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Microbial transplantation and its effect on the course of ulcerative colitis
Březina, Jan ; Drastich, Pavel (advisor) ; Šťovíček, Jan (referee) ; Janoštiak, Radoslav (referee)
The complex etiopathogenesis of idiopathic inflammatory bowel diseases (IBD) remains unclear, with one of the main suspected causes being the dysregulation of mucosal immunity in response to specific components of the gut microbiome. This dissertation investigates the potential of faecal microbiota transplantation (FMT) as an innovative therapeutic intervention aimed at modifying the microbiome and influencing the course of IBD. FMT, involving the transfer of stool from a healthy donor to the patient, has proven highly effective in the treatment of recurrent Clostridioides difficile colitis, where it is already considered a standard therapeutic procedure. However, in relation to IBD, FMT remains an experimental method, predominantly used in clinical studies. Current systematic reviews indicate that the effect of FMT on ulcerative colitis (UC) is variable, both in terms of achieving remission and clinical response. Recent randomized controlled trials for UC, in accordance with our presented data, show a mild to moderate effect of FMT in this indication. The effectiveness of FMT is influenced by a range of factors, particularly the correct selection of donor or donors, the diversity of their microbiome, methods of application, and frequency of administration. In the case of Crohn's disease, the data...
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Dietary habits in inflammatory bowel disease
NÝVLTOVÁ, Natálie
This paper deals with the dietary habits of patients with inflammatory bowel disease. In the theoretical part, the anatomy of the digestive tract is described, then, for example, the epidemiology, clinical picture and therapeutic options for IBD. The first aim of the thesis was to describe the dietary habits of patients with idiopathic intestinal inflammation in the period of relapse and remission, as well as how the patients were educated about nutritional measures and in this way highlight the role of the dietitian. The second aim was to focus on the food choices of the low residue diet (Doberský, 1983) and the CDED diet, then to make comparisons for foods that might appear problematic from the CDED diet choices relative to the low residue diet of Doberský, (1983). Eight respondents diagnosed with IBD participated in the study. Data collection was conducted using a qualitative method with semi-structured interviews, and was subsequently compiled into individual case studies. A table of these selected foods was then evaluated. Finally, the menus sent by the respondents were evaluated using Nutriservis Professional software. Data analysis showed that in 7 of the 8 cases, the dietitian was not independently involved in patient education. Furthermore, in cases where adequate education was not provided, respondents tended to gravitate towards unnecessary dietary restrictions. The eating habits of the respondents during relapse and remission were highly individual. In the part of the paper where the food list was analysed, some respondents tolerated selected foods in relapse and remission, although none of them had an indicated CDED diet or were taking Modulen. This work may serve the patients with IBS themselves to better understand the nutritional issues in UC or CD. Also to students or the general public.
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Mechanisms of immune dysregulation leading to inflammatory bowel disease
Horáčková, Klára ; Froňková, Eva (advisor) ; Filipp, Dominik (referee)
Bc. Klára Horáčková DIPLOMA THESIS Mechanisms of immune dysregulation leading to inflammatory bowel disease Abstract Inflammatory bowel disease (IBD) is a complex disorder characterized by chronic inflammation of the gastrointestinal tract. Classical IBD is a multifactorial disease with adulthood or later-childhood onset. However, children with very early onset IBD (VEO-IBD, before 6 years of age) are a specific cohort, whose pathology can be caused by severe genetic defects in genes connected to immune homeostasis in the gut. We aimed to identify the causal genetic variants in 20 pediatric patients diagnosed with IBD (age of onset from 3 to 154 months) using whole exome sequencing (WES). We evaluated several bioinformatical approaches for WES data analysis. This included a comparison of two methods of variant identification using VarScan2 or GATK4-based tools. Furthermore, we compared 4 gene lists ("virtual panels") for variant filtering, one of which was compiled purposefully for this thesis. We identified and validated via segregation analysis 5 causal variants in 4 genes (DUOX2 compound heterozygote, FOXP3, NLRP3 and NOD2) accounting for 20 % of the cohort. NOD2 (p.A755V) variant has already been reported in IBD cases, while DUOX2 (p.R1216W + p.A1131T), FOXP3 (p.H400L) and NLRP3 (p.V200M) were newly...
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Nutrition care in the treatment of pediatric patients with Crohn's disease
ČADOVÁ, Andrea
This bachelor thesis deals with the nutrition care of pediatric patients with Crohn's disease. The main goal is to find out whether the patients' parents and the patients themselves are sufficiently informed about nutrition and if Crohn's disease had impact on the eating habits of the children. The theoretical part is focused on the current epidemiology, etiopathogenesis, clinical presentation, diagnostic procedure and treatment options. It is also focused mainly on clinical nutrition and dietary measures. For this research, I chose a qualitative approach, which was attended by ten children respondents and ten mothers. The practical part is divided into three subchapters. The first of them is devoted to case reports with basic information about patients obtained from personal and nutritional anamnesis. The second part evaluates the answers of the mothers of the respondents and the respondents themselves to the questions asked during the semi-structured interviews. The last part is devoted to the evaluation of eight week-long menus and two 24-hour calls. This research has shown that parents and pediatric patients are well informed about the diet of Crohn's disease but some of them think that not all the questions they had were answered. Then they can search answers for their unanswered questions on non-professional websites. For most respondents, Crohn's disease did not have a particularly significant impact on their eating habits. Reduction of the number of fried meals and fast food was the most common change in the patients' lives.
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Management of multidisciplinary care in patients with inflammatory bowel disease.
KALMÁROVÁ, Diana
The diploma thesis deals with the management of multidisciplinary care for patients with inflammatory bowel diseases and is divided into a theoretical and a practical part. The theoretical part focuses on inflammatory bowel diseases, their characteristics, etiology and pathogenesis, diagnosis, treatment and psychosocial side of the disease. Another part of the theoretical part is the characteristics of management in nursing, nursing managers, the nursing profession itself, the multidisciplinary team in health care, the issue of competencies and the need for a multidisciplinary approach in the case of inflammatory bowel disease. The first aim of the thesis was to map the role of individual medical and non-medical staff involved in the care of patients with inflammatory bowel diseases, the second goal to find out how cooperation among these workers work and the third objective to identify dispensaries in patients with IBD outside hospital care. For the empirical part of the diploma thesis, a qualitative research survey was chosen, and semi-structured interviews were used as the method of data collection. Five variants of interviews were created, for nurses, doctors, nutrition therapists, psychologists and patients diagnosed with inflammatory bowel diseases. The research was conducted at the Clinical and Research Centre ISCARE in Prague and at the General University Hospital in Prague with the prior consent of the management of these facilities, except for patients who were contacted through patient groups and a psychologist who worked in his private outpatient facility. Based on interviews with nurses, doctors and a nutritional therapist, we were able to find out that as far as IBD centres are concerned, care is really interconnected and individual experts work as a multidisciplinary team led by doctors of various specialties, nurses, ostomy nurse, nutritional therapist. and a social worker. An exception is the representation of a psychologist, who unfortunately is not part of the team and there may be a problem with his / her availability, which was pointed out by some of the interviewees in the interviews. From the results of the research survey, we also managed to find out that patients have various options for better management of the disease, which are most often recommended to them by their attending physicians, but also by nurses. Nurses working in IBD centres are well versed in this issue and know the supportive options for patients with IBD. However, a problem in cooperation was found and appeared on the part of nurses, who in some cases take a passive attitude to education from an ostomy nurse, who is also an important member of a multidisciplinary team. Furthermore, based on research, we found that patients with IBD are often anxious and may have trouble trusting the nursing staff, so the main task of the nurse caring for such patients is to be more aware of these diseases, to know the supportive options, and to be able to educate clients. Respecting and understanding cooperation with other professionals are is important.
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Fungal Microbiota and Inflammatory Bowel Disease
Vančíková, Sabína ; Kostovčíková, Klára (advisor) ; Dobeš, Jan (referee)
Inflammatory bowel disease (IBD) is a term for the gastrointestinal tract's chronic inflammatory disorders, evincing growing worldwide prevalence. Commonly, IBD is divided into two major subgroups, Crohn's disease (CD) and ulcerative colitis (UC). Despite intensive efforts, IBD etiology and development mechanisms are not fully understood. Gut barrier dysfunction, dysbiosis, and overreactive immune response to gut microbiota appear to have a significant impact. While bacteria are the most studied gut inhabitants, research on the role of fungal microbiota (mycobiota) in IBD lags behind. This diploma thesis aimed to study immune responses to gut mycobiota in IBD. Levels of antifungal antibodies against gut residents and biomarkers relevant to gut barrier damage and microbial translocation were measured in the sera of IBD patients and healthy individuals. Sera of individuals diagnosed with UC, CD, and IBD associated with primary sclerosing cholangitis (PSC-IBD) were used. Since continuous intestinal macrophage activation is a feature of IBD, the effect of selected fungal mycobiota species on the reactivity of peripheral blood-derived macrophages from healthy donors was assessed in vitro. The levels of serum antibodies against mycobiota components were higher in IBD patients than in controls, and the...
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Bilirubin influence on the progression of inflammatory bowel disease.
Patková, Anna ; Nachtigal, Petr (advisor) ; Hronek, Miloslav (referee)
Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Bilirubin influence on the progression of inflammatory bowel disease Diploma thesis Anna Patková Supervisor: doc. PharmDr. Petr Nachtigal, Ph.D. Background: Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are chronic inflammatory disorders of the gut caused by an interaction of genetic and environmental factors. It is thought that tissue damage is also partly caused by an oxidative stress. Heme oxygenase-1 and bilirubin are strong antioxidants and both of them provide an anti-inflammatory effect in various tissues. The aim of this diploma thesis was to detect changes of expression of HO-I in the large intestine of normobilirubinemic and hyperbilirubinemic rats after the induction of acute or chronic experimental colitis. Methods: We used Gunn rats with hereditary defect of UDP-glucuronyltransferase, which causes hyperbilirubinemia. The control group of animals was made up of heterozygous littermates of the Gunn rats, which have normal serum bilirubin levels. All animals were treated by dextran sulfate sodium in order to induce an experimental colitis. Rats were divided into two groups. Each of them contained hyperbilirubinemic and normobilirubinemic...
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Role of bacteria and mucosal immune system and their interaction in the pathogenesis of inflammatory bowel disease
Du, Zhengyu ; Hudcovic, Tomáš (advisor) ; Prokešová, Ludmila (referee) ; Kamanová, Jana (referee)
Although the etiology and pathogenesis of inflammatory bowel disease (IBD) is not fully understood, it is generally accepted that the inflammation results from aberrant immune responses to antigens of gut microbiota in genetically susceptible individuals (Sartor et al., 2006). Alteration in intestinal microbiota has been found in IBD patients with increased abundance of certain bacteria and decreased abundance of others. Due to the complexity of the disease, multifaceted interactions between genetic factors, host immune response, gut microbiota and environment factors need to be taken into account. In this thesis, the pathogenesis of IBD was first reviewed in respect with the four factors mentioned above. Then we concentrated on the interaction between IBD-associated bacteria and mucosal immune system. We investigated the ability of mucosal-associated bacteria (MAB) from IBD patients to induce spontaneous colitis in germ-free (GF) mice and the impact of those bacteria on the development of dextran sulfate sodium (DSS)-colitis. Together with the analysis of the composition of gut microbiota of MAB colonized mice, we demonstrated the potential deleterious microbes were able to increase the susceptibility to DSS-colitis once they found a suitable niche. We revealed the mechanism of an E.coli strain...
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Risk factors of manifestation and course of treatment of inflammatory bowel disease in children
Lerchová, Tereza ; Hradský, Ondřej (advisor) ; Ďuricová, Dana (referee) ; Havličeková, Zuzana (referee)
Risk factors of manifestation and course of treatment of inflammatory bowel disease in children Typical Crohn's disease (CD), Crohn's colitis, typical and atypical ulcerative colitis (UC) are currently perceived as different forms of inflammatory bowel disease (IBD). The incidence of IBD is increasing worldwide in both the adult and paediatric populations. Although the role of genetic background and environmental factors in the development of these diseases is known to some extent, the exact cause of IBD has still not been determined. Comprehensive care requires a precise and data-driven approach to minimize the risk of complicated disease course and the development of disease-related and/or treatment-associated complications. The main goal of this work is to identify new predictive factors affecting individual areas of care of paediatric patients with IBD. The range of clinical situations addressed in this work includes the possibility of predicting the diagnosis, the generally complicated disease course, the response to a particular therapeutic regimen, the development of side effects associated with the therapeutic procedure and the patient's adherence to the treatment. Part of the original works was done in a retrospective design, part as prospective observational studies and two of the original works...
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