Role of Holistic Disease Management in Gastro-Intestinal Disease

0Running head: GASTRO-INTESTINAL DISEASE
Role of Holistic Disease Management in Gastro-Intestinal Disease
Name of the Student
Name of University
Author’s note

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Table of Contents
Part 1................................................................................................................................................2
Review of Literature....................................................................................................................2
Introduction..............................................................................................................................2
Rationale of the study..............................................................................................................3
Methodology............................................................................................................................4
Literature Review....................................................................................................................6
Conclusion.............................................................................................................................19
Recommendation...................................................................................................................20
References..................................................................................................................................22
Part 2..............................................................................................................................................28
Reflection...................................................................................................................................28
Bibliography..............................................................................................................................32

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Part 1
Review of Literature
Introduction
Gastro-intestinal disease can be defined as chronic, relapsing and remitting disease the
affects the entire gastro-intestinal tract starting from the oesophagus, stomach, small intestine,
large intestine rectum and associated digestive organ like liver, gall bladder and pancreas
(Hearnshaw et al. 2011). According to the Government of UK (2017), one out of five people
suffers from gastro-intestinal complications each year. One of the common gastro-intestinal
diseases that have a wide range of occurrence in UK is Inflammatory Bowel Disease (IBD)
(National Health Science 2017). IBD encompasses both ulcerative colitis (UC) and Crohn’s
disease (CD) and cause significant morbidity (National Health Science 2017). Other common
gastro-intestinal disease includes gastro-esophagal reflux disease and irritable bowel syndrome.
The accurate aetiology of gastro-intestinal disease is still not clear however, the disease
development, progression and phenotypes are multi-factorial with environmental factors and
genetical factors playing major roles (Gough, Shaikh and Manges 2011). However, laboratory
and epidemiologic data suggest that the environmental factors play a significant role in
modulating the natural risk of disease development while influencing the risk factors associated
with the disease (Ananthakrishnan 2013). Among the environmental factors, smoking is
consistently and widely described factor behind the disease development. Gut mircobiome and it
equilibrium is another key component behind the development of the gastro-intestinal disease
with a special reference to the IBD (Ananthakrishnan 2013). Other factors that promote the onset
or are associated with the management of the disease include application of antibiotics or non-

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steroidal anti-inflammatory drugs, dietary intake and other life style factors (Ananthakrishnan
2013). The following assignment aims to conduct a review of literature in order to draft a plan
for the holistic management of the disease.
Rationale of the study
Crohn's disease (CD) and Ulcerative colitis (UC), two most significant bowel diseases
that affect the gastrointestinal tract (Sajadinejad et al. 2012). Other associated gastro-intestinal
disease includes irritable bowel syndrome, gastro-oesophageal reflux disease (GERD), gall
stones and celiac disease (Hearnshaw et al. 2011). The external manifestation of the disease
occurs in the form of abdominal pain along with immense discomfort associated with highly
disturbed bowel pattern along with recurring or bloody diarrhea, extreme fatigue, weight loss and
tiredness (National Health Science 2017). Thus gastro-intestinal disease cast a significant and
life-long impact on the quality of life (QOL) of the patient. The clinical history of the gastro-
intestinal disease differs substantially among the patients. Some patients have been reported to
suffer from periodic relapse of the disease while other have years of virtually complete remission
(Sajadinejad et al. 2012). According to Sajadinejad et al. (2012) people who are suffering from
long-term gastro-intestinal disease are known to become victims of numerous psychological
disorders like depression and anxiety. Moreover long-term gastro-intestinal disease is known to
increase the absenteeism in work leading to high indirect cost to the company (Gunnarsson et al.
2013). According to Nurmi et al. (2013), despite having a comprehensive public health services
and specialized care plan for treating the patients with gastro-intestinal disease, a majority of the
population suffering from gastro-intestinal disease expressed disturbing symptoms which in turn
affect the quality of life. Molodecky et al. (2012) further reported that incidence and prevalence
of inflammatory bowel disease (IBD) is increasing with time in the developed countries like UK

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and this indicates emergence of IBD as a global threat in comparison to other gastro-intestinal
disease. Moreover, according to the reports published by the National Health Science UK (2017)
at present there are no definite cure plan for the inflammatory bowel disease and other associated
gastro-intestinal disease. A treatment plan is an only way to provide relief from the disturbing
symptoms of the disease (National Health Science 2017). A holistic care plan to manage the
gastro-intestinal disease is the only remedy behind the comprehensive management of the
disease and this requirement truly justify and importance and the purpose of the study. This
holistic care plan will mainly involve change in diet, lifestyle changes, medicines and surgery
(National Health Science 2017).
Methodology
The literature search was carried out in databases named PubMed, Medline, Cinahl,
Discover, Social Care and Embase (from 2010 to 2018) for publications in any language. The
search of the literature was based on broad keywords. However, gastro-intestinal disease is a vast
term and includes numerous disease names under its banner, in order to make the search more
specific, one of the most common name in the field of gastro-intestinal disorder was chosen and
this was inflammatory bowel disease OR IBD AND gastro-esophagal reflux disease (GERD)
(Hearnshaw et al. 2011). The main keywords thus used for the Boolean literature search include
gastro-intestinal disease OR gastrointestinal disease, gastro-esophagal reflux disease (GERD)
OR gastro-oesophageal reflux disease (GERD), gastrointestinal disease AND Nursing
intervention OR nursing care plan, gastrointestinal disease AND holistic care, inflammatory
bowel disease, Crohn's disease OR CD, crohn's inflammatory bowel disease, inflammatory
bowel disease review, systematic review inflammatory bowel disease, inflammatory bowel
disease treatment, inflammatory bowel disease management, inflammatory bowel disease AND

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smoking, inflammatory bowel disease and environmental risk factors, inflammatory bowel
disease AND nutrition gastrointestinal disease AND quality of life, gastro-intestinal disease
AND management, gastro-intestinal disease AND lifestyle. The main inclusion criteria selected
for the literature search was studies which are published on or after 2010, based on the human
studies and available in English. However, the search was not limited by the type or size of the
trials. The studies dealing with the pathogenesis, genetics and symptoms, epidemiology, bacterial
infection cycle, viral IBD, host and microbe interaction were excluded from the study. The main
reason behind this the selection of the exclusion criteria is, the review of literature is mostly
based on the holistic management of the disease and not on the process of the disease prognosis
and other epidemiological factors and hence those studies are excluded in order keep the review
linked with the rationale. In the inclusion criteria, the studies based on the human placebo were
chosen because aim of this literature review is to provide a holistic care plan to the human race
suffering from one of the common gastro-intestinal disease, inflammatory bowel disease.
The keyword search identified 150 papers on the basis of keyword match. These papers
were again reviewed on the basis of their tiles and 50 were found to be of interest, then these 50
papers were reviewed again via reading their abstracts and out of it 30 were found relevant.
These 30 research papers were again reviewed thoroughly and out of these 20 provided
relevancies with the rationale and are thus included in the review. Analysis of the research papers
leads to the generation of five themes. These themes will help to generate a holistic care plan for
the management of the gastro-intestinal disease.

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Literature Review
Theme 1: Disease management via pharmacologic interventions
There are evidences supporting microbial influence in the pathogenesis of gastro-
intestinal disease which in turn results in inappropriate immune response towards the commensal
microbiota (Nagalingam and Lynch 2012). However, there are inconclusive evidences in the
grounds of specific pathogen causing IBD, reports suggest that reduced diversity of luminal
microbiota in IBD along with decrease in Firmicutes like bifidobacteria, Faecalibacterium
prausnitzii and lactobacillus and an increase in mucosal-adherent bacteria is responsible for the
disease development (Nagalingam and Lynch 2012). According to the reports published by
Mowat et al. (2011), the potential drug treatment targeted against bacteria includes use of
steroids, immunosuppressant and aminosalicylates. According to Mowat et al. (2011), non-
steroidal anti-inflammatory drugs (NSAIDs) cause damage of the mucosa via dual inhibition of
both the COX genes (cyclo-oxygenase genes), COX1 and COX2. Mowat et al., (2011) is of the
opinion that selective inhibition done with COX-2 inhibitors or inhibition of COX-1 via low dose
aspirin seems to be effective and safe in treating the disease for short-term. Aminosalicylic used
for the treatment of IBD include 5-Aminosalicyclic acid (5-ASA) or mesalazine. It is
administered in milimolar concentration inside the lumen of the gut via oral tablets, suspensions
or sachets. The release mechanism is pH-dependent and occurs in conjugation via a diazo bond
with a variety of different carrier molecules. Aminosalicylates once inside the large intestine acts
in a bacteriosidal manner via cleaving bacterial enzymes. According to Nguyen, Gulamhusein
and Bernstein (2012), the selection of 5-ASA is debated and is mainly influence by the
tolerability of the drugs, dose schedule and cost. At least 10-45% of people who receive 5-ASA,
become victims of numerous side-effects like headache, epigastric pain, nausea, diarrhoea and

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oligospermia in men (Nguyen, Gulamhusein and Bernstein2012). Nguyen, Gulamhusein and
Bernstein (2012) further opined that aminosalicylates is ineffective in treating IBD developed in
relation to colorectal cancer. It was further opined by Anderson, Edney and Whelan (2012) that
the majority of the patients become refractory towards the standard management and some
develops significant side-effects on adverse drug reactions. Antibiotics have an important role in
curing the secondary complications associated with gastro-intestinal diseased like the over-
growth of bacteria and abscess. Metronidazole, a synthetic nitromidazole antibiotic and
ciprofloxacin have been found to produce effective results in some cases of Crohn’s disease.
However, there are no clear evidences to back the use of these antibiotics in long-term therapy
plan for gastro-intestinal disease (Kostic, Xavier and Gevers 2014). According to Rahier et al.
2014), moderate to severe relapses of both Crohn’s disease and ulcerative colitis and Crohn’s
disease can be treated via corticosteroids. Corticosteroids are regarded as potent anti-
inflammatory agents but have no role in maintenance therapy for either disease which is
responsible for the development of IBD. They function via inhibiting numerous inflammatory
and hypersensitivity pathways. Their main target element towards the process of immune-
suppression include down-regulation of interleukin transcription, induction of I-kappa-beta that
stabilises the NFkb complex, inhibition of the metabolic pathway of arachidonic acid and
stimulation of apoptoticcycle of inflammatory lymphocytes within the lamina propria of the gut
tissue (Rahier et al. 2014). According to the British National Formulary (2010), the anti-
inflammatory dose of 5 mg prednisolone, 0.75 mg betamethasone, 4 mg methylprednisolone and
20 mg hydrocortisone is used for treating IBD. According to Talley et al. (2011), in spite of
having significant medical treatment with antibiotics, a majority of population suffering from
IBD suffer from mild active symptoms and poor quality of live. Anderson, Edney and Whelan