IBD / Coeliac Flashcards
Treatment for IBD?
Nutritional changes/adjunct therapy:
- ANTISPASMODICS, OPIOIDS, LAXATIVES, (probiotics)
Drug therapy:
- Anti-inflammatory: AMINOSALICYLATES, STEROIDS
- Immunosuppressant: IMMUNOSUPPRESANTS, ANTIBODY THERAPY
Surgery:
- give bowel a rest - colostomy/iliostomy - can give prolonged remission
Others
Adjunctive therapy of IBD?
Attention to diet - HIGH FIBRE, ‘healthy diet’
IBS whilst in remission from UC:
- LOW FIBRE
- ANTISPASMODICS: propantheline, mebeverine (antimuscarinic)
- (Avoid anti motility drugs - codeine, loperamide - precipitate paralytic ileum in active UC)
Diarrhoea:
BILE SALTS: COLESTRYTRAMINE - binds bile salts
ANTIBIOTICS: METRONIDAZOLE, CIPROFLOXACIN
C. DIFFICILE colitis - METRONIDAZOLE, VANCOMYCIN
Aminosalicylates for IBD?
SULFASALAZINE (mild-severe)
MESALAZINE (mild-moderate)
OLSALAZINE (mild-moderate)
BALSALAZINE (mild-moderate)
5-amino salicylic acid (5-ASA) poorly absorbed (topical relief)
- Maintenance of remission
- Sulfasalazine developed as arthritis treatment
- Unknown mechanism of action
- Possible block of inflammation, prostaglandins, leukotrienes, platelet activating factor (PAF)
- FIRST LINE treatments for MILD - MODERATE UC, reducing relapse rate
Side effects aminosalicylates?
- Nausea, controlled though reduced dosing
- Ulcers of mouth, sore mouth, loose bowel movements
- Reduced white cell, reduced platelets
- Rash
- Orange urine and sweat
- Depression in young
- Oligospermia
Steroids for IBD?
Corticosteroids: PREDNISOLONE, HYDROCORTISONE, BUDESONIDE
- Main drugs used in acute attacks
- Induce and maintain remission
- Adverse reactions make them unsuitable for maintenance
- Use of budesonide (topical, slow release) → reduced adverse effects
- Liquid or foam enemas for localised rectal disease
- Oral or parenteral for severe or extensive disease
- Used in diffuse inflammatory bowel disease and unresponsive cases
- ORAL PREDNISOLONE and BUDESONIDE (modified release)
- Used in refractory (unresponsiveness to treatment) and moderate disease adjunct to 5-ASA
- Severe IBD - hospital admission and IV steroid use
Side effects?
- Osteoporosis
- Diabetes
- Muscle wasting
- Cushing’s syndrome
- Growth suppression
- Infection
- Adrenal atrophy long term (reduced with slow release budesonide)
Immunosuppressants in IBD?
AZATHIOPRINE in steroid dependent Crohn’s
- Inhibits purine synthesis (
- Can prevent relapse
- MERCAPTOPURINE = active metabolite of Aza
- Can take weeks to months to reach peak effectiveness
- Side effects: nausea, vomiting, pneumonia, herpes and diabetes, pancreatitis (1.2%)
METHOTREXATE: useful in Crohn’s
- Inhibits DHF reductase (DHF –> THF)
- Given IM, special handling and disposal (teratogen)
CALCINEURIN inhibitors: CYCLOSPORIN, TACROMILUS
- Cyclosporin may induce remission in steroid-resistant
- UC, no long term efficacy
- Expensive, toxic, opportunistic infection
Antibody therapy in IBD?
INFLIXIMAB - first monoclonal antibody approved for Crohn’s treatment
Against inflammatory cytokines: TNF, IL-12, IL-23…
Infused → can lead to up to 3 months remission
Antibodies against influximab reduce its effectiveness and that of other injections (anti-anti-TNFa)
Side effects:
- Fever, chills
- Uritcaria (15%) (hives)
serious infection - TB
Effectiveness of immunosuppression in Crohn’s? (mucosal healing, surgery, recurrence)
Corticosteroids
- no mucosal healing
- no decreased need for surgery
- no decreased recurrence after surgery
AZA, 6-MP
- mucosal healing :)
- no decreased need for surgery
- decreased recurrence after surgery :)
Methotrexate
- mucosal healing :)
- no decreased need for surgery
- unknown effect on recurrence after surgery
Enteral feeding
- mucosal healing :)
- no decreased need for surgery
- decreased recurrence after surgery :)
Infliximab
- mucosal healing :)
- decreased need for surgery :)
- unknown effect on recurrence after surgery
Future directions of treatment?
- Local anaesthetics enema or topical gels
- Nicotine
- Heparin LMW
- IFN beta anti-inflammatory (used in MS)
- EGF important in wound healing
- Plasmaphoresis, used in arthritis, and transplantation (reduces immunological products abs etc).
Parasites / plantains?
- Parasites: Th2 response reduces overactivity of cytokines in IBD
- Plantain fibres inhibit bacterial growth
Coeliac disease?
Gluten free (avoidance) also on prescription
Osteoporosis: dexa scan - calcium supplementation
Possible iron, folic acid, and fat soluble vitamin (A, D, E and K) supplementation
Risk of bacterial overgrowth in small intestine - diarrhoea - ORT, CO-AMOXICLAV
STEROIDS if REFRACTORY or AZATHIOPRINE
- Coeliacs may also have increased mouth ulcers, anxiety, fatigue, dyspepsia
Future outlook for IBD sufferers?
- Prone to cancer
- Crohn’s - higher risk of small intestine
- Whole colon involvement especially UC - increased risk of colon malignancy
- Surveillance colonoscopy every 2 years after 8 years of disease
Bone density reduced due to calcium malabsorption
Prevention of relapse - maintenance
Stop smoking
