Posts Tagged ‘Budesonide’

Collagenous Colitis

07.23.09

Collagenous colitis is an inflammatory colonic disease with peak incidence in the 5th decade of life, affecting women more than men. Its clinical presentation involves watery diarrhea, usually in the absence of rectal bleeding. It is often classified under the umbrella entity microscopic colitis, along with a related condition, lymphocytic colitis.

On colonoscopy, the mucosa of the colon typically looks normal, but biopsies of affected tissue usually show deposition of collagen in the lamina propria, which is the area of connective tissue between colonic glands. Radiological tests, such as a barium enema are typically normal.

Treatment of collagenous colitis is often challenging, and many agents have been used therapeutically:
•    Bismuth agents, including Pepto-Bismol
•    5-aminosalicylic acid
•    Budesonide
•    Immunosuppressants, including azathioprine
•    Corticosteroids

An association between collagenous colitis and celiac disease has been reported, but there is no evidence that dietary restrictions used in celiac disease management are of benefit in collagenous colitis therapy.There have also been reports of an association between collagenous colitis and lymphoma.

Collagenous colitis (CC) is a recently described clinico-pathologic entity characterized by intractable chronic watery diarrhea, crampy abdominal pain, normal or near normal colonoscopic examination and histologically by a thickened subepithelial collagenous band associated with chronic inflammatory reaction and increased intraepithelial lymphocytic infiltrate in the colonic biopsies. Its pathogenesis remains nclear. We report a rare case of collagenous colitis in which immunohistochemical studies revealed marked deviations from normal in the endocrine elements of the colonic bowel.

To our knowledge this is the first report of such a study in collagenous colitis. Collagenous colitis is inflammation of the colon, the last portion of the digestive tract that ends at the rectum and anus. The most common symptom is chronic watery, non-bloody diarrhoea. In severe cases, the patient may be going to the toilet up to 20 times a day.
Collagenous colitis is a rare condition that affects about four people in every 10,000. It tends to develop in people aged over 40 years. Women outnumber men 20 to one, for reasons that are not clear.

There is no cure but lifestyle changes and medical treatment can manage the symptoms in most cases. Collagenous colitis is sometimes called microscopic colitis. Collagenous colitis seems to occasionally run in families, which suggests a genetic component to the condition.

However, doctors aren’t sure what causes the inflammation. One theory proposes that an unknown virus or bacterium is to blame. Another theory is that collagenous colitis is a type of autoimmune disorder, which means the immune system attacks a healthy part of the body by mistake. Some people with collagenous colitis also have other autoimmune disorders such as rheumatoid arthritis, scleroderma or Sjogren’s syndrome.

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Alternative Crohns Disease Treatment

05.17.09

The main treatment for Crohns disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery.

The type of symptoms you have and how bad they are will determine the treatment you need. Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohns disease. Antibiotics such as ciprofloxacin and metronidazole may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon.

Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped. Corticosteroids (such as budesonide or prednisone) may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection. Budesonide causes remission in mild or moderate Crohns disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.

Prednisone may help if budesonide does not. Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.

If you have tried all the medicines listed above and none of them have worked, your doctor may give you a tumor necrosis factor (TNF) antagonist such as infliximab (Remicade). This drug may work for people who have not had any success with other medicines for Crohns disease. Infliximab is also used to treat fistulas if antibiotics do not heal them. Another TNF antagonist that may be used to treat Crohns disease is adalimumab (Humira). It may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.

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