Posts Tagged ‘Corticosteroids’

Treatment for Crohns Disease

04.29.10

Crohns Disease treatment is a life-long commitment, as this chronic condition is marked by flare-ups and remission periods that sufferers will unfortunately be forced to deal. Crohns Disease symptoms, and possibly one or more stays in a hospital.

All of that works together with the general stress of life to affect the course of your disease. When it all combines together — you get fatigue. You feel tired, listless. I know. I’ve been there. Proper Crohns Disease treatment is crucial, and it is important to learn everything you can about this debilitating condition.

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Treatment for Crohns disease usually involves drug therapy or, in certain cases, surgery.

Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease.

They include:
• Sulfasalazine (Azulfidine). Doctors have used this drug for many years to treat Crohns disease. Although it can be effective in reducing symptoms of the disease, it has a number of side effects, including nausea, vomiting, heartburn and headache. Don’t take this medication if you’re allergic to sulfa medications.
• Mesalamine (Asacol, Rowasa). This medication tends to have fewer side effects than sulfasalazine has. You take it in tablet form or use it rectally in the form of an enema or suppository, depending on which part of your colon is affected.
• Corticosteroids. Corticosteroids can help reduce inflammation anywhere in your body, but they have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity.

More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, bone fractures, cataracts and an increased susceptibility to infections. Long-term use of corticosteroids in children can lead to stunted growth.

Also, these medications don’t work for everyone with Crohns disease. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn’t respond to other treatments.

A newer type of corticosteroid, budesonide (Entocort EC), works faster than do traditional steroids and appears to produce fewer side effects. Entocort EC is effective only in Crohns disease that involves the lower small intestine and the first part of the large intestine (ileocolitis).

Corticosteroids aren’t for long-term use. They can be used for short-term symptom improvement for about three to four months. They’re also used in conjunction with other medications as a means to induce remission.

For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induce remission, while the immune system suppressors can help maintain remission.

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Fistulizing Crohns Disease

02.19.10

Fistulas are common in Crohns disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators.

Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas. The appropriate treatment of patients with fistulas in the setting of Crohns disease requires a knowledge of the specific medical and surgical literature of fistulizing Crohn’s. The patient with symptomatic fistulizing Crohns disease may respond differently to specific medical therapy than a patient with symptomatic obstructing Crohns disease.

Certain medications that are useful for the treatment of patients with obstructive Crohns disease may not be helpful in the treatment of fistulas in patients with fistulizing Crohns disease (e.g., corticosteroids and mesalamine); in fact, some medications are believed to be detrimental (e.g., corticosteroids). Few studies have been performed to assess the efficacy of specific medications on fistulas directly.

To date, there has been only one published prospective randomized controlled trial that was designed to assess the efficacy and safety of a specific medication on fistulas in patients with Crohns disease; it showed clinical efficacy over placebo in a statistically significant manner. The judicious use of surgery remains an integral part of the management of certain presentations of fistulizing Crohns disease, and the appropriate integration of surgical and medical therapy is of paramount importance in the management of these patients.

This review provides an overview of pertinent medical and surgical literature as it pertains to management of patients with fistulizing Crohns disease. Remicade was also shown to be effective in reducing the number of open, draining fistulas, a painful complication of Crohns disease in which deep openings burrow from the bowel wall through the surface of the skin, causing drainage of mucous and/or fecal material. Remicade is the first product documented to reduce the number of open fistulas in a controlled clinical trial.

In a clinical study of 94 patients with fistulizing Crohns disease (42 patients had single fistula and 52 patients had multiple fistulas), 68 percent of those treated at the recommended dose of Remicade experienced closure of at least 50 percent of fistula(s) for four weeks or more compared with 26 percent of placebo-treated patients. More than one-half (55 percent) of patients with single or multiple fistula(s) treated with Remicade experienced a clinical effect demonstrated clinical response to treatment with Remicade developed an abscess in the area of the fistula between eight and 16 weeks after the last infusion.

“Remicade represents a significant advance in the treatment of Crohns disease,” said Stephen Hanauer, M.D., University of Chicago Medical Center, department of gastroenterology, and a principal investigator in the clinical trials. “These patients suffer terribly and we physicians now have an important option available to treat them.”

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Crohns Disease Medication

11.13.09

Treatment for Crohns disease depends on its location and severity, the presence of complications and the patient’s response to medications. The goal of treatment is to reduce the inflammation that triggers symptoms. Treatment relieves symptoms and results in long-term remission.

Treatment for Crohns disease usually involves medication and/or surgery.Drug therapies must be custom-designed for each patient. Finding which medications best alleviate the symptoms may take time. When a patient with Crohns disease undergoes surgery, it is important that the health care team (including the surgeon, anesthesiologist, and the primary treating physician) know which medications the patient is taking. Many patients with mild to moderate disease are treated with medications containing mesalamine.

These medications differ based on what parts of the bowel are treated. The use of mesalamine to treat Crohns disease, either to achieve or maintain remission, is sometimes controversial because not all studies have consistently shown that mesalamine is effective for Crohns disease. Mesalamine is usually well-tolerated and has no serious side effects. Patients may experience nausea, headache and diarrhea.

Some patients who have severe active disease or do not respond to mesalamine therapy may need corticosteroids such as prednisone to control inflammation and induce remission. These drugs are effective but have significant side effects, such as increased susceptibility to infection, mood swings, anxiety, depression, elevated blood pressure, glaucoma, cataracts and osteoporosis.

Physicians may use different strategies to administer these drugs in order to reduce side effects. Budesonide is a corticosteroid that is rapidly broken down by the liver, resulting in a much lower frequency of side effects. These medications are gradually reduced once remission is achieved — and mesalamine or a drug that suppresses the immune system is used to maintain remission.Antibiotics such as metronidazole are sometimes used to treat Crohns disease.

They are particularly helpful in patients with fistulas and are often combined with other medications. The use of metronidazole to treat active Crohns disease or to delay the recurrence of Crohn’s for the first two to three years after an ileum resection surgery is often controversial because not all studies have consistently shown that metronidazole and other antibiotics are effective in these patient groups.

Metronidazole can be effective in managing perineal Crohns disease (involving the pelvic area). Many patients require surgery because medical therapy does not control their symptoms or because complications such as blockage, abscess, perforation or bleeding into the intestines have developed

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Crohns Disease Cure

09.30.09

Mild to moderate cases are usually treated with oral medications called aminosalicylates that can relieve inflammation and keep Crohns in remission.More serious cases are treated with corticosteroids such as Prednisone, and medications such as Remicade and Humira that can reduce inflammation and heal fistulas.

Due to the potential side effects of these medications, many people opt for natural anti inflammatories such as fish oil. It has been proven to be beneficial in intestinal health, and can be as effective as prescription drugs as a Crohns treatment.

If you have Crohns disease, you will usually be seen regularly by a specialist team. Treatment will aim to increase your quality of life as much as possible, but there is no cure. If you have Crohns disease it’s important that you eat a healthy, balanced diet with a high fibre content, unless you are prone to blockages.

This is especially true when your symptoms flare up, as you will need to replace lost nutrients, although you may not feel like it. If you can eat a normal diet, you should continue to do so. However, you may find that certain foods disagree with you or that you need to eat more of particular types of food such as starchy carbohydrates (eg potatoes, bread and pasta).

When your Crohns disease is active, your doctor may recommend that you have a liquid diet, made up of simple forms of protein, carbohydrates and fats. This is called an elemental diet and is commonly used to treat children.

Many people with Crohns disease find that treatment with medicines is effective. Medicines used to treat Crohns disease include:
•    corticosteroids (eg prednisolone) to reduce inflammation
•    medicines to suppress your immune system (eg methotrexate or azathioprine)
•    a medicine called infliximab – your doctor may recommend this if you have severe Crohns disease that hasn’t responded to other medicines

During flare-ups you may consider taking painkillers, but your GP may advise you not to take certain medicines such as ibuprofen (eg Nurofen) as they can make Crohns disease worse. It’s usually fine to take paracetamol as a painkiller, but check with your GP first. It’s not a good idea to take antidiarrhoeal medicines all the time as they may cover up signs that your disease has become more severe. Speak to your GP if diarrhoea is a problem.

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Colitis Treatment

07.07.09

Because the symptoms and progress of ulcerative colitis vary from person to person, treatments must be tailored to individuals. In most cases, however, drug therapy is the first line of treatment for ulcerative colitis.Drug therapy helps treat the symptoms of ulcerative colitis and prevent them from coming back. The four main categories of medication for ulcerative colitis all work by reducing inflammation. The drug categories are aminosalicylates, corticosteroids, immunomodulators and biologic therapies.

Aminosalicylates are called “5-ASA” drugs because they contain 5-aminosalicylic acid, which helps control inflammation. These drugs usually are the first treatment for people with mild or moderate colitis. Most are taken orally, though if inflammation is located low in the large intestine, they can be delivered in enemas or suppositories.

Azulfidine (sulfasalazine): a combination of 5-ASA and the sulfa drug sulfapyridine, sulfasalazine was the first aminosalicylate used widely to treat colitis. In this combination, the sulfapyridine prevents 5-ASA from being absorbed until it reaches the large intestine. But the sulfa drug can cause unpleasant side effects. Newer 5-ASA drugs, while they still have side effects, are easier for some people to tolerate. Also called steroids, these medications can relieve symptoms quickly, but they usually are not effective in preventing symptoms from returning. They also can have serious side effects. As a result, corticosteroids usually are used for short periods of time only. People with ulcerative colitis gradually taper off corticosteroids since an abrupt stop can bring on symptoms. The drugs can be taken orally, delivered in enemas, suppositories and foams, or given intravenously.

Immunomodulators reduce inflammation by suppressing the immune system. Immunomodulators are usually prescribed for people who:
•    Do not respond to other medications
•    Have become dependent on corticosteroids
•    Have active, severe cases of the disease

Because these drugs are “strong,” people must be monitored carefully for complications, including pancreatitis, hepatitis, reduced white blood cell count and infection. The drugs are taken orally, and it may take up to six months before they are fully effective.

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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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