Optimizing Nutrition to Enhance the Treatment of Patients With Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) consists of chronic, relapsing-remitting autoimmune diseases of the gastrointestinal (GI) tract with an increasing global disease burden. Pathogenetic mechanisms are not well understood, but current hypotheses involve the role of environmental factors, including dietary antigens, in immune dysregulation and proinflammatory shifts in microbial composition (gut dysbiosis) in genetically susceptible individuals. Increased metabolic demand and malabsorption secondary to systemic inflammation, coupled with significant GI symptoms that lead to reduced oral food intake, may leave patients with IBD vulnerable to developing malnutrition. The use of diet as therapy for potential induction or maintenance of remission in IBD has risen to prominence in the past several decades, especially as patients explore diet as a means to improve their symptoms and overall quality of life. However, these nutritional therapies remain underutilized by many gastroenterologists, and randomized controlled trials (RCTs) for most popular diets are lacking. Moreover, formal and consistent assessments of the nutritional status of patients with IBD in the inpatient and outpatient settings are often overlooked. To address these gaps, this article aims to discuss the progress of diet therapy and considerations for optimizing nutrition in patients with IBD, as well as summarize current RCTs evaluating efficacy for the most popular diets in IBD therapy.

Recurrent Strongyloides stercoralis infection in an HIV+ patient.

Although infection with Strongyloides stercoralis is often subclinical, some infections persist for decades due to the parasite's autoinfective lifecycle. Hyperinfection syndrome, however, characterized by a massive increase in parasite burden as a result of host immunosuppression causes a myriad of clinical symptoms and is associated with high mortality. Use of corticosteroids and infection with HTLV-1 virus are the biggest traditional risk factors for hyperinfection syndrome, though its development can occur with virtually any degree of immunosuppression. Recurrent hyperinfection syndrome, though rare, has also been demonstrated in persons with ongoing immunosuppression, prompting many experts to recommend continued prophylactic treatment in at risk populations. We present the case of a recurrent S. stercoralis hyperinfection occurring four years after previous treatment with anti-helminthic therapy in a patient with AIDS with intermittent adherence to antiretroviral therapy (ART), highlighting diagnostic and treatment issues in the management of recurrent S. stercoralis infection.