Crohns & Colitis - 7 Flashcards
(215 cards)
1
Q
What condition was Jonathan diagnosed with?
A
Crohn’s disease
It involved the last part of the small intestine (ileum) and a small section of the large intestine (sigmoid colon).
2
Q
What initial medications were prescribed to Jonathan?
A
Budesonide, metronidazole, and ciprofloxacin
Jonathan experienced side effects from metronidazole.
3
Q
What side effects did Jonathan experience from his medication?
A
Metallic taste and persistent nausea
4
Q
What is the primary goal of drug therapy for IBD?
A
To relieve symptoms
5
Q
What does remission mean in the context of IBD?
A
The absence of symptoms
6
Q
What is a response to treatment in IBD?
A
Improvement in symptoms but not complete absence of symptoms
7
Q
What is a flare in IBD?
A
A recurrence of inflammation and symptoms
8
Q
What are the risks associated with persistent inflammation in patients with IBD?
A
- Increased risk of disease flares
- Irreversible bowel damage and complications
- Increased risk of colon cancer
9
Q
What is mucosal healing?
A
Elimination of active inflammation and healing of ulcers
10
Q
What challenges are associated with achieving mucosal healing?
A
- Higher hurdle than remission
- Not all therapies effectively heal mucosa
- Difficult to confirm mucosal healing
11
Q
What should be the ideal goals of therapy for IBD?
A
- Immediate symptom control
- Long-term control of symptoms
- Avoidance of disease flares
- Prevention of complications
12
Q
What does step-up therapy entail?
A
A stepwise approach to treatment based on response to medications
13
Q
What is top-down therapy?
A
An approach using more potent therapies earlier in treatment
14
Q
What is accelerated step care?
A
A modified step-up therapy with defined timelines and goals
15
Q
What factors complicate the decision-making process for IBD treatment?
A
- Variation in disease forms and locations
- Severity and aggressiveness of the disease
- Patient tolerance to side effects
16
Q
What is personalized medicine in the context of IBD?
A
Treatment approach based on individual patient prognosis or risk
17
Q
What should patients ask their doctors when prescribed new medications?
A
What effect the new medication might have on their IBD
18
Q
True or False: All medications for IBD are designed specifically for treating IBD.
A
False
19
Q
What is personalized health care often referred to as?
A
Personalized medicine
This approach aims to provide the right therapy to the right patient at the right time.
20
Q
What are the two categories of side effects?
A
- Dose-dependent side effects
- Unpredictable side effects
Dose-dependent side effects increase with higher drug doses, while unpredictable side effects can occur at any dose.
21
Q
What is a predictive test used for in drug therapy?
A
To predict the likelihood of experiencing a given side effect from a drug therapy
For example, a blood test can indicate the risk of serious blood complications from azathioprine.
22
Q
Why are doctors more reluctant to use immune-suppressant medications in elderly IBD patients?
A
Higher risk of serious infections
The risk may outweigh the possible benefits of treatment.
23
Q
What should patients discuss with their doctor regarding drug therapy?
A
- Necessity of drug treatment
- Purpose of treatment (control flare or maintain remission)
- Expected benefits and improvements
- Timeframe for improvement
- Follow-up requirements
- Common and serious side effects
- Other therapy options
- Cost of treatment
- Duration of therapy
- Viability of surgery
These questions help clarify the treatment plan and expectations.
24
Q
What are the two main considerations for treatment recommendations?
A
- Whether Crohn’s disease or ulcerative colitis is treated
- Whether the aim is to control a flare or maintain remission
Recommendations may also be subdivided by disease location and severity.
25
Is there one medication effective for all forms of inflammatory bowel disease?
No
## Footnote
Different drugs may be used for different indications within IBD.
26
What is the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in IBD?
They may result in disease flares in some people with IBD
## Footnote
Common NSAIDs include diclofenac, sulindac, naproxen, and ibuprofen.
27
What is the preferred over-the-counter pain relief for IBD patients?
Acetaminophen (Tylenol)
## Footnote
It is effective and safe for IBD.
28
When should opioid medications be used in IBD patients?
Only for episodes of acute pain with a known cause
## Footnote
Chronic use can lead to addiction.
29
What is the purpose of pain clinics for IBD patients?
To control chronic pain that is not manageable through standard treatments
## Footnote
These clinics have a multidisciplinary team to address pain syndromes.
30
List some commonly used IBD medications
* Mesalamine (5-Aminosalicylic Acid) preparations
* Glucocorticoids (Steroids)
* Antibiotics
* Immunosuppressants
* Biologic therapies
## Footnote
Specific examples include sulfasalazine, prednisone, and infliximab.
31
What is the primary action of mesalamine?
Anti-inflammatory actions specific to the intestinal tract
## Footnote
Unlike aspirin, it is not a pain reliever.
32
How is sulfasalazine composed?
A sulfa antibiotic and 5-ASA connected by a chemical bond
## Footnote
This bond is split by enzymes in the intestines.
33
What is sulfasalazine composed of?
A sulfa antibiotic and 5-ASA connected by a chemical bond
34
How is sulfasalazine activated in the body?
Its bond is split by an enzyme produced by bacteria in the large intestine and the last part of the small intestine
35
What is the primary beneficial action of sulfasalazine in IBD?
Due to the 5-ASA part of the drug
36
What happens during a severe flare of ulcerative colitis or Crohn’s disease regarding sulfasalazine?
Sulfasalazine and other 5-ASA-containing drugs are usually not effective
37
What was the accidental discovery related to sulfasalazine?
It was found effective in treating Crohn’s disease and ulcerative colitis while originally used for arthritis
38
What are common side effects of sulfasalazine?
Stomach upset, nausea, vomiting, skin rashes, fever, decreased blood cell counts, infertility in males
39
What side effects are associated with the sulfa part of sulfasalazine?
Skin rashes, fever, decreased blood cell counts, infertility in males
40
What conditions is sulfasalazine effective in treating?
Symptoms of ulcerative colitis and mild flares of Crohn’s disease when the large intestine is affected
41
What are controlled-release mesalamine (5-ASA) preparations designed to do?
Keep the 5-ASA in the intestine and release it where maximum action is needed
42
What is the purpose of the waxy film coating on some 5-ASA preparations?
To dissolve and release 5-ASA when the intestinal acid becomes sufficiently neutralized
43
List examples of 5-ASA preparations
* Asacol
* Pentasa
* Salofalk
* Mezavant
* Lialda
44
What are the benefits of 5-ASA-containing drugs?
* Higher effective doses than sulfasalazine
* Useful in milder flares of IBD
* Safe alternative to steroids in Crohn’s disease
45
What is the long-term safety profile of 5-ASA?
Excellent, with virtually no long-term side effects reported
46
What is balsalazide and how does it work?
A 5-ASA drug that is chemically bonded to another molecule to prevent absorption in the small intestine
47
What are the benefits of balsalazide?
* Effective in treating mild flares of ulcerative colitis
* Prevents relapses once in remission
48
What is the mechanism of action for olsalazine?
Two 5-ASA molecules chemically bonded that are split apart by bacteria in the large intestine
49
What side effect may occur in about 15% of people taking olsalazine?
Increased diarrhea due to irritation of the small intestine lining
50
What are mesalamine enemas and suppositories used for?
To apply 5-ASA directly onto the inflamed intestinal lining in ulcerative colitis
51
What is the first choice of treatment for ulcerative colitis with inflammation limited to the rectum?
Mesalamine enemas or suppositories
52
What is the recommended time to administer a mesalamine enema?
Once per day in the evening before bedtime
53
What are the steps for administering a mesalamine enema?
* Lubricate or moisten the anus
* Lie on the left side with knees tucked
* Insert the tip and squeeze the bottle
* Stay on the left side for at least 15 minutes
54
What should patients do if they cannot retain the enema overnight?
Keep it in for at least 1 to 2 hours for some benefit
55
What is the purpose of a suppository in the treatment of ulcerative colitis?
To release active medication in the rectum
56
What is the primary use of 5-ASA-containing suppositories?
To treat patients who cannot tolerate or retain enemas by delivering medication to the rectum.
57
How do suppositories release the medication?
They dissolve quickly, leaving a thick pasty material containing the medication.
58
When should suppositories be taken for optimal effectiveness?
At bedtime, although some doctors recommend taking them twice daily.
59
True or False: Suppositories deliver medication higher up in the gastrointestinal tract.
False.
60
What is the traditional medication prescribed for very active or severe IBD?
Steroids.
61
What distinguishes budesonide from other steroids used in IBD treatment?
It has a different action compared to other steroids.
62
What is a major benefit of steroid medications in IBD?
They work very quickly.
63
Name two main drawbacks of steroids in IBD treatment.
* Lack of benefit in preventing disease recurrence
* Potential for side effects.
64
What is the most commonly prescribed oral steroid in North America?
Prednisone.
65
What happens if prednisone is stopped suddenly after long-term use?
Withdrawal symptoms such as weakness, light-headedness, and abdominal pain may occur.
66
What is steroid dependency?
When patients cannot stop taking prednisone without worsening their disease.
67
List three common side effects of prednisone.
* Increased appetite
* Weight gain
* Mood swings.
68
What type of weight gain is associated with prednisone use?
Increase in fatty tissue rather than muscle or lean body mass.
69
What is a common side effect of high doses of prednisone related to mood?
Mood swings.
70
Fill in the blank: The most common side effect of prednisone affecting appearance is _______.
moon face.
71
What are some uncommon but possibly irreversible side effects of long-term steroid use?
* High blood pressure
* Diabetes
* Cataracts
* Osteoporosis.
72
What should patients ensure while on steroids to reduce the risk of bone loss?
Adequate intake of calcium and vitamin D.
73
What condition is characterized by a loss of blood flow to the end of a bone due to steroid treatment?
Avascular necrosis.
74
What is the recommended treatment for early detected avascular necrosis?
Core decompression surgery.
75
True or False: Intravenous steroids can be used in patients who are very sick with IBD.
True.
76
What slight risk is associated with steroid use during pregnancy?
Increased risk of cleft lip or cleft palate.
77
What is the drug therapy of choice for severe attacks of ulcerative colitis?
Intravenous steroid treatment.
78
What should be monitored closely in hospitalized patients receiving intravenous steroids?
Daily examinations and frequent blood tests.
79
What is the drug therapy of choice for severe attacks of ulcerative colitis?
Intravenous steroid treatment
## Footnote
Close monitoring is required for patients receiving this treatment.
80
What are some rescue therapies for patients not responding to intravenous steroid therapy?
Cyclsporine and infliximab
## Footnote
These therapies aim to avoid surgery.
81
What is budesonide and how is it different from other steroids?
Budesonide is quickly broken down into an ineffective by-product once absorbed
## Footnote
It has local effects on the intestine and is used to treat IBD.
82
What are the two forms of oral budesonide available for treating IBD?
Entocort and Uceris (Cortiment MMX in Canada)
## Footnote
These formulations target specific areas of the intestine.
83
What part of the intestine does Entocort target?
Last part of the small intestine (ileum) and first part of the colon (ascending colon)
## Footnote
It is used to treat Crohn’s disease.
84
What part of the intestine does Uceris target?
Throughout the entire colon
## Footnote
It is used to treat ulcerative colitis.
85
What are the typical side effects of budesonide?
Loss of bone density and typical steroid side effects
## Footnote
Monitoring for complications is necessary.
86
What is a key benefit of budesonide compared to conventional steroids?
Much less likely to produce typical steroid side effects
## Footnote
It has a local effect on the intestine.
87
What are the benefits of steroid enemas and suppositories?
Effective for active ulcerative colitis and Crohn’s disease in the rectum
## Footnote
They typically have fewer side effects than oral or intravenous steroids.
88
What is the most commonly used steroid for enemas?
Hydrocortisone (Hycort, Cortenema)
## Footnote
Steroid enemas can also be formulated into suppositories.
89
What condition did Naveen's brother have?
Crohn’s disease
## Footnote
He had surgery within 2 years of diagnosis.
90
What symptoms did Naveen experience that led to his doctor's visit?
Blood in stools, pain and swollen lumps around the anus, mild cramping, and diarrhea
## Footnote
He also lost about 15 pounds.
91
What findings did the blood tests reveal for Naveen?
Anemia and low iron levels
## Footnote
Elevated C-reactive protein level indicated inflammation.
92
What did the colonoscopy reveal about Naveen's condition?
Inflammation and ulcers at the bottom of the rectum, normal large intestine, inflammation in small intestine
## Footnote
Swollen skin tags were also observed.
93
What treatment did the gastroenterologist suggest for Naveen?
Start on prednisone
## Footnote
She also recommended updating his immunizations.
94
True or False: Steroid enemas are generally indicated for the treatment of active ulcerative colitis and not Crohn’s disease.
False
## Footnote
They can also be used for Crohn’s disease involving the rectum.
95
What are some advantages of steroid enemas over oral or intravenous steroids?
Lower dose of medication and localized treatment
## Footnote
This reduces systemic side effects.
96
Fill in the blank: Budesonide is effective at treating _______ flares of Crohn’s disease.
mild
## Footnote
It also treats mild or moderate flares of ulcerative colitis.
97
What is a common side effect experienced by some patients using steroid enemas?
Acne, water retention, and weight gain
## Footnote
These side effects can occur with prolonged use of specific steroids.
98
Which antibiotic is commonly used for Crohn’s disease?
Metronidazole (Flagyl)
## Footnote
Ciprofloxacin (Cipro) is the next most commonly used antibiotic.
99
What type of infections do antibiotics treat?
Bacterial infections
## Footnote
Antibiotics are not needed for viral infections.
100
When are antibiotics particularly useful in Crohn’s disease?
When the large intestine is involved or when complications, such as abscesses or fistulas, have occurred.
101
Are antibiotics usually used for long-term maintenance treatment in Crohn’s disease?
No, they are not usually used for long-term maintenance treatment.
102
Fill in the blank: Scientific studies suggest that normal intestinal bacteria contribute to _______.
intestinal inflammation.
103
True or False: Most doctors believe that antibiotics are effective in selected individuals with Crohn’s disease.
True.
104
What misconception exists regarding antibiotics for illnesses other than IBD?
That antibiotics can cause flares of IBD.
105
What infection can result from antibiotic use in IBD patients?
Clostridium difficile infection.
106
What are the common side effects of metronidazole?
Nausea, vomiting, and an unusual metallic taste.
107
What serious side effect can metronidazole cause when combined with alcohol?
A severe reaction including weakness, sweating, and flushing.
108
Ciprofloxacin is usually well tolerated but may cause an increase in _______.
diarrhea.
109
What is a common side effect of antibiotics in women?
Vaginal yeast infections.
110
Name two immunosuppressant medications commonly used to treat IBD.
* Azathioprine
* 6-mercaptopurine
111
What must immunosuppressant medications be used with caution to avoid?
Overly suppressing the immune system and increasing infection risk.
112
What is the average time it takes for azathioprine or 6-mercaptopurine to take full effect?
3 months.
113
What are the potential serious complications of azathioprine and 6-mercaptopurine?
* Allergic reactions
* Abnormal liver blood tests
* Pancreatitis
* Infection and bleeding complications
114
What is the purpose of ongoing monitoring of blood tests for patients taking azathioprine or 6-MP?
To detect abnormalities and adjust medication as needed.
115
What enzyme is measured to assess the metabolism of azathioprine and 6-MP?
Thiopurine methyltransferase (TPMT).
116
The risk of lymphoma associated with azathioprine and 6-MP is considered to be _______.
minimal.
117
Fill in the blank: The use of azathioprine may increase the risk of _______ cancer.
skin.
118
How long would azathioprine need to be taken for someone aged 20-29 to observe one extra case of lymphoma?
More than 4,300 years.
119
True or False: Azathioprine and 6-MP are considered a cure for IBD.
False.
120
What is the risk of lymphoma associated with azathioprine or 6-MP?
The risk is extremely small; it would take more than 4,300 years for someone aged 20-29 to observe one extra case of lymphoma.
121
Are azathioprine and 6-MP cures for IBD?
No, they are not cures; the disease can recur when treatment stops.
122
What does methotrexate interfere with in the body?
It interferes with the production of DNA, reducing the formation of new immune reactive cells.
123
How is methotrexate typically administered for chronic inflammatory disorders?
Usually taken once per week, either by mouth or by injection.
124
What are common side effects of methotrexate?
Nausea and vomiting, especially on the day it is taken.
125
What can reduce nausea from methotrexate?
* Taking the drug in the evening before bed * Taking folic acid * Taking an antinausea medication
126
Is methotrexate effective in ulcerative colitis?
It is not clear whether methotrexate is effective in ulcerative colitis.
127
What serious side effect requires monitoring during methotrexate treatment?
Liver damage.
128
What side effect can occur in patients receiving methotrexate related to the lungs?
Allergic pneumonia.
129
What is cyclosporine primarily used for?
To prevent rejection in transplant patients and to control severe disease flares in ulcerative colitis.
130
What is the initial method of administration for cyclosporine?
Continuous intravenous infusion.
131
What are the potential serious side effects of cyclosporine?
* Serious infections * Kidney damage * High blood pressure * Tremor * Seizure * Increased hair growth
132
Why is cyclosporine not used early in ulcerative colitis treatment?
Due to its potential to cause serious side effects.
133
What infections can cyclosporine increase susceptibility to?
Unusual or rare infections that could be fatal if not detected early.
134
What is a significant consideration when administering cyclosporine?
Monitoring blood levels to reduce the risk of kidney damage.
135
What distinguishes non-biologic (small-molecule) drugs from biologic drugs?
Non-biologics are smaller, not proteins, and can be absorbed when taken orally.
136
What is a key benefit of non-biologic drugs regarding antibody production?
They do not trigger the immune system to produce antibodies against them.
137
What do Janus kinase (JAK) inhibitors target?
The enzyme JAK involved in regulating the body’s immune response.
138
What was the first JAK inhibitor approved for IBD?
Tofacitinib (Xeljanz).
139
What are the benefits of tofacitinib in ulcerative colitis?
* Reduces inflammation * Controls flares * Decreases chance of future flares if continued
140
What is a common side effect associated with tofacitinib?
Increased risk of infection.
141
What infection has been observed more frequently in patients taking tofacitinib?
Shingles.
142
What is the primary characteristic of biologic drugs?
They are proteins or parts of proteins that target specific molecules involved in inflammation.
143
What was the first biologic therapy approved for IBD?
Infliximab (Remicade).
144
Why must biologic drugs be administered via injection or infusion?
They are large proteins that cannot be absorbed if taken orally.
145
What is a potential drawback of biologic drugs related to the immune system?
Patients may develop antibodies against the biologic drug.
146
What can develop against a biologic drug due to its foreign nature?
Antibodies can develop against it
## Footnote
This is how the immune system protects against infections by producing antibodies against foreign proteins.
147
What are TNF-alpha blockers often referred to as?
TNF inhibitors or anti-TNF therapies
## Footnote
These are biologic drugs designed to block the effects of tumor necrosis factor alpha.
148
Name three TNF-alpha blockers mentioned in the text.
* Adalimumab
* Golimumab
* Certolizumab
## Footnote
These drugs have been tested for IBD and are available in many countries.
149
What is Infliximab composed of?
Part human protein and part mouse protein
## Footnote
It is produced using genetic technology and attaches to TNF-alpha.
150
How is Infliximab administered?
Intravenous infusions
## Footnote
It cannot be taken by mouth due to being a protein.
151
What is the typical initial treatment regimen for Infliximab?
One or two infusions given 2 to 4 weeks apart
## Footnote
Some may follow a standard three-dose induction regimen.
152
What is the usual dosing frequency for maintaining Infliximab treatment after initial response?
Every 6 to 8 weeks
## Footnote
This helps maintain the improvement achieved with initial treatment.
153
What is a potential risk when Infliximab treatment is stopped?
Increased risk of recurrent symptoms
## Footnote
Clinical experience indicates flares tend to occur more often after stopping treatment.
154
What significant outcome can repeated dosing of Infliximab achieve?
Complete healing of the inner lining of the intestine
## Footnote
This is not consistently observed with other medical therapies.
155
What are antidrug antibodies?
Antibodies directed against Infliximab
## Footnote
They can increase the risk of side effects and reduce the duration of the drug's effectiveness.
156
What is the risk of serious side effects from TNF-alpha blockers like Infliximab?
About 1 chance in 5,000
## Footnote
This is a low risk compared to the potential need for surgery without proper medication.
157
What is the most common side effect during Infliximab infusion?
Acute infusion reaction
## Footnote
Occurs in 5% to 10% of patients, often involving flushing and chest tightness.
158
What infection risk is associated with Infliximab treatment?
Increased susceptibility to tuberculosis
## Footnote
Patients are often tested for tuberculosis before starting treatment.
159
What is the recommendation for infants whose mothers received TNF-alpha blockers during pregnancy?
Avoid live vaccines during the first 6 to 9 months
## Footnote
This is due to the potential risk of the infant's immune system being suppressed.
160
What is the definitive exception among IBD drugs regarding safety in pregnancy?
Methotrexate
## Footnote
It has been shown to cause spontaneous abortions and fetal malformations.
161
What is the effect of Infliximab on fistulas due to Crohn’s disease?
It causes fistulas to stop draining
## Footnote
This was previously a complication without proven effective treatment.
162
True or False: Infliximab is a cure for Crohn’s disease.
False
## Footnote
It is a treatment, not a cure, and works only as long as it is taken.
163
What should patients receiving Infliximab report to their doctor?
Any unusual symptoms, such as cough or severe headache
## Footnote
Especially if these symptoms are associated with a fever.
164
What happens to the levels of Infliximab in the bloodstream when antibodies develop?
They are much too low or undetectable
## Footnote
This can lead to a decrease in the perceived beneficial effect of the drug.
165
Why do infants not receive live vaccines during the first 6 to 9 months of life?
Because a baby’s immune system could potentially be suppressed and a live vaccine could cause an infection
## Footnote
This is particularly relevant if their mothers were taking certain drugs in the last trimester of pregnancy.
166
What drugs raise questions about whether they should be stopped during the final months of pregnancy?
Infliximab, adalimumab, and golimumab
## Footnote
These are TNF-alpha blockers used for treating inflammatory bowel disease (IBD).
167
What is the potential risk of stopping TNF-alpha blockers during pregnancy?
The risk of IBD flare increases the longer the woman is off treatment
## Footnote
Restarting therapy may also increase the risk of allergic reactions and reduce long-term effectiveness.
168
Which TNF-alpha blocker does not appear to cross over to the baby’s circulation during pregnancy?
Certolizumab pegol (Cimzia)
## Footnote
This characteristic may provide a theoretical advantage over infliximab and adalimumab during pregnancy.
169
What are the concerns regarding the long-term safety of infliximab?
There are reservations about possible long-term effects that may only become apparent after many years of use
## Footnote
Infliximab has been associated with an increased risk of lymphoma.
170
What type of lymphoma has been linked to the use of TNF-alpha blockers?
A rare form of lymphoma occurring primarily in young males
## Footnote
This risk is associated with the combination of TNF-alpha blockers and immune-suppressive drugs.
171
How does adalimumab differ from infliximab in terms of its composition?
Adalimumab is an entirely human antibody, whereas infliximab contains some mouse protein
## Footnote
This makes adalimumab less likely to trigger antibody formation against the drug.
172
What is the administration frequency for adalimumab?
Every 1 to 2 weeks
## Footnote
This is in contrast to infliximab, which is given by intravenous infusion.
173
What is the typical administration schedule for golimumab?
Initially twice in 2 weeks, then once every 4 weeks
## Footnote
Golimumab is not approved for the treatment of Crohn’s disease but is used for ulcerative colitis.
174
What is unique about certolizumab pegol compared to other TNF-alpha blockers?
It is only a fragment of an antibody attached to PEG to slow elimination
## Footnote
This drug is effective in treating Crohn’s disease but is only approved in the US and Switzerland.
175
What is vedolizumab specifically developed to treat?
Only inflammatory bowel disease (IBD)
## Footnote
It prevents white blood cells from entering the intestine but does not suppress the entire body's immune system.
176
How often is vedolizumab administered?
Usually every 8 weeks, occasionally every 4 weeks
## Footnote
It is given by intravenous infusion.
177
What proteins does ustekinumab block to reduce inflammation in Crohn’s disease?
Interleukin-12 and interleukin-23
## Footnote
This action helps control flare symptoms.
178
What is a significant benefit of ustekinumab in Crohn’s disease treatment?
It helps reduce steroid use or allows patients to stop steroids completely
## Footnote
This is particularly beneficial for patients not experiencing significant improvement with steroids.
179
What are biosimilars?
Highly similar drugs that replicate many aspects of a specific biologic drug
## Footnote
They are not true generics due to the complexity of biologic drugs.
180
What must a biosimilar prove to be approved for use?
It must be highly similar to the original biologic drug regarding chemical structure and biological properties
## Footnote
Clinical trials are often required to confirm its effectiveness and safety.
181
What is the potential advantage of biosimilars in drug treatment for IBD?
They are generally less costly than originator biologic drugs
## Footnote
This can help limit the increasing costs associated with IBD treatment.
182
What is the concern for patients switching from an originator biologic to a biosimilar?
Patients may be unwilling to switch due to fear of risking their current treatment success
## Footnote
This concern often arises even if switching is deemed safe.
183
What concerns do individuals with IBD have regarding switching from originator biologics to biosimilars?
They worry about the potential risk of an IBD flare despite it being safe, especially when they are doing well on their current medication.
## Footnote
Patients may question the necessity of switching solely for insurance cost savings.
184
What are the potential cost benefits for individuals considering switching to biosimilars?
Cost benefits may include lower out-of-pocket expenses or avoiding a lifetime cap on drug spending.
## Footnote
These benefits can be significant for those paying for medications.
185
What are the complexities involved in the causes of inflammation in IBD?
The causes are complicated and involve multiple steps in controlling inflammation and repairing damaged tissues.
## Footnote
Understanding these complexities may guide future treatment developments.
186
How are bacteria related to the development of IBD?
Bacteria in the intestine are linked to IBD; animal models show that bacteria are necessary for colitis to occur.
## Footnote
Humans with IBD have different bacterial profiles compared to those without.
187
What is the gut microbiome?
The gut microbiome is the community of bacteria in the intestine involved in the development of IBD.
## Footnote
Altering the gut microbiome is a target for IBD therapies.
188
What are probiotics?
Probiotics are bacteria believed to have health-promoting properties, available in various products containing live or dormant bacteria.
## Footnote
They can be single strains or combinations aimed at maximizing health benefits.
189
What has research shown about the effectiveness of E. coli Nissle in IBD?
E. coli Nissle has shown effectiveness in reducing the chance of flare-ups in patients with ulcerative colitis in remission, similar to 5-ASA medications.
## Footnote
Results have been inconsistent across different studies.
190
What is VSL#3 and its significance in IBD treatment?
VSL#3 is a probiotic powder containing eight bacterial strains, studied for preventing pouchitis in patients with surgically created pouches after colectomy.
## Footnote
It has shown some effectiveness in reducing pouchitis symptoms.
191
What are the limitations of probiotics in treating IBD?
Limited evidence supports probiotics' effectiveness in improving outcomes in ulcerative colitis or Crohn’s disease, despite their perceived safety.
## Footnote
Many patients report mixed experiences with probiotics.
192
What is fecal microbial transplantation (FMT)?
FMT involves transplanting a healthy person's gut bacteria into someone with IBD to normalize their microbiome and control symptoms.
## Footnote
Variability in donor selection and administration methods complicates study results.
193
What are the safety concerns associated with FMT?
Safety concerns include the potential transmission of disease-causing bacteria or viruses from the donor.
## Footnote
Donor screening helps minimize but does not eliminate these risks.
194
What advancements have been made in FMT preparations?
Freeze-dried FMT preparations allow for longer storage of live bacteria before administration.
## Footnote
This addresses logistical challenges in coordinating FMT procedures.
195
What is complementary and alternative medicine (CAM)?
CAM encompasses non-traditional therapies used to manage IBD, including methods like marijuana and massage.
## Footnote
Up to half of IBD patients may try CAM therapies at some point.
196
What are some common plant-derived therapies used in CAM for IBD?
* Aloe vera
* Bilberry
* Boswellia
* Curcumin
* Evening primrose oil
* Marijuana
* Slippery elm bark
* Thunder god vine
* Wheat grass
* Wormwood
## Footnote
These therapies are thought to have anti-inflammatory properties.
197
What are some mind-body therapies used in CAM?
* Cognitive therapy
* Guided imagery
* Hypnotherapy
* Mindfulness
* Relaxation techniques
* Stress management
## Footnote
These therapies focus on the connection between mental and physical health.
198
What role does marijuana play in the treatment of IBD?
Marijuana may help alleviate symptoms like nausea and abdominal pain but does not reduce intestinal inflammation.
## Footnote
Its effects are primarily on the brain rather than direct healing of the intestine.
199
What is a notable case study related to CAM and IBD?
Rebecca, a 34-year-old diagnosed with Crohn's disease, sought CAM therapies after conventional treatments were ineffective, finding marijuana helpful for symptom relief.
## Footnote
Her experience highlights the exploration of alternative treatments when traditional options fail.
200
What are some forms of Complementary and Alternative Medicine (CAM)?
* Acupuncture and moxibustion
* Exercise-based therapies
* Massage therapy
* Fecal microbial transplantation
* Probiotic therapies
* Dietary therapies, such as fish oil supplementation
## Footnote
These therapies are discussed in other sections of the book.
201
What was the finding of a study using a cannabinoid derivative of marijuana on Crohn's disease symptoms?
No significant impact on Crohn’s disease symptoms.
202
What are mind-body therapies?
* Mindfulness
* Hypnotherapy
* Cognitive therapy
* Stress management
* Relaxation techniques
* Guided imagery
* Mind-body training
## Footnote
These therapies generally improve depression and anxiety but may not affect intestinal inflammation.
203
What did studies find about acupuncture and moxibustion in IBD?
Some studies demonstrated improvement in bowel symptoms, but the effect on inflammation is unclear.
204
What is the most commonly used clinical study design?
Randomized controlled trial.
205
In a randomized controlled trial, how are patients assigned to treatment groups?
Randomly assigned, such as by the flip of a coin.
206
What is the purpose of blinding in clinical trials?
To ensure participants and doctors do not know which group an individual has been assigned to.
207
What safeguards are in place for participants in clinical trials?
Informed consent documents detail risks, benefits, and rights.
208
What are newer types of study designs comparing in clinical trials?
Treatment strategies that may include different medications and laboratory testing.
209
What should a participant understand about their obligation to participate in a study?
They should not feel obliged, and their care will not be affected if they choose not to participate.
210
What is the aim of clinical research in IBD?
To find and develop new treatments for IBD and determine the best existing treatments.
211
What are some reasons people participate in clinical research?
* Chance to try new therapies
* Advance research
* Close follow-up and monitoring
## Footnote
These reasons may vary among participants.
212
What is a question to ask about a clinical study's purpose?
What is the purpose of the study?
213
What is an important aspect of IBD management beyond medication?
Surgery.
214
How should the need for surgery in IBD be viewed?
Not necessarily a failure of the patient, family, or healthcare team.
215
What benefits can surgery provide for IBD patients?
Relief from symptoms that may not be possible using medications.
