Three Case of IBD or Exacerbation of IBD after Ovulation Induction

Document Type : Case report

Authors

1 Gastroenterologist

2 Professor of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Clinical Pathologist

4 Resident of Internal Medicine,Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Ulcerative colitis (UC) and Crohn’s disease (CD), collectively referred to as inflammatory bowel disease (IBD), present with different histology and cytokine profiles. While the precise mechanisms underlying the development of IBD are not known, sufficient data have been collected to suggest that it results from a complex interplay of genetic , environmental, and immunologic factors. An inappropriate mucosal immune response to normal intestinal constituents is a key feature, leading to an imbalance in local pro- and anti-inflammatory cytokines. Neutrophil and monocyte influx occurs with subsequent secretion of oxygen radicals and enzymes, leading to tissue damage.
[
Case report
Here we report three patients with sever symptom of IBD after ovarian stimulation.
Conclusion
Cytokine profile after ovarian stimulation may contribute to the altered intestinal permeability due to increase in systemic inflammatory cytokines and neutrophil or macrophage activation.
In our hypothesis ovulation induction can induce inflammation in intestinal mucosa or exacerbate previous IBD by different cytokines.

Keywords


1- Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and
maintenance therapy for ulcerative colitis. N Engl J Med 2005; 353:2462–2476.
2- Orvieto R. Department of obstetrics and gynecology, controlled ovarian hyperstimulation--an inflammatory state. J
Soc Gynecol Investig 2004; 11:424-426.
3- Rizk B, Aboulghar M, Smitz J, Ron-El R. The role of vascular endothelial growth factor and interleukins in the
pathogenesis of severe ovarian hyperstimulation syndrome. Hum Reprod Update 1997; 3:255-266.
4- Calogero AE, Nicoletti F, Palumbo MA, Burrello N, Di Mauro M, Lunetta M, et al. Macrophage-derived cytokines
in the follicular fluids of women with infertility due to immunological causes. Elevated levels of interleukin 6 and low
levels of granulocyte-macrophage colony-stimulating factor. Cytokine 1998; 10:814-818.
5- Cornish JA, Tan E, Simillis C, Clark SK, Teare J, Tekkis PP. The risk of oral contraceptives in the etiology of
inflammatory bowel disease: a meta-analysis. Am J Gastroenterol 2008; 103:2394-400. Epub 2008 Aug 5.