>> DR. ALAN LOW: If you have inflammatory bowel
disease often shortened as IBD,
you might feel a bit overwhelmed about all
the treatment options available.
You have probably heard of many different
medications diets and surgeries. In this video,
I'm going to go over some of the different
medications how they work and why they might
be prescribed.
When using medications to treat IBD
which includes Crohn's disease and ulcerative colitis,
we focus on two main strategies:
managing symptoms directly and reducing disease activity
in order to limit future symptoms.
Symptoms and their impact on health and well-being
are the most distressing component of the disease
and direct treatment of these particularly
chronic pain and diarrhea will improve the quality
of your life. To reduce pain, we use analgesic medications.
Acetaminophen also known as Tylenol is the ideal
over-the-counter choice.
Non steroidal anti inflammatory drugs or NSAIDS
such as a acetylsalicylic acid,
ibuprofen and naproxen are effective at relieving
pain but can irritate the gut, so use these cautiously.
To manage diarrhea without treating
the underlying cause you might use antivirals
that slow down the transit time of food
in the intestines or anti spasmodic agents that improve
cramping associated with diarrhea.
Fiber supplements can help adjusts to a looseness
and frequency by binding to water.
By modifying its consistency,
it may be easier for you to pass the stool.
While medications that ease the symptoms are helpful,
the primary goal of treatment for IBD is to stop
inflammation in the gastrointestinal
tract and halt disease activity.
Treating the cause often eliminates the symptoms
entirely and it's preferred over simply treating
the symptoms as they appear.
Remission is when your disease is managed and the goal
is to use medications to stay in this state
for as long as possible.
Your physician might prescribe any
of the following medications perhaps
individually or in combination.
It could take some time to find the right mix
for you as each case of IBD is unique.
Depending on the location of your disease,
different drug delivery methods such as oral,
rectal or combination can help to ensure that all areas
of active disease are treated.
5 ASA or five aminsalycilic acid is a medication used
to reduce inflammation in mild to moderate IBD.
It has a long record of success. Five —
ASA is generally safe and well tolerated for long term use.
The most common forms of these drugs are coated
oral tablets and capsules but it is also available
for rectal administration in the forms
of enemas or suppositories.
Sometimes sulfasalazine is used which is a chemical
combination of five ASA and sulfa.
However it's not for you. If you have a sulfa allergy.
Five ASA also known as mesalamine helps
to settle acute inflammation and when taken
on a long term basis,
which we call maintenance is effective in keeping
inflammation under control.
It is important to maintain your medicine regimen even
if you are symptom free and you feel completely well.
Maintenance therapy can be at the full initial dosage or at
a reduced dosage and interval depending
on the disease response.
If you stop taking your medications.
Symptoms can return quickly and it may be more difficult
to regain control compared to continued
maintenance regiments.
Your doctor might prescribe corticosteroids such
as prednisone used orally and budesonide available
for oral and rectal administration,
to reduce inflammation in the shorter term.
Another corticosteroids,
hydrocortisone is available in rectal
formulations including enemas, foams and suppositories.
corticosteroids are effective at reducing inflammation
but they aren't great for long term use because they can have
many unpleasant side effects.
Physicians sometimes prescribe corticosteroids
for administration intravenously in hospital from more severe
cases or for a faster response.
Corticosteroids should not be used for long
term or for maintenance therapy.
Slow tapering off of these medications is necessary
after prolonged use of high doses.
Most physicians prescribe oral versions of five ASAs
or corticosteroids since patients
prefer taking pills.
However if these medications have a specially
designed release mechanism,
they may not reach and treat the area where
the disease is most active.
Oral tablets even with the coating
to help drug release at the active inflammation site,
might not be the optimal way to reach the end of the colon,
where stool can interfere with its effectiveness.
Unfortunately this is also the area in the colon
where a flare usually starts.
The best way to reach this area is by delivering
the drug into the rectum.
To get the best coverage of topical rectal therapies,
it is best to lie down on your left side.
The human anatomy is not symmetrical and the way
the organs lay went on the left side makes
for better passage and flow of medication through the anus,
rectum and into the colon.
A suppository will travel into the rectum
and usually reach about 15 centimeters
inside from the anus.
An enema in liquid form or foam will reach
farther about 60 centimeters.
It is best to insert these formulations before bedtime
to ensure that the medication is retained
for as long as possible.
Stool does not usually interfere with the drug
since the bowel area is typically relatively
empty right before bed.
Rectal preparations are particularly good at
treating urgency and bleeding which are bothersome symptoms.
A positive response often occurs within days
of treatment immuno modulating drugs can help prevent flares
and reduce dependence on corticosteroids
such as azathioprine, cyclosporine, 6-MP, methotrexate
or a newer medication called Toetofacitinib,
depending on specific circumstances.
These can take up to 12 weeks for therapy to start
working and six months to be fully effective.
While these are used to reduce dependence on steroids,
recent literature does not show effectiveness when used alone.
With these drugs,
there can be an increased risk some infections
and adverse effects so regular blood tests will be required.
The newest category of medications to treat
IBD are biologics.
These products are specifically developed proteins created
with living cells which selectively block
mediators that are involved in the inflammatory process.
Gastroenterologists routinely prescribe biologics
to induce clinical remission of inflammatory bowel disease.
Biologics are highly effective and they tend to work
where other medications fail.
Some are self-administered under the skin,
every two to 12 weeks and others require a health
care professional to administer them
through intravenous infusion, approximately every eight weeks.
Initial treatment may require more frequent infusions.
Broad spectrum antibiotics such as Metrometronidazole
and ciprofloxacin are important for treating
secondary problems of the disease such
as peri anal abscess and fistula in Crohn's disease.
Even though the treatment goal is to maintain remission,
sometimes you might experience a sudden onset
of symptoms which is called a flare.
It is important to discuss with your physician in advance,
exactly what you should do if the disease flares.
Having this important conversation with your
health care team means that you can prepare for some
immediate self-management when necessary while keeping
everyone aware of your condition.
However if you have severe symptoms you should seek
help immediately.
Even if that means heading to the hospital emergency room.
It is necessary to treat a flare early.
Inflammation typically does not resolve without treatment
and early intervention results in a better
outcome than waiting.
Delaying treatment may limit the options available
to your health care team and you'll experience symptoms
longer before getting relief.
Living with constant or longer periods
of inflammation might also increase your risk
for future complications,
as inflammation may cause damage to the gut wall
which accumulates in severity with each flare.
Individuals with IBD may be anemic from a combination
of factors,
such as chronic blood loss or mal absorption of certain
vitamins and minerals.
Iron supplements might help improve this condition,
but if you don't respond to pills then injectable
iron by infusion is available.
If signs of IBD occur outside of the gastrointestinal tract,
such as arthritis or inflamed eyes,
your physician will address these conditions
individually and you might require
referrals to other specialists.
While there is currently no known cure for IBD,
it is a highly treatable condition.
With the right medications,
working with your health care team,
along with dietary and lifestyle changes,
you can live a long healthy life. I'm Dr. Alan Low,
pharmacist and board adviser to the GI Society.
Visit bad gut dot org slash IBD for more information.