Multiple myeloma- The Symptoms

Multiple myeloma, also known as plasma cell myeloma or Kahler’s disease, is a types of abnormal growth of plasma cells collected in the none marrow where they grow and multiple to interfere with the production of normal blood cells. Paraprotein, an abnormal antibody produced by the plasma cell myeloma not only can causes kidney problem but also interference with the Roche automated total bilirubin assay is caused by precipitate formation of that can cause clinical confusion, according to the study by the Harvard Medical School, Boston(1). Other study indicated that the production of paraproteins caused spurious results on individual analytes including total bilirubin (TBIL), direct bilirubin (DBIL), or HDL-cholesterol (HDL-C)(b). there is also a report of a 50 years old
chloride resistant metabolic alkalosis in a patient with hypercalcemia related to Multiple Myeloma (MM)(c).
I. Symptoms
1. Bone and back pain
Bone pain, especially back pain, is a common presenting feature of myeloma patients. According to the study by the University of Arkansas for Medical Sciences, there is a report of three multiple myeloma patients with exacerbations of back pain and referred shoulder pain resulting from vertebral infections(1).
2. Infections
Multiple myeloma (MM) is a malignancy of clonal plasma cells, resulting in an increased production of ineffective immunoglobulins with suppression of non-involved immunoglobulins. According to the study by The John Theurer Cancer Center at Hackensack University Medical Center,  patients with MM are at increased risk of infectious complications, particularly streptococcal and staphylococcal infections(2).
3. Fatigue, pain, sleep and mood disturbances, and diminished functional performance.
Cancer-related fatigue and insomnia are common distressing symptoms and may affect mood and performance status. In the study to describe fatigue, sleep, pain, mood, and performance status and the relationships among these variables in 187 patients with newly diagnosed multiple myeloma (MM) and conduct an analysis using the correlates of fatigue, showed that patients with newly diagnosed MM presented with fatigue, pain, sleep and mood disturbances, and diminished functional performance. The regression model, which included all of these variables along with age, sex, and stage of disease, was statistically significant with a large measure of effect. Mood was a significant individual contributor to the model(3).
4. Vertebral fracture
Patients with painful vertebral compression fractures produced by multiple myeloma (MM) often experience reduction in pain after spinal augmentation with kyphoplasty or vertebroplasty, according to teh study by the The University of Texas MD Anderson Cancer Center(4)
5. Others symptoms
According to the study by the Sultan Qaboos University Hospital, Multiple myeloma is a rare, largely incurable malignant disease of plasma cells. Patients usually present with hypercalcemia, renal insufficiency, anemia and/or lytic bony lesions along with a monoclonal protein in the serum and/or urine in addition to an increase in the number of clonal plasma cells in the bone marrow(5). Other study indicated that patients with MM reported a mean decrease (e.g., worsening) between baseline and 1-yr follow-up scores for: quality of life (mean, 68 vs. 55, respectively, P < 0.001; 74% of patients had a deteriorated score), fatigue (33 vs. 39, P < 0.05; 50%), nausea and vomiting (6.3 vs. 13, P < 0.05; 71%), pain (33 vs. 43, P < 0.05; 59%), and dyspnea (17 vs. 33, P < 0.001; 66%). The most bothering symptoms during the past week were tingling hands/feet (32%), back pain (28%), bone aches/pain (26%), pain in arm/shoulder (19%), and feeling drowsy (18%)(6).

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(a) http://www.ncbi.nlm.nih.gov/pubmed/12521367
(b) http://www.ncbi.nlm.nih.gov/pubmed/18251580
(c) http://www.ncbi.nlm.nih.gov/pubmed/22073517 
(1) http://www.ncbi.nlm.nih.gov/pubmed/12648075 
(2) http://www.ncbi.nlm.nih.gov/pubmed/22678167 
(3) http://www.ncbi.nlm.nih.gov/pubmed/21522061
(4) http://www.ncbi.nlm.nih.gov/pubmed/22543044
(5) http://www.ncbi.nlm.nih.gov/pubmed/23386937
(6) http://www.ncbi.nlm.nih.gov/pubmed/22762785 

Enteritis - Treatments In Traditional Chinese medicine perspective

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
In traditonal Chinese medicine perspective
1. Qiwei baizhu powder
Sixty cases of rotaviral enteritis treated with Qiwei Baizhu Powder (QWBZP) revealed a better efficacy than that treated with Oral Rehydration solution (ORS, chi 2 = 6.07, P < 0.05), according to the study by the Hunan Academy of Traditional Chinese Medicine(54).

2. Jiechang Mixture (JCM)
In the study to evaluate the therapeutic effect and mechanism of Jiechang Mixture (JCM) in treating infantile mycotic enteritis, showed that the time of stool forming, diarrhea relieving and fungi vanishing in the treated group were significantly shorter than those in the control group (P < 0.01), and JCM also showed a better effect in improving clinical symptoms and signs of patients than the control. Results of experimental study showed that JCM could abate the ink evacuation of small intestine in mice. The fungi inhibitory test suggested that Candida albicans was susceptible to JCM(55).

3. Zhixie buye mixture
In the study to observe the therapeutic effect of Zhixie Buye mixture (ZXBYM) on infantile diarrhea patient with mild and middle degree of dehydration, indicated that the ZXBYM is an effective mixture in the treatment of diarrhea with dehydration. It has a good prospect of development and application(56).

4. Fu-zheng qu-xie
In the study of the of fu-zheng qu-xie on gastric disease infected with Campylobacter pyloridis] by Jiangsu Provincial Hospital of TCM, pointed out that the principle of Chinese herbal medicine treatment of gastric disease by campylobacter pyloridis was fu-zheng qu-xie. Fu-zheng was achieved by Astragalus membranaceus, Atractylodes macrocephala and Paeonia lactiflora, whereas qu-xie by Taraxacum monogolicum and Oldenlandia diffusa. Chinese herbal medicine for fu-zheng played an important role in modulating immune function. Qu-xie was directly disinfective and indirectly anti-bacterial. Chinese herbal medicine combined with western drugs will decrease the side effects and enhance the curative effect at the same time(57).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(54) http://www.ncbi.nlm.nih.gov/pubmed/9208531
(55) http://www.ncbi.nlm.nih.gov/pubmed/12577434
(56) http://www.ncbi.nlm.nih.gov/pubmed/11783278
(57) http://www.ncbi.nlm.nih.gov/pubmed/2065393
 

Enteritis - Treatments In Herbal medicine perspective

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
In herbal medicine perspective
1. Psidium guajava L (Guava)
In the study to observe the clinical effect of olium Psidium guajava (PG) in treating infantile rotaviral enteritis in Sixty-two patients of rotaviral enteritis randomly divided into the treated group treated with PG and the control group treated with Gegen Qinlian decoction, showed that The rate of recovery in 3 days of the treated group was 87.1%, significantly higher than that of the control group (58.1%, P < 0.05). The time of ceasing diarrhea of the treated group (25.1 +/- 9.5 hr) was significantly shorter than that of the control group (38.7 +/- 15.2 hr, P < 0.01)(52).

2. Gastritis-granule and Wei-Mei-Su
According to the study by Dr. Pu CS., In the group treated with granule-gastritis, the effective rate for CP was 81.3% (26/32), and the improvement rates of the symptoms and histopathological lesion were 87.5% (28/32) and 40.6% (13/32) respectively. In the group treated with Wei-Mei-Su as the control group, the figures were 25%, 40% and 10% respectively. These differences were statistically significant (P less than 0.01-0.000). The results showed that the effect of granule-gastritis on chronic gastritis infected with CP was better than that of Wei-Mei-Su(53). 

3. Etc.
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(52) http://www.ncbi.nlm.nih.gov/pubmed/11938857
(53) http://www.ncbi.nlm.nih.gov/pubmed/2624985 

Enteritis - Treatments In conventional medicine perspective

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Treatments
A. In conventional medicine perspective
Treatment depending to the underlined causes of the diseases.
Beside taking certain steps in relieving the symptoms of the patients by providing short-lived and  general supportive care(49), such as
Oral rehydration therapy for older children and adults:

• Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea.
• Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes.
• The absence of food allows the intestines to rest.
• May be able to advance to full liquid diet once symptoms improve
• Effective to treat mild to moderate dehydration

Intravenous fluids for severe dehydration

Clear liquid diet

BRAT diet (i.e. bananas, rice, applesauce, toast)

But according to the study by the Christiana Care Health System, probiotics reduce diarrheal duration from a number of etiologies. Professional nursing practice based on evidence and clinical expertise supports a diet-containing probiotics to manage acute diarrhea. Dietary limitations included in the BRAT (bananas, rice, applesauce, and toast) diet recommended by many nurses need to be reexamined in light of the newest evidence(48a).

Medications for nausea and vomiting:

• Metoclopramide (Reglan) but side effects are not limit to hives, difficulty breathing, swelling of your face, lips, tongue, or throat.
• Ondansetron (Zofran) but side effects are not limit to headache, fatigue, constipation, etc.
• Olanzapine has been shown to be a safe and effective agent for the prevention of  nausea and vomiting  for patient with entertitis, but side effects are not limit to  hives; difficulty breathing; swelling, etc.
• Prochlorperazine (Compazine, Compro) but side effects are not limit to Constipation, headaches, dizziness, etc.

Medications for diarrhea:

• Loperamide (Imodium) but side effects are not limit to abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, vomiting, etc.
• Diphenoxylate and Atropine (Lomotil) but side effects are not limit to thirst, decreased urination, muscle cramps, weakness, fainting, etc.

A.1. Bacterial entertitis
Atibiotic used are depending to types infectous organism, including Ciprofloxacin (Cipro),  Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX),  Ceftriaxone (Rocephin) Cefotaxime (Claforan) Vancomycin (Vancocin, Lyphocin, etc., but side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
According to the study by Enterics laboratory, US Army Research Unit, Nairobi, in screening of the 651 patients screened, the highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin(49a).


A.2. Viral entertitis
There is no specific treatment for viral entertistis as antibiotic are not helpful in treating the diseasse. Make sure you are vaccinate against certain virus in a specific season.
According to the study by Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences,  clinical effective rate of Novalac AD in infantile rotavirus enteritis was 100%. All 20 subjects stool turned normal and systemic symptoms disappeared after treatment, with 17 within 48 h (85%,17/20) and 3 within 72 h (15%, 3/20)(50).

A.3. Radiation-induced enteritis
Radiation-induced enteritis van be prevented, according to the University Hospital Mannheim, Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach(50a).
According to the study the Provincial Hospital affiliated to Shandong University, in the evaluation of the effect of actovegin (Nycomed, deproteinized hemoderivative of calf blood injection) on intestinal mucosa in rats with acute radiation enteritis, and observe the changes of expression of apoptosis-related bcl-2/bax genes, showed that Actovegin accelerates the recovery of the acute radiation-injured intestinal mucosal epithelium by decreasing apoptosis via down-regulation of the expression of activating apoptosis protein bax and up-regulation of inhibiting apoptosis protein bcl-2(51).

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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287  

(48) http://www.ncbi.nlm.nih.gov/pubmed/10821115
(48a) http://www.ncbi.nlm.nih.gov/pubmed/22517350
(49) http://www.freemd.com/bacterial-enteritis/treatment.htm
(49a) http://www.ncbi.nlm.nih.gov/pubmed/22842944
(50) http://www.ncbi.nlm.nih.gov/pubmed/21110440
(50a) http://www.ncbi.nlm.nih.gov/pubmed/18461520
(51) http://www.ncbi.nlm.nih.gov/pubmed/20021825

Enteritis Preventions - The Antioxidants

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Antioxidants to prevent Enteritis
1. Melatonin
In the study to tests the hypothesis that "the intake of melatonin can minimize the morphological features of cell damage associated with radiation enteritis", conducted by the Assuit University, Assuit, Egypt, found that Administration of melatonin prior to irradiation can protect the intestine against X-rays destructive effects, i.e. radiation enteritis(44).

2. Cu/Zn-superoxide dismutase (SOD1)
In the study to analyze the therapeutic value of Cu/Zn-superoxide dismutase (SOD1) supplementation in an experimental model of radiation-induced intestinal inflammation and explore its mechanistic effects, showed that Treatment with SOD1 decreases oxidative stress and adhesion molecule upregulation in response to abdominal irradiation. This is associated with an attenuation of the radiation-induced intestinal inflammatory response(45).

3. Vitamin A
Vitamin is a free radical scavenger. It emhances the immune system in fighting against forming of free radicals and foreign invasion. In the study to examine Serum retinol, retinyl palmitate, and total vitamin A concentrations, and jejunoileal morphology  in neonatal calves infected with Cryptosporidium parvum, showed that
Cryptosporidium parvum infection was associated with significant (P < or = 0.05) reduction in postadministration serum retinol, retinyl palmitate, and total vitamin A concentrations in calves of groups 2, 3, and 4. Cryptosporidium parvum infection caused significant (P < or = 0.05) reduction in villus height. Decreased villus height, villus blunting and fusion, and attenuation of the intestinal mucosa were associated with reduced absorption of vitamin A, as indicated by lower peak postadministration retinyl palmitate concentration in C parvum-infected calves(46).

4. Vitamin E
In the study to the effects of a nonenzymatic oxygen radical scavenger (vitamin E) and an exogenous PGE1 analog known to increase mucosal blood flow (misoprostol) on acute radiation enteritis in rats, showed that  ionizing radiation reduces in vivo intestinal fluid absorption without significant changes in histologic or morphometric appearance. Treatment with vitamin E, but not misoprostol, protects gastrointestinal mucosa against radiation-induced absorptive injury(47). Other study showed that selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury may have some beneficial effects against irradiation-induced intestinal injury(48).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287 
(44) http://www.ncbi.nlm.nih.gov/pubmed/18762261
(45) http://www.ncbi.nlm.nih.gov/pubmed/15752897
(46) http://www.ncbi.nlm.nih.gov/pubmed/1456546
(47) http://www.ncbi.nlm.nih.gov/pubmed/1735337
(48) http://www.ncbi.nlm.nih.gov/pubmed/10821115 

Enteritis Preventions - The Phytochemicals

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Phytochemicals to prevent Enteritis
1. Genistein
Genistein, a principal soy isoflavone, has been identified as a protein kinase inhibitor that possesses immunosuppressive and anti-inflammatory properties. According to the study by the Louisiana State University School of Medicine, Genistein, at low doses, also appeared to attenuate immunohistochemical staining for inducible nitric oxide synthase (iNOS) and nitrotyrosine. The beneficial effects of genistein were not apparent at doses above 0.1 mg/kg. Genistein also inhibited LPS-induced nitrite production by cultured macrophages and protected against LPS-induced necrosis despite its ability to cause apoptosis. These results indicate that genistein displayed mild anti-inflammatory properties which may, in part, involve an attenuation of nitric oxide release via inducible nitric oxide synthase, and the formation of peroxynitrite(41).

2. Resveratrol and curcumin
In the study to investigate the potential anti-inflammatory and immunomodulatory mechanisms of the above mentioned compounds in a murine model of hyper-acute Th1-type ileitis following peroral infection with Toxoplasma gondii conducted by the Charité-Universitätsmedizin Berlin, indicated that Oral treatment with Resveratrol, Curcumin or Simvastatin ameliorates acute small intestinal inflammation by down-regulating Th1-type immune responses and prevents bacterial translocation by maintaining gut barrier function. These findings provide novel and potential prophylaxis and treatment options of patients with inflammatory bowel diseases(42).

3. Beta-carotene
Beta-carotene is known as a potent free radical quencher and antioxidant. According to the study conducted by the B'nai Zion Medical Center, Haifa, Israel, the result demonstrate the effectiveness of beta-carotene in a rat model as a prophylactic dietary measure in reducing the effects of acid-induced enteritis and raise the possibility that patients with Crohn's disease may benefit from the consumption of natural beta-carotene(43).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(41) http://www.ncbi.nlm.nih.gov/pubmed/9492347
(42) http://www.ncbi.nlm.nih.gov/pubmed/21151942
(43) http://www.ncbi.nlm.nih.gov/pubmed/14671486

Enteritis Preventions - The Diet

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Diet ot prevent Enteritis
1. Probiotic
Oral administration of a probiotic preparation was shown to be effective in preventing the recurrence of chronic pouchitis in a classic double-blind, placebo-controlled trial. According to the study by the East Carolina University, Greenville, dysbiosis, a condition of microbial imbalance, has been implicated in the pathogenesis of inflammatory bowel disease. Rather than administering antibiotics to treat the microflora with each relapse of pouchitis, the emphasis was placed on preventing chronic flare-ups by administering probiotics to correct dysbiosis. In addition, the choice of bacteria, optimal dose, and timing of administration have yet to be determined. Finally, the mechanisms by which probiotics provide their beneficial effects remain unresolved(38).

2. Green tea
In the study to investigate the  Green tea's repair fasting-induced mucosal damage in rat intestine, showed that use of green tea was associated with a significant increase in total plasma antioxidants (P < 0.001), and mucosal SOD (P < 0.001), catalase (P = 0.006) and GPx (P = 0.017), but a significant decrease in MPO activity (P < 0.001). Green tea reverses the fasting-induced damage to the intestinal mucosa by its antioxidant and anti-inflammatory effect(39).

3. Origanum vulgaris and Allium sativum
According to the study to  investigate the efficacy of Virbamix PE (Virbac SA, France) an appetite enhancer and feed flavouring material containing plant extracts of Origanum vulgaris and Allium sativum, added to the feed at one single dose in the control of proliferative enteropathy (PE) in weaning pigs,  in comparison to reference treatment with tiamulin (Tiamutine 6.5 Premix/Ceva Animal Health) group and a negative control group indicated that administration of Virbamix PE was found to be effective for the control of PE, as shown by the reduction of prevalence of Lawsonia intracellularis in the intestine at the end of the treatment period, as determined by PCR method comparatively with the T1 group, while no significant difference was found between T2 and T3 groups. The diarrhoea score (DS) was significantly higher (P < 0.05) in the control group in comparison with T2 and T3 groups. However, no significant differences were noticed between T2 and T3 groups during the treatment period (P > 0.05)(40).

4. Etc.
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287
(38) http://www.ncbi.nlm.nih.gov/pubmed/22378800
(39) http://www.ncbi.nlm.nih.gov/pubmed/?term=green+tea+and+Enteritis
(40) http://www.ncbi.nlm.nih.gov/pubmed/19886265