As Easter approaches and kids eagerly wait for candy from the Easter Bunny, parents will be watching to make sure they don’t eat too much at once and get a stomachache. All of us have experienced stomach upset from time-to-time and regardless of what caused it, it was an unpleasant experience. Unfortunately, unpleasant GI experiences occur on a much more frequent basis for individuals with Crohn’s disease or ulcerative colitis.
Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases (IBD) that cause inflammation of the lining of the digestive tract. Resulting inflammation can lead to abdominal pain, severe diarrhea, and even malnutrition. In Crohn’s disease, the inflammation often spreads deep into the layers of the affected tissue and can affect various areas of the digestive tract1. Ulcerative colitis, on the other hand, tends to only affect the colon and rectum2.
While the initial cause of IBD remains unclear, some literature suggests that viral infections are associated with the onset and aggravation of IBD. Of these viral infections, cytomegalovirus (CMV) is of particular interest to the development and worsening of the conditions. Mucosal injury, or damage to the intestinal tract, is also a component of the chronic nature of these diseases3.
IBD, CMV infection, and mucosal injury can all contribute to the symptoms that plague patients3 (Figure 1).
- Patients with IBD are often treated with immunosuppressive medications to reduce symptoms. These patients may also suffer from poor nutrition due to damaged intestinal tissues. The combination of immunosuppressive medications and poor nutrition make it easier for CMV to infect or re-infect a host.
- IBD can also worsen mucosal injury. Inflamed mucosa may play a crucial role in inducing and sustaining CMV reactivation as epithelial cells can serve as permissive hosts for CMV during inflammatory responses. This means they could possibly create a friendly environment for CMV reactivation and replication which in turn enhances the chance of chronic viral infection. This process can result in an increase in CMV infections over time.
- CMV infection may be a result of mucosal injury, but it may also be a cause. Reactivation of or new CMV infection is thought to cause severe colitis, particularly in patients with ulcerative colitis that are treated with immunosuppressive agents.
In addition to the physical symptoms IBD and CMV infection can cause, poor nutrient absorption by the damaged intestinal tract can also lead to malnutrition. This lack of nutrients may mean that the necessary building blocks for neurotransmitters and hormones are insufficient. This deficiency can lead to symptoms like anxiousness, sleep difficulty, or fatigue. Identifying and addressing neurotransmitter and hormonal imbalances with targeted support may help ease a patient’s secondary symptoms.
Guest author: Rachel Rixmann is a manager of the Clinical Support & Education Department at NeuroScience, Inc. and the resident expert in gastroenterology and nutrition.
Cytomegalovirus (CMV)-Specific Perforin and Granzyme B ELISPOT Assays Detect Reactivation of CMV Infection in Inflammatory Bowel Disease. Nowacki, Tobias M et. al. Cells 2012, 1, 35-50; doi:10.3390/cells1020035.