1. Lower Gastrointestinal Tract Dysfunction
1.1. Signs & Symptoms
1.1.1. Periodic abdominal pain
1.1.2. Cramping
1.1.2.1. Higher frequency over the past month
1.1.3. Diarrhea 1-2 days of the week
1.1.3.1. Bowel motions daily
1.2. Risk Factors
1.2.1. Family history of Crohn's disease
1.2.1.1. Linked to abdominal pain, cramping, and low body weight (Gajendran et al., 2018)
1.2.2. Irregular eating patterns
1.2.2.1. Lack of control over diet and discomfort eating due to upper GIT symptoms
1.3. disease/dysfunction pathogenesis/theories/underlying pathways
1.3.1. Inflammation starting from the oral mucosa (Canani et al., 2011)
1.3.1.1. Compromised integrity of the gastrointestinal tract (Fishbein et al., 2023)
1.3.2. Inflammation throughout the gastrointestinal tract
1.3.2.1. Release of inflammatory cytokines destroying the mucosa of the GIT wall (Chu et al., 2024)
1.3.2.1.1. Cell apoptosis, ulceration (Chu et al., 2024)
1.3.2.1.2. Gastrointestinal bleeding
1.3.3. Increased intestinal permeability
1.3.3.1. Gastrointestinal mucus permeable to bacteria (Faye et al., 2023)
1.3.4. Atrophy & scarring of intestinal villi
1.3.4.1. Decreased absorption of nutrients (Fishbein et al., 2023)
1.3.4.1.1. Low body weight of 55kg
1.3.4.1.2. Decreased absorption of iron
1.3.5. Previous use of antibiotics
1.3.5.1. Disruption to gastrointestinal (Faye et al., 2023)
1.3.5.1.1. Imbalance of the microbiota
1.3.5.1.2. Decrease in microbial diversity in the gastrointestinal tract (Fishbein et al., 2023)
2. Upper Gastrointestinal Tract Dysfunction
2.1. Signs & Symptoms
2.1.1. Recurring mouth ulcer (10 months)
2.1.1.1. 2 ulcers LHS of tongue / small white patches, 1cm in diameter
2.1.2. Yellow coating along centre of tongue (Li et al., 2021).
2.1.3. Discomfort while eating
2.1.4. Assumed oral infection by dentist
2.1.4.1. unsuccessful antibiotics
2.2. Risk Factors
2.2.1. Family history of Crohn's disease (Pecci-Lloret et al., 2023).
2.2.1.1. Linked to mouth ulcers (Pecci-Lloret et al., 2023).
2.2.2. Family history of GORD
2.2.2.1. Linked to mouth ulcers (Shu & Tong 2022).
2.2.3. Potential nervous system dysregulation
2.3. disease/dysfunction pathogenesis/theories/underlying pathways
2.3.1. Iron deficency (Sumathi et al., 2014).
2.3.1.1. Linked to recurring mouth ulcers (Sumathi et al., 2014).
2.3.2. Build up of bacteria on tongue (Li et al., 2021).
2.3.2.1. Influenced by oral hygiene, age, diet & immune function (Li et al., 2021).
2.3.2.1.1. Decreased immune function linked to recurring mouth ulcers (Chu et al., 2024).
2.3.3. Vitamin B12 deficency (Volkov et al., 2005).
2.3.3.1. Linked to recurring mouth ulcers (Volkov et al., 2005).
2.3.4. Dysregulated nervous system affecting salviary cortisol levels in upper GIT
2.3.4.1. Delayed wound healing and exacerbated inflammation in oral mucosa (Chu et al., 2024).
2.3.5. Bacterial Infection
2.3.5.1. Build up of bacteria on tongue (Li et al., 2021).
2.3.5.2. Disrupts oral microbiome influencing mouth uclers (Jin et al., 2024).
3. Nervous System Dysfunction
3.1. Signs & Symptoms
3.1.1. Experiencing feelings of sadness (Won & Kim, 2016).
3.1.2. Recurring mouth ulcers for 10 months (Verma et al., 2023).
3.1.3. Fatigue (Chu et al., 2024).
3.1.4. Decreased appetite (Chu et al., 2024).
3.1.5. Altered digestive function (Kenney & Ganta, 2015).
3.1.5.1. Loose stools 2 times / week
3.1.5.2. Abdominal cramping & pain
3.1.6. Bradycardia - 55 bpm.
3.2. Risk Factors
3.2.1. Busy life style
3.2.1.1. Full time university student
3.2.1.2. Working a night job 5 days a week
3.2.1.3. Eating out, no time to cook at home
3.2.2. Living in a new country for 1 year
3.2.3. Insufficent sleep at night due to work and university commitments
3.3. disease/dysfunction pathogenesis/theories/underlying pathways
3.3.1. Chronic activation of Sympathetic nervous system
3.3.1.1. HPA axis hyperactivity (Kenney & Ganta, 2015).
3.3.1.1.1. Increased secretion of stress hormones:norepinephrine, adrenaline, and cortisol (Kenney & Ganta, 2015).
3.3.1.2. Stress induced cheek bite (Verma et al., 2023).
3.3.1.2.1. damage to oral mucosa (Verma et al., 2023).
3.3.2. Reflex bradycardia in response to emotional stress.
4. D
5. Diet
5.1. Signs & Symptoms
5.1.1. Fatigue
5.1.1.1. Vitamin B12 deficiency anemia
5.1.1.1.1. Essestintial for energy production
5.1.1.1.2. Required for red blood cell formation can lead to megalobastic anemia
5.1.1.2. Iron deficiency
5.1.1.2.1. Reduced oxygen transportation can lead to iron defficiency anemia
5.1.1.2.2. Imaipaired cellular function
5.1.1.3. Folate deficiency
5.1.1.3.1. Required for blood cell formation can lead to megaloblastic anemia
5.1.2. Ulcers
5.1.2.1. Vitamin B12 deficiency
5.1.2.1.1. Weakened immune system
5.1.2.1.2. Impaired production and repair of cells in mucous membrane
5.1.2.1.3. Megalobastic anemia
5.1.2.2. Folate defiiciency
5.1.2.2.1. Essential for DNA synthesis and cell divison in mouth tissue
5.1.2.2.2. Impacts red blood cell production lead to megaloblastic anemia
5.1.2.2.3. Maintain mucos membrane
5.1.2.2.4. Weakend immune system
5.1.2.3. Iron deficiency
5.1.2.3.1. Can weaken mucus membrane
5.1.2.3.2. Low oxygen in blood leading to iron deficiency anemia
5.1.2.3.3. Compromise immune system
5.1.2.4. Zinc deficiency
5.1.2.4.1. Essential growth and repair of mucus membranes
5.1.2.4.2. Weakened immune system
5.1.2.4.3. Reduces collagen formation essestital for wound healing
5.2. Risk Factors
5.2.1. Diet is lacking fruit, vegetables, protein, complex carbohydrates and healthy fats
5.2.2. Fast food
6. Treatment Aim
6.1. Zinc
6.1.1. it helps to maintain of cell membrane and other essential co factor and enzymes
6.1.2. engage in maintaining oxidative stress and managing inflammatory cytokines
6.2. probiotics
6.2.1. Probiotics have positive effect on gut and wound healing
6.2.2. probiotics can aid in healing process by reducing the spread of infections and regulating the inflammatory response (Togo et al., 2022).
6.3. Iron
6.3.1. reviewed study shows that how to use the lactobacillus plantarum 299v to helps in prevention from iron deficiency (Rusu et al., 2020).
6.3.2. The absorption of iron occurs in intestine, it also depend on which categories of iron is present
6.4. Omega 3
6.4.1. The Importance of having omega 3 in diet is to help with tissue recovery, reduce inflammation and boost the immune response of the body
6.4.2. which helps in inflammatory mediators consist of EPA and DHA oral supplement, may reduce inflammation