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Modulen Ibd Latte Polvere 400g

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Another mechanism of dietary interaction with the host is via a direct effect on the immune system, where dietary antigens by themselves may trigger an immune response. The typical western-style diet, high in sugar and saturated fats and low in fibre, can lead to systemic low-grade inflammation, as described in obesity. 25 In animal models, the consumption of milk-derived saturated fats alters bile acid composition, allowing for a bloom of sulphate-reducing bacteria, which in turn can produce greater amounts of the potentially mucosal toxic hydrogen sulphide and production of helper T cell (Th1) proinflammatory cytokines. 26 Vasseur P, et al. Dietary Patterns, Ultra-processed food, and the risk of inflammatory bowel diseases in the NutriNet-Santé cohort. Inflamm Bowel Dis. 2021 Jan 1;27(1):65-73. Sigall-boneh et al., Dietary therapies induce rapid response and remission in pediatric patients with active Crohn’s disease. Clin Gastroenterol Hepatol. 2021 Apr 1, Vol. 19, Issue 4, p.752-759. There are no data regarding the use of organic products and the risk of flare. But some recent data suggest that regular consumption of organic food could be protective for the development of some cancers. 78 We can hypothesize that organic food, due to a reduction of pollutants, may reduce the proinflammatory role of food and by this mechanism, help to reduce inflammation in IBD. Clinical outcomes were consistent in adults and children. 60% of adults achieved clinical response vs 71% of children. 40% of adults and 38% of children achieved clinical remission.

Anti-TNF treatment is not all-encompassing despite its vital role in IBD treatment. Up to 40% of patients do not respond to TNF inhibitors, and nearly 23–46% of patients experience secondary loss-of-response 1 year after anti-TNF-α treatment ( 6). It may be possible to achieve long-term remission through dose escalation, shorter intervals between infusions ( 78) or combination therapy ( 79). Due to anti-TNF agents' dose-related therapeutic benefit, measurement of serum trough level and anti-drug antibody is advocated ( 80, 81). Anti-IL-12/23 Therapy The next stage was to investigate whether CDED can be used to treat adults with CD, patients with severe luminal CD, therapy for longer than 12 weeks and for patients refractory to biologics and/or as an adjuvant therapy to biologics. At week 6, 68.4% of patients in the CDED plus PEN group and 57.1% of patients in the CDED alone group had achieved clinical remission (p=0.4618). Among the 25 patients in remission at week 6, 63.2% and 38.2% were in sustained remission at week 24 in the CDED+PEN and the CDED alone group respectively. 35% of the overall patient cohort were in endoscopic remission at week 24.Yanai H, Levine A, et al. The Crohn’s Disease Exclusion Diet for induction and maintenance of remission in adults with mild-to-moderate Crohn’s disease (CDED-AD). Lancet Gastroenterol Hepatol. 2022 Jan;7(1):49-59. Side effects associated with 5-ASA, including flatulence, nausea, abdominal pain, diarrhea, and headache, are generally mild. In contrast, the side effects of SASP, such as infertility, hemolytic anemia, photosensitization, and granulocytosis, are much more than those of 5-ASA ( 12). However, a few patients may develop nephrotoxicity within 1 year of 5-ASA administration ( 23). CSs

Modulen ® effectiveness to induce remission has been shown in many studies ( Table 1). These studies have several limitations, while they are mainly retrospective or with no randomized control, and the endpoints were clinical remission rather than mucosal healing. Among patients treated exclusively with Modulen ®, 65% of patients (19/27 children) have displayed a PCDAI ≤ 15 after 6–8 weeks [ 1] and 79% (23/29 children) have reached clinical remission with a PCDAI ≤ 10 after 8 weeks of CT32I Nestlé ® formula treatment [ 2]. A similar rate (80%) has been described by Buchanan et al. (105/114 children), who have combined both oral and nasogastric administration [ 3]. The mode of administration depends on patients’ clinical status [ 33], but does not affect the clinical remission rate. After eight weeks of exclusive Modulen ®, oral and nasogastric administration induces 75% and 85% of clinical remission respectively (PCDAI < 10), without any statistical difference between treatments ( Table 2) [ 4]. Considering the severe corticosteroid side effects, numerous studies have already illustrated that exclusive nutrition has an equal efficiency to corticosteroids in children contrary in adults [ 34]. To our knowledge, only two studies comparing corticosteroids to exclusive nutrition have been performed by adopting the current Modulen ® formula [ 5, 6]. In the first one [ 5], an exclusive 10-week diet induced clinical remission and the PCDAI reduction was similar to corticosteroid treatment. However, endoscopic and histological healing was achieved at 73% in the polymeric diet group (14/19 children), significantly higher compared to 40% in the corticosteroid group (6/15). In the second one [ 6], PCDAI significantly decreased after eight weeks of polymeric diet compared to corticosteroids, from the second week until the third. In a long-term follow-up on mesalamine maintenance, the remission rate was longer when the induction treatment was performed by the polymeric diet, as more than 80% of individuals were in remission one year after. Another study has compared corticosteroids, cyclosporine A and enteral nutrition (EN) with an elemental diet (Flexical, Mead Johnson) or a polymeric diet (Nestlé) ( Table 1) [ 35]. After 8 weeks of treatments, among the three patients treated with the polymeric diet, two of them had an improved histological inflammation. This outcome was similar to the elemental diet (5/6) and cyclosporine A (6/9), while it did not improve on prednisolone (1/10). However, the number of TNFα secreting cells only decreased on cyclosporine A. Modulen® IBD is a nutritionally complete formula suitable for oral and tube feeding, especially designed for the dietary management of Crohn’s Disease in paediatric (>5years) and adult patients. Svolos V, Hansen R, Nichols B, Quince C, Ijaz UZ, Papadopoulou RT, Edwards CA, Watson D, Alghamdi A, Brejnrod A, Ansalone C, Duncan H, Gervais L, Tayler R, Salmond J, Bolognini D, Klopfleisch R, Gaya DR, Milling S, Russell RK, Gerasimidis K. Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology. 2019 Apr;156(5):1354-1367.e6. doi: 10.1053/j.gastro.2018.12.002. Epub 2018 Dec 11. A short pilot study reported symptomatic improvement through excluding foods with high immunoglobulin (Ig)G4 levels (mostly eggs and beef). 64 Your diet can be helpful in managing your inflammatory bowel disease (IBD) during flares and periods of remission. Your healthcare team, including a registered dietitian specializing in IBD, may recommend a particular diet based on your symptoms.Levine et al., Crohn’s Disease Exclusion Diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology. 2019;157:440-450 Specialized IBD diets are often debated in the medical community because they don’t work in every case and can be restrictive, which may lead to weight loss or malnutrition. The best diet is one that meets your individual nutritional needs and helps you manage your IBD symptoms. CSs may be a kind of treatment selection for patients with UC who have not responded to mesalazine within 2–4 weeks, and those with mild-to-moderate CD, especially with extensive lesions ( 28). CSs have no proven efficacy in maintaining remission in IBD and should not be used for this purpose. Systemic oral CSs may result in numerous side effects, such as opportunistic infections, diabetes mellitus, hypertension, ocular effects, venous thromboembolism (VTE), osteoporosis, etc ( 29, 30). Steroid dependency or excess was found in ~15–40% of IBD patients ( 31, 32). Further investigation should define appropriate corticosteroid use and find measures for the improvement in CSs prescription management. A first study 28 was conducted in adult patients with clinical endoscopic disease (29% steroid-refractory patients, 55% biologic-refractory patients). Patients were randomized to one of three groups:

The effects of nutrition and diet on the host are multiple: food ingredients can directly interact with epithelial cells or under certain conditions with the immune system, as well as indirectly via gut microbiota. Gut microbiota form a complex and dynamic system with a steady state, which can be perturbed by many environmental factors, including diet. A homeostatic balance of the host–bacteria relationship is important and vital for a normal health process. An imbalanced intestinal microbiota termed ‘dysbiosis’ has been repeatedly seen in IBD and is now recognized as a key factor in gut inflammation. 12 Sokol and colleagues 13 showed a significant decrease in the proportion of the Clostridium leptum phylogenetic group in patients with colonic CD. These results were confirmed by a metagenomic approach, revealing a restriction in biodiversity depending on bacteria belonging to the Firmicutes phylum ( C. leptum and Clostridium coccoides) with a decrease in the proportion of bacteria belonging to the C. leptum phylogenetic group. 14, 15 This dysbiosis is characterized by a high instability of the microbiota over time, the presence of approximately 30% of unusual bacteria, a marked increase in mucosal bacterial concentration, and a restriction in biodiversity regarding the Firmicutes phylum. Within this group, a decrease in C. leptum has been shown and particularly its major representative, Faecalibacterium prausnitzii. 12 In another randomized controlled trial 25, 44 adults with mild to moderate CD were treated with CDED. Patients were randomly assigned to CDED plus PEN (20) or CDED alone (24) for 24 weeks. The primary endpoint was clinical remission. The study showed that CDED plus PEN was better tolerated than exclusive enteral nutrition (EEN) in children with mild to moderate CD. The combination of CDED plus PEN induced sustained remission in a significantly higher proportion of patients than EEN and produced changes in the fecal microbiome associated with remission.

Abstract

Patient selection for CDED is important. For complex fistulating disease, EEN would still be the first line, but CDED can be considered if the patient is stable enough without the presence of abscesses, usually after an initial period of EEN. If a patient presents with tight inflammatory strictures or a bowel obstruction, EEN would also be considered as the first line. However, with small adaptions, CDED can still be used once inflammation reduces. Immunomodulators are important for patients with IBD and mainly include thiopurines (TPs), methotrexate (MTX), calcineurin inhibitors, and Janus Kinase (JAK) inhibitors. The studies on the efficacy and safety of immunomodulators in IBD are summarized in Supplementary Table 1. TPs Multiple studies have suggested that IL-12/23 and IL-23 antagonists are potential therapeutic options for IBD treatment. Experts recommended IL-12/23 and IL-23 antagonists as a first- or second-line therapy because of their efficacy in biologic-naïve and experienced patients ( 90). Anti-integrin Therapy

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