IBD

Hyperbaric Oxygen Therapy for Ulcerative Colitis

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This article is part of the IBD Index. Last updated on March 14, 2022.

I initially focused on either UC-specific or general IBD evidence, but hope to eventually update this post to include Crohn’s-specific evidence as well.

What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at greater than atmospheric pressure for a period of time, usually between 30-120 min. This is done either in a single-person pressurized chamber, or in a multi-person room where oxygen is delivered via hoods or masks. Treatments can take place in hospitals or outpatient clinics, or at home with soft hyperbaric oxygen chambers (although the efficacy of soft chambers is debated).

HBOT is most commonly used for refractory wound healing in situations like advanced diabetes, severe burns, and skin grafts, but it’s being investigated for therapeutic potential in a number of different conditions (including IBD!). Few clinical trials have been conducted so far, but the ones that have (plus the documented case studies) are extremely promising (see references below).

[Read more…]

Small Intestinal Bacterial Overgrowth (SIBO) and IBD

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This article is part of the IBD Index. Last updated on March 14, 2022.

Small intestinal bacterial overgrowth, or SIBO, is one area of research in the field of intestinal health that has gone from relative obscurity to almost totally mainstream just in the past decade. As research has progressed, the name “overgrowth” has become a bit of a misnomer, with recent evidence indicating that the issue isn’t bacterial overgrowth per se, but rather bacterial dysbiosis in the small intestine.

In any case, SIBO is often identified in patients with IBD*, and can both affect and be affected by other IBD-related disease processes. Therefore, the question of whether and how to treat it is highly relevant. While treatment of SIBO is certainly a lever one can pull that may affect symptoms and overall disease state, SIBO is also often a symptom of other dysfuctions and environmental factors, such that addressing those other factors could resolve the SIBO without explicit treatment. And because testing for and treating SIBO is often quite complicated, it’s best to take it in context and consider whether there are other “no-brainer” levers that could be pulled first.

[Read more…]

Vagus Nerve Stimulation for IBD

Alyssa Luck · Jan 27, 2022 · Leave a Comment

Summary: Vagus nerve stimulation is an up-and-coming intervention for chronic inflammatory disorders including IBD. Clinically, it involves electrical stimulation of the vagus nerve through implanted or external devices, but natural methods such as yoga, meditation, and specific breathing practices have also been shown to increase vagal tone. Research in both animals and humans indicates that stimulation of the vagus nerve is able to reduce inflammation via various neural and hormonal pathways, with similar targets to popular pharmacological IBD treatments. Clinically, this is an exciting new treatment that is actively being researched; practically, vagus nerve stimulation via natural methods provides a safe way to reduce inflammation and improve health.

This article is part of the IBD Index. Last updated on January 27, 2022.

Vagus nerve stimulation is an ongoing area of research and experimentation for me. If you want to follow along on my personal journey, follow me on Instagram! Eventually, I will update and expand this post as well.

Table of Contents
What is vagus nerve stimulation?
What is the vagus nerve?
What’s the science behind vagus nerve stimulation for IBD?
        Activation of the HPA axis
        Cholinergic anti-inflammatory pathway
        Activation of sympathetic anti-inflammatory pathways
Is there clinical evidence for vagus nerve stimulation in IBD?
Are there any risks to vagus nerve stimulation?
How can I increase vagal tone at home?
        Mind-body disciplines: yoga, tai chi, qigong, meditation
        Left-nostril breathing
        Other possible interventions
Review of the literature
Technical details of clinical vagus nerve stimulation

What is Vagus Nerve Stimulation?

In the clinical research setting, vagus nerve stimulation (VNS) refers to stimulation of the vagus nerve via electrical impulses. This can be done either invasively, via a surgical implant, or noninvasively, via electrodes stuck to the skin in the ear. (For technical details, check out this section at the bottom of this article.)

VNS has been approved by the FDA for the treatment of drug‐resistant epilepsy and depression, and interest is building for its application in the treatment of chronic inflammatory disorders such as rheumatoid arthritis (and of course, IBD). VNS is not yet available as a clinical treatment for IBD, but two small trials have been conducted in patients with Crohn’s Disease (CD), and two more trials are underway.

Outside of clinical research, talk of stimulating the vagus nerve typically refers to at-home practices that naturally stimulate the vagus nerve, including things like deep breathing and meditation. More on these techniques below!

[Read more…]

Akkermansia Muciniphila: Bane or Boon for IBD?

Alyssa Luck · Mar 21, 2021 · Leave a Comment

Summary: Akkermansia muciniphila is a commensal bacteria found in healthy human colons that is widely regarded as a promising next-generation probiotic. Researchers have mainly focused on therapeutic potential for obesity and diabetes, but there’s also substantial interest in the field of IBD, particularly for its beneficial effects on gut barrier function. However, a minority of researchers have suggested that Akkermansia muciniphila could worsen colitis. Despite that, most of the evidence thus far suggests that A. muciniphila could potentially be leveraged as a beneficial therapy for IBD and gut health in general once more research has been done.

This post is part of the IBD Index.

Lactobacillus and Bifidobacteria species may still be the darlings of the probiotic world, but there’s a new kid on the block: Akkermansia muciniphila.

This bacteria was isolated for the first time in 2004 (1) so it’s still relatively new to the game, but you can see from this fun trend analysis (2) that research has exploded, especially in the last couple years.

Source: Hojat et al., Global scientific output trend for *Akkermansia muciniphila* research: a bibliometric and scientometric analysis, 2020

So what is Akkermansia muciniphila, and why the interest all of a sudden?

[Read more…]

Mouse Models of Ulcerative Colitis: What Can They Really Tell Us?

Alyssa Luck · Mar 21, 2021 · Leave a Comment

Summary: Animal models of colitis are invaluable to ulcerative colitis (and more broadly, IBD) research, both in helping to elucidate potential disease mechanisms and in the process of testing and approving new therapies. A huge variety of mouse models of colitis have been developed, but they can be grouped into just a few categories based on the mechanism of disease induction, and a small handful of models are the most widely used by far.

Despite the importance of these models, no animal model yet exists that is an accurate mimic of human ulcerative colitis, and therefore each particular model and its limitations must be taken into account both when deciding which model to use and when drawing conclusions based on the findings.

This article is linked in the IBD Index as a special topic. Last updated on April 20, 2022.

Much of what we know about the etiology of ulcerative colitis (UC) comes from animal research, and we owe all of our current UC therapies to the intensive drug-approval process that begins with preclinical animal studies.

Models of colitis have been developed for many different lab animals from fruit flies (really) to pigs, but since mouse models are by far the most common, we’ll focus on those.

A semantic note: If you read any UC research in mice, you’ll notice that the term “ulcerative colitis” isn’t used to describe what’s happening in the mice; the more general term “colitis” is used instead. That’s because while the mice are exhibiting inflammation of the colon (ie, colitis), it’s not accurate to liken it to human ulcerative colitis. So yes, the title of this article is a bit of a misnomer. More on this below.

[Read more…]