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Pomnik, Poland

Szczeblowska D.,Klinika Chorob Wewnetrznych | Serwin D.,Klinika Chorob Wewnetrznych | Hebzda A.,Klinika Chorob Wewnetrznych | Wojtun S.,Klinika Gastroenterologii | Grys I.,Klinika Chorob Wewnetrznych
Pediatria i Medycyna Rodzinna | Year: 2011

The non-specific enteritis include ulcerative inflammation of the large intestine and the Crohn's disease. As the peak of incidence of the diseases is between 15 and 35 years old and these concerns people in procreative period, some questions and doubts on the influence of the diseases and their treatment on fertility, the course of gestation, labour and the safety of breast feeding are born. In the paper, some rules on the treatment of nonspecific enteritis in males and females planning having offspring as well as pregnant and feeding females are showed. It should be underlined that non-specific enteritis are not contraindication to become pregnant. Gestation also does not constitute indication for the non-specific enteritis treatment interruption. It should be underlined that gestation is not indication for the non-specific enteritis treatment interruption as their exacerbation relates to higher risk for offspring than implementation of an invasive but successful treatment. The disease activation increases the risk of miscarriage, preterm labours and intrauterine death of foetus. Continuous pharmacotherapy of the enteritis with non-carcinogenic substances has great influence on the birth of a healthy child. The best time to become pregnant is the period after at least 3 months of the disease remission. At the time of gestation planning, folic acid supplementation is indicated. © Pediatr Med Rodz 2011.

The main forms of IBD are ulcerative colitis and Crohn's disease (CD), which may present with malnutrition as one of clinical symptom. In this study, causes of malnutrition such as insufficient energy and nutrient supply, intestinal malabsorbtion, diarrhea, higher energy expenditure, and interactions with pharmacological treatment were presented. It was pointed that diet in remission should correspond with feeding of healthy children, while in aggravation it should be adapted to nutritional tolerance with polymeric, semi-elementary or elementary mixtures taken under consideration. In children, enteral nutrition, the effectiveness of which is comparable to steroid therapy, is administered more often than in adults. Clinical effects of enteral nutrition are due to its lower antigen stimulation, decrease of concentration of proinflammatory cytokines, as well as activation of healing process and influence of inflammatory microbiota. Trophic elements such as glutamine, short- and long-chain fatty acids, omega-3 fatty acids and probiotics were pointed. However, there is no strong evidence that omega-3 fatty acids and probiotics are an effective maintenance therapy in CD patients. © 2011 Cornetis.

Nowak A.,Technical University of Lodz | Slizewska K.,Technical University of Lodz | Libudzisz Z.,Technical University of Lodz | Socha J.,Klinika Gastroenterologii
Zywnosc. Nauka. Technologia. Jakosc/Food. Science Technology. Quality | Year: 2010

Beneficial effects of probiotics on human health were discussed in this paper, and, in particular, their role in reducing risks of civilization diseases, such as: tumours, obesity, allergies. A separate chapter was devoted to the safety aspects of using (consuming) probiotic products.

Inflammatory bowel diseases (IBD) affect mainly the young population and therefore fertility and pregnancy-related issues are important clinical considerations. Generally, men and women with IBD do not have decreased fertility compared to the general population. Drugs used for IBD do not affect significantly fertility in humans, except sulfasalazine, which causes a temporary reduction in spermatogenesis, but does not reduce fertility itself. The disease course during pregnancy and the risk of pregnancy-related complications depend mainly on the disease activity at the time of conception, therefore, pregnancy should be planned during a phase of remission. Except for methotrexate, mycophenolate mofetil and thalidomide, which are strongly contraindicated, drugs used for IBD appear safe in pregnancy, if they are administered carefully. The highest degree of safety was proved for 5-ASA- -containing agents, thiopurines and corticosteroids. The use of TNFα agents remains disputable, especially in the third trimester of pregnancy, due to their high concentration in the infant`s blood and the lack of data concerning its long-term safety. Surgery, if necessary, should be delayed if possible, although pregnancy is not a contraindication for surgical procedures. The management of IBD in reproductive age and pregnant women remains still controversial, because literature data comes mostly from retrospective studies. The aim of this paper was to summarize and to present proper management of patients with IBD prior to conception, as well as pregnant women and breast-feeding mothers with IBD, based on current European Crohn's and Colitis Organisation (ECCO) guidelines and available literature.

Non-steroidal anti-inflammatory drugs are drugs of choice for chronic pain, which is most common in chronic conditions, rheumatism in particular. According to current recommendations, these medications should be used continuously or intermittently, and their choice should be tailored to each patient. Unfortunately, non-steroidal anti-inflammatory drugs have multiple adverse effects ranging from the most insignificant dyspepsia to severe upper gastrointestinal bleeding. Therefore, gastroscopy and, in the case of confirmed Helicobacter pylori infection, eradication is advisable for planned long-term treatment with these agents. Long-term use of proton pump inhibitors is recommended in rheumatic patients chronically receiving non-selective non-steroidal anti-inflammatory drugs, while celecoxib (a selective COX-2 inhibitor) combined with proton pump inhibitor should be administered in patients at high risk of gastrointestinal complications. In rheumatic patients, the type of non-steroidal anti-inflammatory drug and the route of its administration should be tailored to each patient in terms of strength and duration of drug action, the type of disease and comorbidities as well as contraindications. Adverse gastrointestinal effects are due to the mechanism of action of non-steroidal anti-inflammatory drugs, and therefore independent of the route of administration. The use of proton pump inhibitors with cardioprotective doses of aspirin should be limited to patients with risk factors for gastrointestinal complications. High non-steroidal anti-inflammatory drug doses are limited to gout attack, acute pain and axial spondyloarthropathy showing high clinical activity. In other cases, the lowest effective non-steroidal anti-inflammatory drug dose is recommended. Advancing age is characterised by impairment in the function of all organs, therefore elderly patients should receive lower non-steroidal anti-inflammatory drug doses. Concomitant use of two or more non-steroidal anti-inflammatory drugs in rheumatic diseases is not recommended. According to the latest recommendations, non-steroidal anti-inflammatory drugs can be combined with paracetamol and medicinal products with different mechanisms of action. © Pediatr Med Rodz 2016.

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