Introduction

Colitis is inflammation of the colon and is not a disease itself but rather a complication of several factors acting independently or in relation. It may be acute or chronic, the signs and symptoms vary and are dependent on given cause and factors that modify its severity. Signs and symptoms include, mild to severe abdominal pain, recurring bloody diarrhea, feacal incontinence, fatigue, loss of appetite and unexplained weight loss. There are many types of colitis and they are usually classified by the cause. These include immune related; inflammatory bowel disease (IBD), ulcerative colitis (UC) and crohns disease (CD); Idiopathic colitis which is normally diagnosed by microscopy and includes; microscopic colitis, lympocytic and collagenous colitis; latrogenic which includes; diversion and chemical colitis. Finally, ischaemic colitis and infectious colitis. Irritable Bowel syndrome (IBS) is a gastrointestinal disorder that is characterized by frequent abdominal pain, bloating and defecation disorder (Thompson and  Longstreth 1999). The causes are still being studied, but increase in pain sensitivity and altered small bowel and colon motility have been identified as the main factors contributing to the signs and symptoms (Drossman and Camilleri  2002). There is a lack of laboratory based diagnosis, therefore clinical presentation is mainly used as a diagnostic tool, this includes but is not limited to frequent abdominal pain for at least three days a month in the previous three months in combination with two or more of the following symptoms; improvement with defecation, change in stool frequency, and change in stool form (Longstreth and Thompson 2006). Global estimates of prevalence of IBS vary from 5% to 15% for men and women (Chang  2002). Prevalence for women is 14.0% and with 8.9% in men (Lovell 2009). The prevalence of IBS decreases with increasing age, and thus new onset of symptomac patients after 50 years  of age is uncommon (Lovell 2009). Severe cases can lead to limitations in work, school, social situations and difficulty in leaving home.

Crohn’s disease (CD) is an IBD that can affect any part of the gastrointestinal tract from the mouth down to the anus (Baumgart 2012). Clinical presentation of Crohn’s disease includes abdominal pain, diarrhoea, and fever and weight loss. Other complications of the disease include anaemia, skin rashes arthritis and tiredness.  The disease is caused by a combination of environmental, immune and bacterial factors in genetically susceptible individuals and mutation in 70 genes contribute to the risk factor (Barrett and Hansoul 2008). Crohn’s disease is classified as an immune related disease not an autoimmune disease. The assessment of generic and immune system data indicate a malfunction in the innate immune system, which the adaptive immune system tries to compensate for causing chronic inflammation. Failure of the immune system to produce adequate inflammatory mediator results in insufficient activation of neutrophils which leads to inadequate clearing of bacteria and foreign debris. Those remaining bacteria and foreign debris within the bowel are taken up by the macrophages, which results in granulomatous inflammation which is a characteristic of CD.  In some cases, this malfunction is compensated by signalling through NOD2 as demonstrated in figure 1 below (Marks 2008). A significant proportion of risk (50%) has been related to genetics. Tobacco smokers are at an increased risk by 2-fold ( Cosnes 2004). Crohns disease affects about 3.2 per 1,000 people in Europe and north America (Molodecky et al 2012). Since 1970, emerging cases have been noted in the developing world. It resulted in 35,000 deaths globally in 2010 and diagnosed patients have slightly reduced life expectancy (Ozano and Naghavi 2012). There are three main classifications of the disease based on the area it emerged from, IIeocolic Crohns account for fifty percent of the cases, Crohns illetis accounts for thirty percent ,while Crohns colitis of the large intestine accounts for the remaining twenty percent (Tan and Allan 1993).

Fig. 1: Malfunction in the innate immune system in Chron’s Disease (Marks 2008).

There are two types of available treatment for IBS, colitis and Crohn’s disease; A pharmacological treatment approach and naturotropathic treatment approach. This research will focus on the naturopathic treatment approach. The pharmacological treatment approach uses conventional drugs in the treatment of these conditions. However, this is an expensive approach and is not readily available to people in rural areas lacking modern medicine. Naturopathic medicine is a distinct primary healthcare profession that uses therapeutic methods that encourages inherent self-healing process of the body. It commonly employs multi-modal interventions, i.e. nutrition and lifestyle change recommendations plus dietary supplements. This is cheaper and is more readily available. Several non-pharmacological therapies exist for IBS (Ringstrom , Storsrud and Posserud 2010), which include; patient education which can be geared towards explaining what IBS means, that it does not suggest an underlying disease; lifestyle changes that may attenuate the symptoms, information on foods that may elevate the symptoms (Saito et al 2004). Stress management in identifying stressors and coping mechanisms to deal with them (Bengtsson , Ulander and Börgdal 2006). A small but compelling volume of evidence exists for example a meta-analysis by Bradley et al (2015) showed naturopathic medicine is associated with improved health outcomes and quality of life in patients with or at risk of a IBD by reducing the prevalence of metabolic syndrome, blood pressure, improvement in anxiety,  and reduced pain severity (Bradley et al. 2015).

Aim

The aim of this research project is to investigate the current naturopathic methods used for treatment of IBS, colitis and CD. The efficacy of these treatment methods will be compared with that of the conventional pharmacological treatment options. Evidence will be given to show success rate of treatment methods and the advantages and disadvantages of the two types of treatment approach will be discussed and conclusions will be drawn from evidence presented on both forms of treatment approach.

Methods

This is a literature based research. Only peer reviewed papers were used in

this project. Majority of them were obtained online while some others were

gotten from the university library. Some of the key search words and phrases

used in accessing the journal articles used in this project include; nicotine

addiction, mechanism of nicotine addiction, eect of nicotine on the brain,

brain of a nicotine addict vs healthy brain, etc. Google was my main search

engine. A comprehensive research diary detailing every action and decisions

I made towards this research project was kept and will be submitted at the

end of this research project for marking.

This is a literature based research. Only peer reviewed papers were used in

this project. Majority of them were obtained online while some others were

gotten from the university library. Some of the key search words and phrases

used in accessing the journal articles used in this project include; nicotine

addiction, mechanism of nicotine addiction, eect of nicotine on the brain,

brain of a nicotine addict vs healthy brain, etc. Google was my main search

engine. A comprehensive research diary detailing every action and decisions

I made towards this research project was kept and will be submitted at the

end of this research project for marking.

This is a literature based research. Only peer reviewed papers were used in

this project. Majority of them were obtained online while some others were

gotten from the university library. Some of the key search words and phrases

used in accessing the journal articles used in this project include; nicotine

addiction, mechanism of nicotine addiction, eect of nicotine on the brain,

brain of a nicotine addict vs healthy brain, etc. Google was my main search

engine. A comprehensive research diary detailing every action and decisions

I made towards this research project was kept and will be submitted at the

end of this research project for marking.

This research project will be a literature based systematic review, hence only information from peer reviewed journals will be used. These journal articles were accessed mainly online and others were obtained from the university library. To source these research journal articles, key words were used for search engine optimization of results. Some of the main key words and phrases used were; IBS, colitis, Crohn’s disease, treatment of IBS, Colitis and Crohn’s disease, pharmacological treatment of colitis, naturopathic treatment of CD, IBS, IBD. Google scholar was my search engine and some of the sites I visited for this research journal articles included; research gate, New England journal of medicine site, Elsevier site etc. A complete research diary of the various steps and research performed during the research project will be produced.

Literature Review

This segment of this research proposal focuses on some of the pharmacological and naturopathic treatment methods used for IBS, Colitis and Crohn’s disease and will compare and contrast these treatment methods using data and evidence from published works. Some of the current pharmacological treatment strategies for IBS, colitis and Crohn’s disease includes the use of; methotrexate, infliximab and cyclosporine. Also another pharmacological approach involves the use of humanised monoclonal antibody anti–interleukin-12. The commonly used naturopathic treatment methods includes; herbal treatment with peppermint, ginger, cinnamon, pomegranate, flax weed etc. Also acupuncture and dietary fibre are other commonly used naturopathic treatment methods used for IBS, Colitis and Crohn’s disease.

Various research studies have been carried out into understanding and discovery of a better approach in treating IBS, Colitis and Crohn’s disease. Table 1 below summarizes some of the research articles, their authors, research focus, brief methods, results and authors of some of these journals that will be referred to throughout the project report.

RESEARCH FOCUS	METHODS	RESULTS	AUTHORS	WHY I CHOOSE THIS JOURNAL
Methotrexate for the treatment of Crohn’s disease.	A total of 141 patients who had chronically active Crohn’s disease were randomly assigned in a 2:1 ratio to methotrexate in a double-blind, placebo controlled multicenter study of weekly injections of methotrexate.	After 16 weeks, 37 patients (39.4%) were in clinical remission in the methotrexate group, as compared with 9 patients (19.1%) in the placebo group (P _0.025; relative risk, 1.95; 95 percent confidence interval, 1.09 to 3.48).	Feagan et al., 1995.	Focuses on the efficacy of methotrexate as a pharmacological treatment approach for Crohn’s disease. Was able to show that methotrexate was more effective than placebo in improving symptoms
Infliximab for Induction and Maintenance Therapy for Ulcerative Colitis	Two randomized (ACT 1 and ACT 2), double-blind, placebo-controlled studies involving 364 patients with moderate-to-severe active ulcerative colitis. They were placed on placebo or infliximab (5 mg or 10 mg per kilogram of body weight) intravenously at weeks 0, 2, 6 and then every 8 weeks through week 46	In first study (ACT 1) 69% of patients ON 5 mg of infliximab & 61% of on 10 mg had a clinical response at week 8, compared to 37% of patients on placebo. The second study (ACT 2), 64% of patients on 5 mg of infliximab & 69% of those on 10 mg had a clinical response at week 8, compared with 29% of those on placebo.	Rutgeerts et al., 2005.	This research was focused on evaluating  the efficacy of infliximab For induction and maintenance therapy in adults with ulcerative colitis.
Anti–Interleukin-12 Antibody for Active Crohn’s Disease	This is a double-blind involving 79 patients with active Crohn’s Disease. Patients were randomly assigned to receive seven weekly subcutaneous injections of 1 mg or 3 mg of anti–interleukin-12 per kilogram of body weight or placebo.	After seven weeks of uninterrupted treatment with 3 mg of anti–interleukin-12 per kilogram higher response rates was observed for anti–interleukin-12 (75%) than placebo administration (25%) P=0.03).	Mannon et al., 2009.	This study evaluated the safety and efficacy of a human monoclonal antibody against interleukin-12 (anti–interleukin-12) in patients with active Crohn’s Disease.
Treatment of IBS using a selected herbal Combination medicines	An eight week randomised clinical study on 40 patients of both who had been diagnosed with IBS for 5–10 years. The patients were allocated to either of two groups, each consisting of 20 patients. Group A was treated with mebeverine (an antispasmodic drug for IBS), and Group B was treated with a capsule containing a combination of three herbs (mint, ginger and nut grass) prepared as fine powders	The mean of the total improvement percentage in patients treated with mebeverine (group A) was 66.88%. The mean total improvement percentage 3.12% lower than the 70% mean total improvement that was observed in patients treated with the herbal combination (group B). This difference is not statistically significant	Salih A. (2013).	This study investigated the effectiveness of a combination of three herbal agents (mint, ginger and nut grass) that are widely used in treating IBS

Despite the limited data on effectiveness of naturopathic medicine (NM), there are studies that suggest with NM there is reduction in societal cost for management of the disease, which is paramount because healthcare resources are increasingly consumed in management of chronic conditions. The financial edge (cheap cost), easy access to naturopathic treatment approach as well as the side effects that are associated with the pharmacological treatment approach that are used, and the lack of a cure for this disorder, has resulted in making  about 50% global IBS patients to resort to naturopathic treatment approach (Hussain and Quigley, 2006).

Conclusion…?

References

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Baumgart DC, S.W.S. (2012)., 2012. Crohn’s disease. The Lancet, 380(9853), pp.1590–605.

Bengtsson M, Ulander K, Börgdal EB,  et al., 2006. A course of instruction for women with irritable bowel syndrome. Patient Educ Cons, 62, pp.118– 25.

Bradley, R. et al., 2015. Estimated Effects of Whole-system Naturopathic Medicine in Select Chronic Disease Conditions : A Systematic Review Alternative & Integrative Medicine Estimated Effects of Whole-system Naturopathic Medicine in Select Chronic Disease Conditions : A Systematic Review. , (April 2016).

Chang L, H.M., 2002. Gender differences in irritable bowel syndrome. Gastroenterology, 123, pp.1686–701.

Cosnes J., 2004. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice”. Best Practice & Research Clinical. Gastroenterology, 18 .(3), pp.481–96.

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Ozano, R; Naghavi, M., 2012. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010″. Lancet, 380(9859), pp.2095–128.

Ringstrom G, Storsrud S, Posserud I,  et al., 2010. Structured patient education is superior to written information in the management of patients with irritable bowel syndrome: a randomized controlled study. 2010; Eur J Gastrenterol Hepatol, 22, pp.420–8.

Rutgeerts P., Sandborn W.J., Feagan, B.G., Reinisch, W., Olson A., Johanns J., Travers S., Rachmilewitz D., (2005). Infliximab for Induction and Maintenance Therapy for Ulcerative Colitis. The New England Journal of Medicine. 353 (23), 2462-2476.

Saito YA, Prather CM, Van Dyke CT, 2004. et al. Effects of multidisciplinary education on outcomes in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol, 2, pp.576–84.

Salih A. (2013). Treatment of Irritable Bowel Syndrome Using A Selected Herbal Combination Of Iraqi Folk Medicines. Journal of Ethnopharmacology. 148, 1008–1012.

Tan, WC.; Allan, R., 1993. Diffuse jejunoileitis of Crohn’s disease. Gut, 34(10), pp.1374–8.

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