Podcasts about extraintestinal

Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Katherine Falloon, MD Extraintestinal manifestations (EIMs) that occur in inflammatory bowel disease (IBD) are almost any manifestation that occur outside the gastrointestinal tract. And patients with Crohn's disease or ulcerative colitis are at an increased risk for developing these manifestations. So to review EIMs in IBD and discuss the importance of a multidisciplinary approach, Dr. Peter Buch is joined by Dr. Katherine Falloon, Gastroenterologist at the Cleveland Clinic.

3.22 Escherichia Coli (E. Coli) Microbiology review for the USMLE Step 1 Exam Esherichia coli (E. coli) is a lactose-fermenting, gram-negative rod causing various diseases, ranging from mild gastroenteritis to septic shock. E. coli diseases can be divided into two categories: intestinal infections and extraintestinal infections (outside the GI system). E. coli is part of the normal flora in the human GI tract, but some strains are pathogenic. Four pathogenic strains of E. coli are Entertoxigenic E. coli (ETEC), Enterohemorrhagic E. coli (EHEC), Enteroinvasive E. coli (EIEC), and Enteropathogenic E. coli (EPEC). ETEC causes watery diarrhea and is commonly found in food and water in areas with inadequate sanitation and is the most important cause of travelers' diarrhea. EHEC, also called Shiga toxin-producing E. coli (STEC), causes bloody diarrhea and is associated with contaminated food (spinach, sprouts, lettuce, fruit, undercooked beef). Shiga toxin produced by EHEC causes cell death in the GI tract and can lead to hemolytic uremic syndrome (HUS) in about 10% of cases. EIEC causes dysentery-like symptoms such as abdominal pain, fever, and bloody diarrhea. EPEC causes diarrhea, malnutrition, and growth retardation, especially in children. Extraintestinal infections include urinary tract infections (UTIs), neonatal sepsis, and pneumonia (incomplete list)  

Histamine is often overlooked as a cause of chronic health problems yet the fix for this issue can be quite straightforward. In this article, I cover the details of histamine and how to follow a low histamine diet. Histamine intolerance (HIT) affects approximately 1% of the population. Approximately 80% of those affected are middle-aged.1 Histamine intolerance occurs when an individual has more histamine in their system than they can breakdown. Excess systemic concentrations of histamine can result from overproduction, overconsumption, and/or having a reduced ability to clear out histamine from the body. For those with HIT, eating a diet that results in increased histamine can contribute to chronic inflammation due to the ongoing exposure to histamine. This excess histamine often accumulates as a result of decreased diamine oxidase (DAO) activity.2, 3 The resulting excess histamine contributes to the physical symptoms associated with HIT. Following a low-histamine diet along with supplemental DAO is often recommended to decrease the symptoms associated with HIT. Eating a low-histamine diet involves more than simply eliminating foods that are high in histamine. This article will help to explain the challenges with following a low histamine diet and will highlight the many ways excess histamine can occur in food and in the body. Histamine Synthesis and Degradation Excess histamine concentrations may be exogenously released from food or endogenously produced. Histamine is synthesized by a variety of cells in the body including mast cells, basophils, platelets, histaminergic neurons, and enterochromaffin cells. Endogenous histamine is released in response to a variety of immune and inflammatory related stimuli as well as certain foods, alcohol, or drugs which can activate release.1 Endogenous histamine supplies are also controlled by genes that code for the enzymes that synthesize and degrade histamine. Genetic polymorphisms in histamine receptors and DAO can decrease the rate of DAO activity, reducing the rate of clearance and increasing systemic histamine concentrations.3 Exogenous sources of histamine mainly comes from ingested foods. Several factors in food processing and storage can increase the histamine content of certain foods as well. Histamine is normally metabolized by amine oxidases in healthy individuals. These amine oxidases include monoamine oxidase (MAO), DAO, and histamine N-methyltransferase (HNMT), with DAO being the primary enzymes for metabolism of histamine.5 It is thought that low gastrointestinal levels of DAO contributes to an individual being unable to break down histamine in the intestines, resulting in the increased sensitivity to histamine found in common foods. As excess levels accumulate, intolerance symptoms develop.1, 2, 6, 7 Symptoms Associated with Histamine Intolerance There is great heterogeneity in the presentation of symptoms in those with HIT, making it difficult to define a clear clinical picture. Histamine intolerance is generally suspected when symptoms appear after the ingestion of histamine containing food.3 Symptoms may develop immediately or can be delayed as much as three hours following ingestion.5 Histamine receptors are found ubiquitously throughout the body, making different organ systems susceptible to adverse reactions due to excess histamine concentrations. This results in a wide variety of symptoms that may be exhibited by an individual, contributing to the difficulty in diagnosis. These symptoms include gastrointestinal issues such as abdominal pain, bloating, diarrhea, and constipation. Extraintestinal complaints may affect neurological, respiratory, dermatological, and/or hemodynamic systems.2 Histamine has vasoactive properties that may result in flushing, headaches, and/or hypertension.5 Other common symptoms related to HIT include brain fog, fatigue, dizziness, itching, and difficulty swallowing, low blood pressure, nasal congestion, sneezing,

In this podcast, expert clinicians review the variety of extraintestinal manifestations seen in patients with IBD, discussing strategies for assessment and management.

Today’s guest is Veronica Blancato. With more than 15 years of fighting Crohn’s Disease, she shares her journey from diagnosis to remission, battling a variety of extra-intestinal manifestations along the way. She shares her experiences with surgery, arthritis, osteochondromas, pancreatitis, fatigue, and more. Veronica’s symptoms began when she was 8 years old, but it wasn’t until she was 15 that she received an official diagnosis of Crohn’s Disease. Growing up with IBD, she faced discrimination from peers and the people around her, which resulted in lost friendships and eventually led her to stop talking about Crohn’s. Throughout the years she tried numerous medications, had part of her intestines removed, and dealt with multiple obstructions. It wasn’t until 2015 that she achieved remission and described it as an intoxicating feeling to finally be well. She shares her many tips and tricks for dealing with symptoms and flares, how her diet evolved from white bread and pasta to nutritious whole foods and enjoying most foods in moderation, and how becoming part of the social media IBD community has both humbled her and made her more aware of the depth and breadth of Crohn’s and Ulcerative Colitis. She talks about the importance of having supportive people in your life when dealing with any chronic illness–especially an invisible one–and how her husband has been a strong and supportive partner. His positivity and desire to learn more and be involved in the management of her Crohn’s has helped to change her own mindset to a more positive one. Despite the many challenges and complications that she has faced with Crohn’s Disease, she continues to learn from others, share her experiences, and–most of all–appreciate life. Follow Veronica:https://www.instagram.com/crohns_queen/

Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital.  In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!). Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Paul Williams MD Edited by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Adam Ehrlich MD Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.   Time Stamps 00:00 Sponsor: MKSAP 18 00:32 Disclaimer, Intro, guest bio 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow 09:25 Sponsor: ACP’s MKSAP 18 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD) Ulcerative Colitis 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis 19:10 Smoking and ulcerative colitis 21:17 Initial workup for suspected IBD; Fecal calprotectin 25:50 A bit more on CRP and IBD 26:55 When to refer for colonoscopy 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC) 30:33 Extraintestinal manifestations of UC 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis 39:50 Treatment of ulcerative colitis 43:02 Some specifics on steroids, plus topical therapies Crohn’s disease 47:05 A case of Crohn’s disease; initial approach and differential diagnosis 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia 53:58 Treatment of Crohn’s disease 58:26 Specifics about biologic therapy for IBD; Endpoints 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine 64:48 Can drug therapy be stopped or tapered in IBD? 66:50 Prognosis in Crohn’s and initial patient counseling Primary Care considerations 68:35 Surveillance endoscopy, 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy? 76:31 Immunizations 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies 82:27 Take home points 86:28 Outro

Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study. Vavricka SR1, Gubler M, Gantenbein C, Spoerri M, Froehlich F, Seibold F, Protic M, Michetti P, Straumann A, Fournier N, Juillerat P, Biedermann L, Zeitz J, Misselwitz B, Scharl M, Heinrich H, Manser CN, Safroneeva E, Raja Ali RA, Rogler G, Schoepfer AM, Greuter T; Swiss IBD Cohort Study Group. BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). ...

Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study. Vavricka SR1, Gubler M, Gantenbein C, Spoerri M, Froehlich F, Seibold F, Protic M, Michetti P, Straumann A, Fournier N, Juillerat P, Biedermann L, Zeitz J, Misselwitz B, Scharl M, Heinrich H, Manser CN, Safroneeva E, Raja Ali RA, Rogler G, Schoepfer AM, Greuter T; Swiss IBD Cohort Study Group. BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). ...

Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study. Vavricka SR1, Gubler M, Gantenbein C, Spoerri M, Froehlich F, Seibold F, Protic M, Michetti P, Straumann A, Fournier N, Juillerat P, Biedermann L, Zeitz J, Misselwitz B, Scharl M, Heinrich H, Manser CN, Safroneeva E, Raja Ali RA, Rogler G, Schoepfer AM, Greuter T; Swiss IBD Cohort Study Group. BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). ...

Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study. Vavricka SR1, Gubler M, Gantenbein C, Spoerri M, Froehlich F, Seibold F, Protic M, Michetti P, Straumann A, Fournier N, Juillerat P, Biedermann L, Zeitz J, Misselwitz B, Scharl M, Heinrich H, Manser CN, Safroneeva E, Raja Ali RA, Rogler G, Schoepfer AM, Greuter T; Swiss IBD Cohort Study Group. BACKGROUND: Extraintestinal manifestations (EIMs) in patients with inflammatory bowel disease (IBD) are frequently observed. Little is known about the efficacy of anti-tumor necrosis factor (TNF) in EIM management. We assessed the effect of 3 anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) on EIM evolution. METHODS: Data on 1249 patients from the Swiss IBD Cohort Study (SIBDCS) were analyzed. All EIMs were diagnosed by relevant specialists. Response was classified into improvement, stable disease, and clinical worsening based on the physician's interpretation. RESULTS: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF. A total of 299 treatments were started for 355 EIMs. Patients with EIM were significantly more often treated with anti-TNF compared with those without EIM (58.2% versus 21.0%, P < 0.001). ...

Host: Caren Heller, MD Guest: Christina Ha, MD, FACG, AGAF Dr. Caren Heller, Chief Scientific Officer at the Crohn’s & Colitis Foundation chats with Dr. Christina Ha, Assistant Clinical Professor of Gastroenterology at the University of California-Los Angeles about what physicians need to know regarding extraintestinal findings in IBD.

Host: Caren Heller, MD Guest: Christina Ha, MD, FACG, AGAF Dr. Caren Heller, Chief Scientific Officer at the Crohn’s & Colitis Foundation chats with Dr. Christina Ha, Assistant Clinical Professor of Gastroenterology at the University of California-Los Angeles about what physicians need to know regarding extraintestinal findings in IBD.

The microbiome of hibernating bears, and zebrafish as a model for bacterial sepsis feature in this animal-centric episode of TWiM hosted by Vincent, Michael, and Michele. Hosts: Vincent Racaniello, Michele Swanson, and Michael Schmidt. Subscribe to TWiM (free) on iTunes, Stitcher, RSS, or by email. You can also listen on your mobile device with the Microbeworld app. Links for this episode Microbiome of hibernating brown bear and energy metabolism (Cell Rep) Ten animals that hibernate (Cons Inst) Zebrafish model of sepsis (mSphere) Image credit Letters read on TWiM 126 This episode is sponsored by ASM Agar Art Contest and ASM Microbe 2016 Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss at microbeworld.org and tag them with twim.  

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli. Links for this Episode: Virus/allergen interactions in asthma (Curr Allerg Asth Rep) Features of rhinovirus C (Microbes Infect) Multidrug resistant ExPec in animals and food (Vet Micro) STS131 an emerging pathogen among veterans (Clin Inf Dis) Send your microbiology questions and comments (email or mp3 file) to twim@twiv.tv, or call them in to 908-312-0760. You can also post articles that you would like us to discuss atmicrobeworld.org and tag them with twim.

Vincent and Michael recorded this episode at the 53rd ICAAC in Denver, where they spoke with James Gern and James Johnson about rhinoviruses and extra-intestinal pathogenic E. coli.

Extraintestinal Features with Eliza Skinner See acast.com/privacy for privacy and opt-out information.

Extraintestinal pathogene Escherichia coli (ExPEC) sind die häufigsten Erreger von Harnwegsinfektionen beim Menschen. Darüber hinaus können sie eine Vielzahl weiterer Erkrankungen wie Pneumonie, Wundinfektion, Neugeborenenmeningitis oder Sepsis hervorrufen. Hierzu verfügen ExPEC über ein breites Repertoire von Pathogenitätsfaktoren wie Adhäsine, Toxine und Eisenaufnahmesysteme. Wesentlicher Bestandteil von Eisenaufnahmesystemen sind Rezeptoren in der bakteriellen Außenmembran, wie z. B. die Siderophorrezeptoren FyuA und IroN sowie der Häminrezeptor ChuA. Ihre Assoziation mit der Virulenz von ExPEC und die Lokalisation in der Außenmembran bzw. an der bakteriellen Oberfläche lassen Eisenaufnahmerezeptoren als geeignete Zielstrukturen eines Impfstoffes gegen ExPEC erscheinen. Die vorliegende Arbeit erbrachte grundlegende Erkenntnisse hinsichtlich der Eignung von Eisenaufnahmerezeptoren als potentielle Zielstrukturen, indem Seren von Patienten mit einer E. coli-Infektion und Seren aus dem Mausinfektionsmodell im Immunoblot auf Antikörper gegen FyuA, ChuA und IroN untersucht wurden. Hierzu wurde eine Sammlung von E. coli-Patientenisolaten und der entsprechenden Patientenseren angelegt. Die Isolate wurden mittels PCR hinsichtlich mehrerer ExPEC-assoziierter Gene, u. a. fyuA, chuA, iroN und usp charakterisiert. Im Immunoblot wurden dann die Seren auf Antikörper gegen die rekombinanten Proteine FyuA, IroN, ChuA und Usp getestet. Im Unterschied zu FyuA, ChuA und IroN handelt es sich bei dem zusätzlich untersuchten Usp um ein ExPEC-Protein mit bisher weitgehend unklarer Funktion. Die unterschiedliche Prävalenz von ExPEC-assoziierten Faktoren unter den Patientenisolaten konnte bestätigt werden. Es gelang erstmals, bei Patienten spezifische Antikörper gegen Eisenaufnahmerezeptoren von ExPEC nachzuweisen. Für die hierzu durchgeführten Immunoblot-Untersuchungen konnte in dieser Arbeit erstmals der Häminrezeptor ChuA rekombinant exprimiert und aufgereinigt werden. Die humorale Immunantwort gegen die einzelnen Eisenaufnahmerezeptoren wies ein relativ heterogenes Bild auf. Während bei den Patienten einerseits Antikörper unter der Infektion gebildet wurden (ChuA), waren sie andererseits bei IroN offenbar schon vorher vorhanden oder konnten, wie für FyuA gezeigt, nicht nachgewiesen werden. Auch im Mausmodell der ExPEC-Peritonitis fanden sich nur Antikörper gegen IroN, die in einem entsprechenden Tiermodell der ExPEC Harnwegsinfektion nicht darstellbar waren. Aufgrund der Ergebnisse dieser Arbeit ist es denkbar, dass die Bildung von Antikörpern gegen ExPEC-Außenmembranproteine zum einen von der Intensität und der Dauer der Infektion und zum anderen von Unterschieden in der Expression und in der Immunogenität der einzelnen Eisenaufnahmerezeptor-Proteine abhängig ist. Es ist jedoch nicht völlig auszuschließen, dass auch methodische Gründe(z. B. bei der Durchführung des Immunoblots) die Antikörpernachweise negativ beeinflusst haben. Die Ergebnisse dieser Arbeit konnten die Bedeutung von Eisenaufnahmerezeptoren als potentielle Zielstrukturen eines Impfstoffes bestätigen. Insbesondere die Rolle von IroN wurde durch die Beobachtungen unterstrichen. Die unterschiedliche Prävalenz der einzelnen Eisenaufnahmesysteme unter ExPEC und die Unterschiede der humoralen Immunantwort deuten jedoch darauf hin, dass es nötig sein wird, einen polyvalenten Kombinationsimpfstoff herzustellen, der gleichzeitig gegen mehrere Eisenaufnahmerezeptoren sowie weitere Zielstrukturen wie Adhäsine und Toxine Antikörperantworten erzeugt