**7. References**


verbally and also in the form of ancient texts. Medicinal plants are the foundations for modern therapeutic agents. Herbal medicines are an important part of the health care system in many developing countries. The use of herbal medicines, as health promoting agents, in developed countries has also increased and this trend is continuing. Healthcare professionals need to be aware of the pharmacology of these herbal medicines in order to provide well informed advice to patients. The traditional herbal medicines field is very vast. In this chapter we attempted to provide scientific evidence for the herbs with historical use in three major GIT disorders namely: peptic ulcer, diarrhoea and IBD. Researchers successfully reproduced these human disorders in animals by employing a range of chemical agents and scientific procedures. In some cases, these models not only have supported the traditional claims, but also provided important information on the mechanism of action of the plant extracts and in some cases their components. The majority of these preclinical studies established the scientific evidence to traditional herbal medicines. Unfortunately, very few clinical trials are conducted to translate animal data into humans. As clinical trials are important to furnish efficacy and safety data, the lack of clinical data has become the main impediment in developing traditional herbal remedies into mainstream medicines. Recent progress in the quality control of herbal products is very promising in gaining consumer confidence and promoting consideration of herbal medicines as complementary and in some cases alternative approaches to conventional therapies. Medicinal plants listed in this chapter have the potential to treat peptic ulcer, diarrhoea and IBD. Additional studies on quality, efficacy and safety in animals and

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**15** 

Neeraj Prasad

*University of Salford United Kingdom* 

**Evaluating Lymphoma Risk in** 

The risk of lymphoma in inflammatory bowel disease (IBD) has been a topic of great interest for many years. In 1928, the first published series of colorectal malignancies in ulcerative colitis (UC) patients included a case of lymphosarcoma, the name given to an early classification of lymphoma (Bargen, 1928). Since then a huge number of case reports, case series, cohort studies, population-based studies and meta-analyses have been presented on the topic but the matter remains controversial with conflicting results based on poor quality evidence. Most recently, a type of non-Hodgkin's lymphoma (NHL) known as hepatosplenic T-cell lymphoma (HSTCL) has understandably drawn much attention despite its rarity. HSTCL has an invariably fatal outcome despite reports of early response to treatment, it almost exclusively affects young men with Crohn's disease (CD) and seems to be linked to commonly used drugs for the management of IBD, the thiopurines and tumour necrosis factor (TNF) antagonists (Kotlyar et al., 2011). A further source of concern stems from a trend by IBD physicians to use these drugs earlier in the course of disease and also in combination because recent studies suggest that these strategies may improve outcomes

Proving causality has been difficult because it is difficult to separate the multiple factors involved in lymphomagenesis using the evidence that is available (see Figure 1). It has long been suspected that the chronic inflammation seen in IBD itself may be the cause of lymphoma in this setting but there has been growing concern that it is in fact the drugs used in the treatment of IBD which confers this risk. One could also speculate that it is the

The case of lymphosarcoma identified by Bargen in 1928 was in an era when immunomodulators were not available for the treatment of IBD suggesting that the disease itself may predispose to lymphoma development. There are other reports of lymphoma in drug-naïve IBD patients (Aydogan et al., 2010). There does appear to be an increased risk of lymphoma in other chronic inflammatory and autoimmune conditions as well including rheumatoid arthritis (RA), primary Sjögren's syndrome, systemic lupus erythematosus (SLE) and Hashimoto's thyroiditis (Smedby et al., 2006). There is some evidence that increased severity of the disease may increase the risk of lymphoma in these conditions

combination of both these factors which results in the development of lymphoma.

(Baecklund et al., 2006, Theander et al., 2006, Lofstrom et al., 2007).

**1. Introduction** 

(Colombel et al., 2010, D'Haens, 2009).

**Inflammatory Bowel Disease** 

*Royal Albert Edward Infirmary, Wigan* 

