26) http://www.ncbi.nlm.nih.gov/pubmed/19180134
(27) http://www.ncbi.nlm.nih.gov/pubmed/21084368
(28) http://www.ncbi.nlm.nih.gov/pubmed/15923490
(29) http://www.ncbi.nlm.nih.gov/pubmed/17637949
(29a) http://www.ncbi.nlm.nih.gov/pubmed/21309881
(29b) http://www.ncbi.nlm.nih.gov/pubmed/20624137
(30) http://www.ncbi.nlm.nih.gov/pubmed/21694489
(31) http://www.ncbi.nlm.nih.gov/pubmed/15700692
(32) http://www.ncbi.nlm.nih.gov/pubmed/9676400
(33) http://www.ncbi.nlm.nih.gov/pubmed/12744585
(34) http://www.ncbi.nlm.nih.gov/pubmed/21209172
(35) http://www.ncbi.nlm.nih.gov/pubmed/22989825
(36) http://health.allrefer.com/health/enteritis-prevention.html
(37) http://digestive.niddk.nih.gov/ddiseases/pubs/viralgastroenteritis/#diagnosed
(38) http://www.ncbi.nlm.nih.gov/pubmed/22378800
(39) http://www.ncbi.nlm.nih.gov/pubmed/?term=green+tea+and+Enteritis
(40) http://www.ncbi.nlm.nih.gov/pubmed/19886265
(41) http://www.ncbi.nlm.nih.gov/pubmed/9492347
(42) http://www.ncbi.nlm.nih.gov/pubmed/21151942
(43) http://www.ncbi.nlm.nih.gov/pubmed/14671486
(44) http://www.ncbi.nlm.nih.gov/pubmed/18762261
(45) http://www.ncbi.nlm.nih.gov/pubmed/15752897
(46) http://www.ncbi.nlm.nih.gov/pubmed/1456546
(47) http://www.ncbi.nlm.nih.gov/pubmed/1735337
(48) http://www.ncbi.nlm.nih.gov/pubmed/10821115
(48a) http://www.ncbi.nlm.nih.gov/pubmed/22517350
(49) http://www.freemd.com/bacterial-enteritis/treatment.htm
(49a) http://www.ncbi.nlm.nih.gov/pubmed/22842944
(50) http://www.ncbi.nlm.nih.gov/pubmed/21110440
(50a) http://www.ncbi.nlm.nih.gov/pubmed/18461520
(51) http://www.ncbi.nlm.nih.gov/pubmed/20021825
(52) http://www.ncbi.nlm.nih.gov/pubmed/11938857
(53) http://www.ncbi.nlm.nih.gov/pubmed/2624985
(54) http://www.ncbi.nlm.nih.gov/pubmed/9208531
(55) http://www.ncbi.nlm.nih.gov/pubmed/12577434
(56) http://www.ncbi.nlm.nih.gov/pubmed/11783278
(57) http://www.ncbi.nlm.nih.gov/pubmed/2065393
Types of Entertitis
1. Campylobacter enteritis (Campylobacter jejuni)
Campylobacter enteritis is the commonest form of infective diarrhoea in most developed countries of the world. According to the statistic from Wales laboratory, the an annual incidence of about 85/100,000, but the true rate is probably nearer 1100/100,000. Most infections are sporadic and believed to be foodborne; large outbreaks are infrequent and mostly as a result of the consumption of raw milk or unchlorinated water. Raw meats and animal products, notably broiler chickens, are the main source of campylobacters in food(c). Other indicated that Cross-contamination and improper handling and cooking of foods of animal origin account for the majority of disease. Hygienic measures must be applied in order to reduce the incidence of campylobacteriosis in humans(b).
2. E. coli enteritis (E. coli)
In an age cross sectional cohort analysis of 340 0-47 month old children and newborn cohort analysis of 144 newborns to determine the diarrheogenic Escherichia coli incidence in Santa Julia, a low socioeconomic community in Santiago, Chile, between December 1986 and February 1990, showed thatthe age cross sectional cohort had 1178 episodes of diarrhea and the newborn cohort had 674 episodes. No difference in the isolation rate of enteroaggregative E. coli existed between cases and controls. Since most households in Santa Julia have access to potable water (68%) and an indoor toilet (64%), food contamination were likely the vehicles of E. coli transmission because more than 50% of households do not have a refrigerator(e). Other in the review of the outbreak of E. coli O142 K86 H34, the enteritis of adults and children are due to enteroinvasive (EIEC) and enterotoxigenic (ETEC) strains, suggested that routine search for EPEC is suggested in cases of infantile enteritis in hospitals and other institutions(f).
3. Clostridium perfringens enteritis
Clostridium perfringens is an important anaerobic pathogen causing foodborne and non-foodborne gastrointestinal diseases in humans and animals. This pathogen is also the more common Clostridium species associated with bacteraemia. We report on a fatal case of C. perfringens infection in an adult with type 2 diabetes(g).
4. Staphylococcal enteritis (Food poisioning)
The disease is as reslt of eating or drinking substances contaminated with staph enterotoxin. The enterotoxins are fast acting, sometimes causing illness within one to six hours. Patients typically experience nausea, vomiting, stomach cramps, and diarrhea(h).
5. Radiation enteritis
Radiation therapy may damage the lining of the intestines (bowels) and cause inflammation.
The clinicopathologic features of radiation enteritis are reviewed in 44 children receiving whole abdominal radiation therapy between 1961-1972 at the Institut Gustave-Roussy. Five of 14 long-term survivors (36%) developed severe delayed radiation injury with small bowel obstruction, occurring within 2 months after completion of irradiation. All had previously had acute radiation reaction during therapy, according to the study by Dr. Donaldson SS and the research team(i).
6. Salmonella enteritis
Salmonella enterica and Campylobacter spp. cause a considerable number of human illnesses each year, and the vast majority of cases are foodborne(j). Other study indicated thatthe most common disease syndromes caused by Salmonella serotypes in humans, typhoid fever and enteritis, can be modeled using Salmonella enterica serotype Typhimurium infections in mice and calves, respectively(k).
7. Shigella enteritis
Shigella species cause bacillary dysentery in humans by invasion, intracellular multiplication, spread to adjacent cells, and induction of brisk inflammatory responses in the intestinal epithelium(l). According to the study, in August 2002, an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5-6 August 2002. The estimated primary attack rate was 9.97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16.49%)(m).
8. Etc.
I. Symptoms
1. Abdomen Pain, diahrrea and fever
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(1).
2. Post-infectious fatigue and abdominal symptoms
Some patients with Severity of Giardia infection after treatment may be experience Post-infectious fatigue and abdominal symptoms. According to the study by Haukeland University Hospital, Protracted and severe giardiasis seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the Giardia infection(2).
3. Bloating, Iron and vitamin deficiency
Patient with Campylobacter jejuni enteritis may be experioence with symptoms of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies.
There is a report of a young woman with no previous gastrointestinal complaints who was initially diagnosed with postinfective irritable bowel syndrome (IBS) after a confirmed case of Campylobacter jejuni enteritis. However, because of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies(3).
4. Hematochezia
Hematochezia is defined as a condition of passing fresh blood through the anus and in or with stools. In most cases it is caused by the bleeding of lower gastrointestine.
5. Dizziness
Patient with cryptogenic multifocal ulcerous stenosing enteritis, may be experiencerecurrent colicky abdominal pain and dizziness(4).
6. Acute intestinal obstruction or perforation
Although Acute intestinal obstruction or perforationare rare in patient with enteritis. There is a report of a case of a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis(5).
7. Constipation
There is a report of a case of mucosal Eosinophilic gastroenteris (EG) presenting as constipation and abdominal pain in a 43 year old female. EG should be considered in the differential diagnosis of patients presenting with constipation and abdominal pain and can easily be diagnosed with mucosal biopsies and treated with steroid therapy(5a).
8. Others
Patients may be also experience to symptoms of loss of appetite, dehydration, vomiting, thirst, change in stool pattern, high CRP and leucocytosisetc, etc(5b).
II. Causes and Risk factors
A. Causes
1. Radiation-induced enteritis
Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. According to the study by Fovárosi Onkormányzat Uzsoki Utcai Kórház Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145, during the radiotherapy of tumors in the minor pelvis and abdomen intestinal inflammation of different degree may occur even if special attention is paid. Irradiation to the minor pelvis causes in half of the cases radiation induced acute enteritis, whereas in 25% chronic enteritis and colitis will develop(6).
2. Virus
Certain virus can induce entertitis including Cytomegalovirus and Norovirus. The Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries, according to the study to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis by Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey, indicated that NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%)(7).
3. Bacteria
Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract, according to the study by Universidad de Barcelona, Barcelona, España(8).
4. Crohn's disease
Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology(9). Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel, according to the study by, there is a report of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. Laboratory tests indicated iron-deficiency anemia. There was no evidence of bleeding on esophagogastroduodenoscopic and colonofiberscopic examination. With capsule endoscopy, multiple mucosal ulcers were visualized in the jejunoileal area. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis(10).
5. Medication such as proton pump inhibitors
Gastric acid is a defense mechanism against gastrointestinal infections caused by ingested bacteria. According to the study by Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain, gastric acid suppression induced by proton pump inhibitors (PPIs) but not H2RAs is associated with an increased risk of Campylobacter and Salmonella GE(11).
6. Drugs
There is a report of a 25-year-old woman who was hospitalized repeatedly during a 5-year period due to abdominal pain, change in stool pattern, high CRP and leucocytosis. A thorough interview revealed a recreational use of cocaine, and diary recordings confirmed the association between her abdominal pain and cocaine use(12).
B. Risk Factors
1. Intestinal illness
People who have a family memeber with intestinal illness are at increased risk to develop gastroenteritis.In the study to evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection, showed that Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p < 0.01)(13).
2. Undercooked ground meat and foods
Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection(14).
3. Environmental risk
Campylobacter is a common cause of bacterial gastro-enteritis characterized by multiple environmental sources and transmission pathways. According to the study, regional characteristics associated with an increased regional risk of campylobacteriosis, for at least some geographical units, were high ruminant density, high poultry density, high population density, and presence of a large poultry slaughterhouse, whereas a reduction in risk was associated with a lower percentage of people with diplomas, a lower level of precipitation, and warmer temperature. Two clusters of elevated residual risk were observed, with different location and size depending on the geographical unit used(15).
4. Biologically plausible risk
In the study to to evaluate whether the increase in incidence of campylobacteriosis observed in humans in Norway from 1995 to 2001 was statistically significant and whether different biologically plausible risk factors were associated with the incidence of campylobacteriosis in the different counties in Norway, found that treated water was a protective factor against Campylobacter infections in humans with an IRR of 0.78 per percentage increase in people supplied. Campylobacter infections did not appear to be clustered in any particular county in Norway(16).
5. Immune dysfunction
Immune system is responsible in fighting against invasion of bacteria and virus. Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS)(17).
6. Aging
Elderly are more susceptible to bacterial and virus infection and inflammation, as a result of weakened immune system.
7. Etc.
II. Diseases associated to Entetitis
1. Functional gastrointestinal disorders (PI-FGID)
A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). According to the study by the University of Bergen, Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations suggesting a possible immunological abnormality in these conditions(18).
2. Small bowel perforation
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(19).
3. Severe intraluminal hemorrhage
There is a report of 4 9-month-old Simmental male calves were presented with a history of sudden death. The necropsy and microscopic findings allowed a diagnosis of enteritis and severe intraluminal hemorrhage with blood clots in the jejunum, suggestive of jejunal hemorrhage syndrome, according to the study by Institute of Veterinary Medicine Belgrade(20).
4. Chronic and recurrent occlusion events and multiple small intestinal ulcers
Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel. According to the study by Seoul Paik Hospital, Inje University, College of Medicine Seoul, there is a case of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis. Cryptogenic multifocal ulcerous stenosing enteritis should be considered in cases of chronic or recurrent occlusion events and multiple small intestinal ulcers and strictures of unknown origin(21).
5. Hypereosinophilic syndrome
Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide(21a).
6. Systemic lupus erythematosus
There is a reprot of a 38-year-old Persian Iranian woman admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis, according to the study by Tehran University of Medical Sciences(21b)
III. Complications
1. Chronic fatigue syndrome
A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. In the study to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection, showed that in a total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis(22).
2. Irritable bowel syndrome and chronic fatigue
Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications. In the study to estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis, indicated that Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness.This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic(23).
3. Arthritis symptoms
According to the London Kidney Research Unit, Division of Nephrology, London Health Sciences Centre, Acute bacterial gastroenteritis necessitating medical attention was associated with a higher risk of arthritic symptoms, but not arthritic medications, up to 4 yrs afterwards(24).
4. Risk of pregnancy-related hypertension
In the study to evaluate the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water, by the University of Western Ontario, London, indicated that of 148 eligible pregnancies, antenatal audits with blood pressure data were available for 135. PRH was detected in 20.7% pregnancies, of which 6.7% were chronic hypertension and 14.1% gestational hypertension. Although nonsignificant, we observed a consistent trend toward higher rates of PRH and mean arterial pressure, particularly prior to 20 weeks gestation, among women who reported symptomatic gastroenteritis compared to asymptomatic women. BP should be monitored closely in women after exposure to contaminated water(25).
5. Diabetes mellitus
Ingestion of Escherichia coli O157:H7 can cause a spectrum of acute illness, ranging from overt hemolytic-uremic syndrome (HUS), to gastroenteritis with bloody diarrhea, to no symptoms. According to the study by the University of Western Ontario, survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection. However, less severe forms of infection, such as E. coli O157:H7 gastroenteritis without overt HUS, do not appear to result in an increased risk of type 2 diabetes(26).
6. Hypertension, Renal impairment, and Self reported cardiovascular disease
In the study to evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter, showed that Gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter was associated with an increased risk for hypertension, renal impairment, and self reported cardiovascular disease. Annual monitoring of blood pressure and periodic monitoring of renal function may be warranted for individuals who experience E coli O157:H7 gastroenteritis(27).
Other study also indicated that acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection(28).
7. Celiac disease
According to the study by the McMaster University Medical Centre, CD should be considered in the differential diagnosis of persistent IBS-like symptoms after an episode of infectious gastroenteritis(29).
8. Seizures and even GE encephalopathy
In the study to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections of a data of a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009, found that Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode(29a).
9. Dehydration
According to the Department of Pediatrics, CHU Sainte-Justine, From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001)(29b).
10. Etc.
III. Misdiagnosis and diagnosis
A. Misdiagnosis
1. Primary NK/T cell lymphoma
Primary natural killer (NK) cell like T cell lymphoma of the terminal ileum is extremely rare. It most frequently occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. NK/T cell lymphoma involving gastrointestinal tract has characteristic endoscopic features of Inflammatory bowel disease. According to the study by the Hallym University College of Medicine, there is a case of primary NK/T cell lymphoma misdiagnosed as Behcet's enteritis of the terminal ileum colonoscopically and complicated by cecal bleeding and perforation(30).
2. Acute appendicitis
Acute appendicitis is the most common cause of urgent surgery in children. Bacterial enteritis limited to the ileocecal region appears to be responsible for an appreciable number of unnecessary appendectomies. On the other hand, diagnostic errors in appendicitis may delay early appendectomy and result in the formation of appendiceal mass(31).
3. Acute abdomen pain
Enteritis cystica profunda, an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The third case of enteritis cystica profunda in children is presented with special emphasis on diagnosis and treatment. This rare entity may mimic acute abdomen and should be kept in mind in the differential diagnosis(32).
4. Others
Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. According to the study by, there is a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone(33).
B. Diagnosis
Diagnosis is depending to the underlined causes of the diseases
1. Stool culture
The aim of the test is to identify the bacteria and virus which cause the diseases. According to the study of "New methods for detection of campylobacters in stool samples in comparison to culture" by the University Hospital, Frankfurt/Main, current detection in stools is done essentially by culture on selective and nonselective media with filtration. These methods were compared to 2 molecular biology methods, an in-house real-time PCR and a multiplex PCR named Seeplex Diarrhea ACE Detection, and 3 immunoenzymatic methods, Premier Campy, RidaScreen Campylobacter, and ImmunoCard Stat!Campy. Out of 242 stool specimens tested, 23 (9.5%) fulfilled the positivity criteria, i.e., they were positive by one or both culture methods or, in case of a negative culture, by a positive molecular method and a positive immunoenzymatic method. The striking feature of this study is the low sensitivity of culture, in the range of 60%, in contrast to immunoenzymatic and molecular tests(34).
2. [13]C-acetate breath test
[13C]acetate breath test is the measure of gastric emptying of the liquid phase both in liquid and semisolid test meals by simultaneous radioscintigraphy.There is a report of eosinophilic enteritis in which the (13)C-acetate breath test was effective(35).
IV. Preventions
A. The do and do not's list
In case of entertitis outbreak
A.1. The article by All Refer.com health(36) suggested the followings
1. Always wash hands after using the toilet and before eating or preparing food or drink.
2. You may also clean your hands with a 60% alcohol based product.
3. Avoid drinking from unknown sources, such as streams and outdoor wells, without boiling the water first.
4. Use only clean utensils for eating or handling foods, especially when handling eggs and poultry.
5. Cook food completely and properly.Store food appropriately in coolers.
A.2. Others according to the article of Viral Gastroenteritis by National Digestive Diseases Information Clearinghouse (NDDIC)(37) the following may increase the risk of virural entertitis
1. Touching contaminated surfaces or objects and then touching their mouths.
2. Sharing food, drink, or eating utensils with infected people
3. Eating foods that are contaminated with the virus, such as oysters from contaminated waters
4. Swallowing airborne particles that contain viruses.
B. Diet ot prevent Enteritis
1. Probiotic
Oral administration of a probiotic preparation was shown to be effective in preventing the recurrence of chronic pouchitis in a classic double-blind, placebo-controlled trial. According to the study by the East Carolina University, Greenville, dysbiosis, a condition of microbial imbalance, has been implicated in the pathogenesis of inflammatory bowel disease. Rather than administering antibiotics to treat the microflora with each relapse of pouchitis, the emphasis was placed on preventing chronic flare-ups by administering probiotics to correct dysbiosis. In addition, the choice of bacteria, optimal dose, and timing of administration have yet to be determined. Finally, the mechanisms by which probiotics provide their beneficial effects remain unresolved(38).
2. Green tea
In the study to investigate the Green tea's repair fasting-induced mucosal damage in rat intestine, showed that use of green tea was associated with a significant increase in total plasma antioxidants (P < 0.001), and mucosal SOD (P < 0.001), catalase (P = 0.006) and GPx (P = 0.017), but a significant decrease in MPO activity (P < 0.001). Green tea reverses the fasting-induced damage to the intestinal mucosa by its antioxidant and anti-inflammatory effect(39).
3. Origanum vulgaris and Allium sativum
According to the study to investigate the efficacy of Virbamix PE (Virbac SA, France) an appetite enhancer and feed flavouring material containing plant extracts of Origanum vulgaris and Allium sativum, added to the feed at one single dose in the control of proliferative enteropathy (PE) in weaning pigs, in comparison to reference treatment with tiamulin (Tiamutine 6.5 Premix/Ceva Animal Health) group and a negative control group indicated that administration of Virbamix PE was found to be effective for the control of PE, as shown by the reduction of prevalence of Lawsonia intracellularis in the intestine at the end of the treatment period, as determined by PCR method comparatively with the T1 group, while no significant difference was found between T2 and T3 groups. The diarrhoea score (DS) was significantly higher (P < 0.05) in the control group in comparison with T2 and T3 groups. However, no significant differences were noticed between T2 and T3 groups during the treatment period (P > 0.05)(40).
4. Etc.
C. Phytochemicals to prevent Enteritis
1. Genistein
Genistein, a principal soy isoflavone, has been identified as a protein kinase inhibitor that possesses immunosuppressive and anti-inflammatory properties. According to the study by the Louisiana State University School of Medicine, Genistein, at low doses, also appeared to attenuate immunohistochemical staining for inducible nitric oxide synthase (iNOS) and nitrotyrosine. The beneficial effects of genistein were not apparent at doses above 0.1 mg/kg. Genistein also inhibited LPS-induced nitrite production by cultured macrophages and protected against LPS-induced necrosis despite its ability to cause apoptosis. These results indicate that genistein displayed mild anti-inflammatory properties which may, in part, involve an attenuation of nitric oxide release via inducible nitric oxide synthase, and the formation of peroxynitrite(41).
2. Resveratrol and curcumin
In the study to investigate the potential anti-inflammatory and immunomodulatory mechanisms of the above mentioned compounds in a murine model of hyper-acute Th1-type ileitis following peroral infection with Toxoplasma gondii conducted by the Charité-Universitätsmedizin Berlin, indicated that Oral treatment with Resveratrol, Curcumin or Simvastatin ameliorates acute small intestinal inflammation by down-regulating Th1-type immune responses and prevents bacterial translocation by maintaining gut barrier function. These findings provide novel and potential prophylaxis and treatment options of patients with inflammatory bowel diseases(42).
3. Beta-carotene
Beta-carotene is known as a potent free radical quencher and antioxidant. According to the study conducted by the B'nai Zion Medical Center, Haifa, Israel, the result demonstrate the effectiveness of beta-carotene in a rat model as a prophylactic dietary measure in reducing the effects of acid-induced enteritis and raise the possibility that patients with Crohn's disease may benefit from the consumption of natural beta-carotene(43).
D. Antioxidants to prevent Enteritis
1. Melatonin
In the study to tests the hypothesis that "the intake of melatonin can minimize the morphological features of cell damage associated with radiation enteritis", conducted by the Assuit University, Assuit, Egypt, found that Administration of melatonin prior to irradiation can protect the intestine against X-rays destructive effects, i.e. radiation enteritis(44).
2. Cu/Zn-superoxide dismutase (SOD1)
In the study to analyze the therapeutic value of Cu/Zn-superoxide dismutase (SOD1) supplementation in an experimental model of radiation-induced intestinal inflammation and explore its mechanistic effects, showed that Treatment with SOD1 decreases oxidative stress and adhesion molecule upregulation in response to abdominal irradiation. This is associated with an attenuation of the radiation-induced intestinal inflammatory response(45).
3. Vitamin A
Vitamin is a free radical scavenger. It emhances the immune system in fighting against forming of free radicals and foreign invasion. In the study to examine Serum retinol, retinyl palmitate, and total vitamin A concentrations, and jejunoileal morphology in neonatal calves infected with Cryptosporidium parvum, showed that
Cryptosporidium parvum infection was associated with significant (P < or = 0.05) reduction in postadministration serum retinol, retinyl palmitate, and total vitamin A concentrations in calves of groups 2, 3, and 4. Cryptosporidium parvum infection caused significant (P < or = 0.05) reduction in villus height. Decreased villus height, villus blunting and fusion, and attenuation of the intestinal mucosa were associated with reduced absorption of vitamin A, as indicated by lower peak postadministration retinyl palmitate concentration in C parvum-infected calves(46).
4. Vitamin E
In the study to the effects of a nonenzymatic oxygen radical scavenger (vitamin E) and an exogenous PGE1 analog known to increase mucosal blood flow (misoprostol) on acute radiation enteritis in rats, showed that ionizing radiation reduces in vivo intestinal fluid absorption without significant changes in histologic or morphometric appearance. Treatment with vitamin E, but not misoprostol, protects gastrointestinal mucosa against radiation-induced absorptive injury(47). Other study showed that selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury may have some beneficial effects against irradiation-induced intestinal injury(48).
V. Treatments
A. In conventional medicine perspective
Treatment depending to the underlined causes of the diseases.
Beside taking certain steps in relieving the symptoms of the patients by providing short-lived and general supportive care(49), such as
Oral rehydration therapy for older children and adults:
- Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea.
- Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes.
- The absence of food allows the intestines to rest.
- May be able to advance to full liquid diet once symptoms improve
- Effective to treat mild to moderate dehydration
- Metoclopramide (Reglan) but side effects are not limit to hives, difficulty breathing, swelling of your face, lips, tongue, or throat.
- Ondansetron (Zofran) but side effects are not limit to headache, fatigue, constipation, etc.
- Olanzapine has been shown to be a safe and effective agent for the prevention of nausea and vomiting for patient with entertitis, but side effects are not limit to hives; difficulty breathing; swelling, etc.
- Prochlorperazine (Compazine, Compro) but side effects are not limit to Constipation, headaches, dizziness, etc.
- Loperamide (Imodium) but side effects are not limit to abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, vomiting, etc.
- Diphenoxylate and Atropine (Lomotil) but side effects are not limit to thirst, decreased urination, muscle cramps, weakness, fainting, etc.
Atibiotic used are depending to types infectous organism, including Ciprofloxacin (Cipro), Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX), Ceftriaxone (Rocephin) Cefotaxime (Claforan) Vancomycin (Vancocin, Lyphocin, etc., but side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
According to the study by Enterics laboratory, US Army Research Unit, Nairobi, in screening of the 651 patients screened, the highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin(49a).
A.2. Viral entertitis
There is no specific treatment for viral entertistis as antibiotic are not helpful in treating the diseasse. Make sure you are vaccinate against certain virus in a specific season.
According to the study by Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, clinical effective rate of Novalac AD in infantile rotavirus enteritis was 100%. All 20 subjects stool turned normal and systemic symptoms disappeared after treatment, with 17 within 48 h (85%,17/20) and 3 within 72 h (15%, 3/20)(50).
A.3. Radiation-induced enteritis
Radiation-induced enteritis van be prevented, according to the University Hospital Mannheim, Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach(50a).
According to the study the Provincial Hospital affiliated to Shandong University, in the evaluation of the effect of actovegin (Nycomed, deproteinized hemoderivative of calf blood injection) on intestinal mucosa in rats with acute radiation enteritis, and observe the changes of expression of apoptosis-related bcl-2/bax genes, showed that Actovegin accelerates the recovery of the acute radiation-injured intestinal mucosal epithelium by decreasing apoptosis via down-regulation of the expression of activating apoptosis protein bax and up-regulation of inhibiting apoptosis protein bcl-2(51).
B. In herbal medicine perspective
1. Psidium guajava L (Guava)
In the study to observe the clinical effect of olium Psidium guajava (PG) in treating infantile rotaviral enteritis in Sixty-two patients of rotaviral enteritis randomly divided into the treated group treated with PG and the control group treated with Gegen Qinlian decoction, showed that The rate of recovery in 3 days of the treated group was 87.1%, significantly higher than that of the control group (58.1%, P < 0.05). The time of ceasing diarrhea of the treated group (25.1 +/- 9.5 hr) was significantly shorter than that of the control group (38.7 +/- 15.2 hr, P < 0.01)(52).
2. Gastritis-granule and Wei-Mei-Su
According to the study by Dr. Pu CS., In the group treated with granule-gastritis, the effective rate for CP was 81.3% (26/32), and the improvement rates of the symptoms and histopathological lesion were 87.5% (28/32) and 40.6% (13/32) respectively. In the group treated with Wei-Mei-Su as the control group, the figures were 25%, 40% and 10% respectively. These differences were statistically significant (P less than 0.01-0.000). The results showed that the effect of granule-gastritis on chronic gastritis infected with CP was better than that of Wei-Mei-Su(53).
3. Etc.
C. In traditonal Chinese medicine perspective
1. Qiwei baizhu powder
Sixty cases of rotaviral enteritis treated with Qiwei Baizhu Powder (QWBZP) revealed a better efficacy than that treated with Oral Rehydration solution (ORS, chi 2 = 6.07, P < 0.05), according to the study by the Hunan Academy of Traditional Chinese Medicine(54).
2. Jiechang Mixture (JCM)
In the study to evaluate the therapeutic effect and mechanism of Jiechang Mixture (JCM) in treating infantile mycotic enteritis, showed that the time of stool forming, diarrhea relieving and fungi vanishing in the treated group were significantly shorter than those in the control group (P < 0.01), and JCM also showed a better effect in improving clinical symptoms and signs of patients than the control. Results of experimental study showed that JCM could abate the ink evacuation of small intestine in mice. The fungi inhibitory test suggested that Candida albicans was susceptible to JCM(55).
3. Zhixie buye mixture
In the study to observe the therapeutic effect of Zhixie Buye mixture (ZXBYM) on infantile diarrhea patient with mild and middle degree of dehydration, indicated that the ZXBYM is an effective mixture in the treatment of diarrhea with dehydration. It has a good prospect of development and application(56).
4. Fu-zheng qu-xie
In the study of the of fu-zheng qu-xie on gastric disease infected with Campylobacter pyloridis] by Jiangsu Provincial Hospital of TCM, pointed out that the principle of Chinese herbal medicine treatment of gastric disease by campylobacter pyloridis was fu-zheng qu-xie. Fu-zheng was achieved by Astragalus membranaceus, Atractylodes macrocephala and Paeonia lactiflora, whereas qu-xie by Taraxacum monogolicum and Oldenlandia diffusa. Chinese herbal medicine for fu-zheng played an important role in modulating immune function. Qu-xie was directly disinfective and indirectly anti-bacterial. Chinese herbal medicine combined with western drugs will decrease the side effects and enhance the curative effect at the same time(57).
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