Mitigating Factors in Inflammatory Bowel Disease Impacting Symptomatology And Quality Of Life

This thesis describes and evaluates the current means of measuring disease activity in patients diagnosed with inflammatory bowel disease (IBD) and targets of treatment. Also discussed are the limitations of these current approaches and the exploratory avenues such as intestinal barrier function biomarkers, functional peptides, and dietary interventions, which may offer both further understanding of IBD symptoms and potentially new targets in general gastrointestinal well-being. Enzyme-linked immunosorbent assays of serum zonulin and intestinal fatty acid binding protein (IFABP) were performed in a cohort of IBD patients (both with active and inactive disease) and healthy controls to assess their suitability as non-invasive biomarkers of intestinal barrier function. Impact of IBD on quality of life (QoL) and well-being was evaluated in a cohort of UC patients in remission by use of QoL questionnaires, hand grip strength (HGS), and nutritional intake assessment. Effects of UL-2-132, a protein food supplement, on intestinal microbial diversity and QoL in patients with dysbiosis were studied in an IBD cohort. Pertinent findings include the following: • No significant difference was found in either serum zonulin or IFABP levels according to disease activity, as measured by Mayo Endoscopic Score, or biochemical markers.• Prevalence of fatigue in a population of UC patients was 43.3% and ’Energy/Fatigue’ scores were significantly lower when compared to normal Irish population data despite disease remission. • A high prevalence of impaired muscle function measured by HGS despite disease remission, with significant correlation demonstrated between predicted HGS and ’Energy/Fatigue’ 36-item Short Form scores (standardised β-coefficient = 0.397, p = 0.030). • Effects of UL-2-132 on intestinal microbial diversity and quality of life in patients with dysbiosis in an inflammatory bowel disease cohort did not meet primary of secondary outcomes of the pilot study. While HGS is a recognised clinical tool in geriatric populations, it remains underutilised in IBD cohorts. This thesis can conclude HGS be to a convenient means of measuring muscle function in an IBD population at risk of sarcopenia which also correlates significantly with ’Energy/fatigue’ 36-item Short Form scores. These results suggest HGS as an objective easily applied measure which merits validation as a potential outcome measure for intervention studies to improve fatigue and improve quality of life in patients with IBD .