Tuesday, 3 December 2013

Colitis as a result of Inflammatory bowel disease (IBD) - The Conventional medicine Treatments

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
A. In conventional medicine perspective
Treatments in the conventional medicine is depending to the types of colitis.
A.1. Inflammatory bowel disease (IBD)
A.1.1. Non surgical therapy
1. Self care at home
a. Through home telemanagement
In a a randomized, controlled trial to evaluate a home telemanagement system for UC (UC HAT) on disease activity, quality of life (QoL), and adherence compared to best available care (BAC), showed that UC HAT did not improve disease activity, QoL, or adherence compared to BAC after 1 year,  but after adjustment for baseline disease knowledge, UC HAT trial completers experienced significant gains in disease-specific QoL from baseline compared to BAC trial completers. The results suggested a potential benefit of UC HAT. Further research is indicated to determine if telemedicine improves outcomes in patients with IBD(77).

b. Web-guided therapy
In the study to test the thesis: 1) In a European evidence based consensus to assess the IBD patients' need for Quality of Health Care (QoHC); 2) To validate the influence of a Patient Educational Center (PEC) and a web-based treatment solution program, www.constant-care.dk, on patients' disease self-management, adherence, Quality of Life, and disease course after 1 year of self-initiated 5-ASA treatment. UC patients in a conventional out-patient setting were used as controls; 3) To validate two new quantitative rapid tests (RT scanning and HT photo) for Faecal Calprotectin (FC) measurement, and to assess whether HT photo can be useful as a home test to help the patients deciding on self-initiated treatment, found that the new rapid home test (HT photo) was accurate and comparable with the Enzyme-Linked Immunosorbent Assay (ELISA) with a 90% specificity and a 96% sensitivity. The rapid test can be useful in clinical settings concerning disease self-monitoring at home, which would decrease the use of endoscopy in some cases. The findings corresponded well with action plan for a European e-Health Area and could be a helpful tool to provide more efficient health care for UC patients. Widespread implementation of the "Constant-Care" is possible, but it may require a reshaping of the current health care for IBD patients both legally and economically. It may also empower patients in disease self-management and reduce dependency on doctors(78).

3. Pain management
Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. According to the study byUniversity Clinic of Essen, University of Duisburg-Essen,  there is growing evidence linking peripheral and mucosal immune changes and abdominal pain in IBS, supporting disturbed peripheral pain signalling. Findings in post-infectious IBS emphasize the interaction between centrally-mediated psychosocial risk factors and local inflammation in predicting long-term IBS symptoms. Investigating afferent immune-to-brain communication in visceral hyperalgesia as a component of the sickness response constitutes a promising future research goal(78a).

4. Biological therapy, including aminosalicylates, corticosteroids, immune modifiers, anti-tumor necrosis factor (TNF) agents, antibiotics, etc.
a. According to the study conducted by Helsinki University Central Hospital, with questionnaire rerponse including demographic questions and questions about IBD patients' use of biological medications, indicated that the use of antidepressants (OR: 1.44, 95% CI: 1.28-1.61), anxiolytics (OR: 1.52, 95% CI: 1.31-1.78), oral bisphosphonates (OR: 6.08, 95% CI: 4.56-8.11), cardiovascular medications (OR: 1.38, 95% CI: 1.24-1.54), antibiotics (OR: 4.01, 95% CI: 3.57-4.51), proton pump inhibitors (OR: 3.90, 95% CI: 3.48-4.36), and nonsteroidal anti-inflammatory analgesics (OR: 1.17, 95% CI: 1.07-1.28) was significantly more common in IBD than among the controls. The study also said that those who used antidepressants, anxiolytics, or analgesics had significantly impaired HRQoL (p < 0.001)(79a). 
Also in the study of one hundred and twenty-five patients fulfilled the inclusion criteria who were issued questionnaires, of these 78 questionnaires were returned (62 percent response), showed that  33 patients (42 percent) preferred infliximab and 19 patients (24 percent) preferred adalimumab (p = 0.07). Twenty-six patients (33 percent) did not indicate a preference for either biological therapy and were not included in the final analysis. The commonest reason cited for those who chose infliximab (iv) was: "I do not like the idea of self-injecting," (67 percent). For those patients who preferred adalimumab (sc) the commonest reason cited was: "I prefer the convenience of injecting at home," (79 percent). Of those patients who had previously been treated with an anti-TNF therapy (n = 10, all infliximab) six patients stated that they would prefer infliximab if given the choice in the future (p = 0.75)(79). Other study indiacted that the anti-TNF╬▒ inhibitors represent a momentous advance in the treatment of Crohn's disease and ulcerative colitis refractory to conventional treatments. They offer significant benefits in quality of life and mucosal healing, and may have the potential to change the evolution of the disease when given early(80).
Treatment with anti-TNF antibodies is accompanied by sexual dimorphic profile of ADR with female patients being more at risk for allergic reactions and subsequent discontinuation of the treatment, according to the department of Gastroenterology and Hepatology, Erasmus MC University Medical Center(81).

b. Side effects
Side of below medication are not limit to
b.1. Aminosalicylates
Side effects include Trouble breathing, Hives, Swelling of your face, lips, tongue, or throat, etc.

b.2. Corticosteroids
According to the study by, Short-term corticosteroid use is associated with generally mild side effects, including cutaneous effects, electrolyte abnormalities, hypertension, hyperglycemia, pancreatitis, hematologic, immunologic, and neuropsychologic effects, although occasionally, clinically significant side effects may occur. Long-term corticosteroid use may be associated with more serious sequel, including osteoporosis, aseptic joint necrosis, adrenal insufficiency, gastrointestinal, hepatic, and ophthalmologic effects, hyperlipidemia, growth suppression, and possible congenital malformations(81a).

b.3. Immune modifiers
Side effects include flu-like symptoms including fever, chills, nausea, appetite loss, etc.

b.4. Anti-tumor necrosis factor (TNF) agents
b.4.1. Infliximab-induced or-exacerbated psoriatic lesions(82)
b.4.2. A rare cancer of white blood cells
b.4.3. Risk of opportunistic infections
b.4.4. TB and fungal infection

b.5. Antibiotics
Side effects include dry eyes, mouth and skin,  ringing in his ears,  delayed urination, uncontrollable shaking, etc.

5. Probiotics
According to the study by the University of Washington, Seattle, in a an altered or pathogenic microbiota causes inflammation in a genetically susceptible individual, indicated that Probiotics have some efficacy in the treatment of ulcerative colitis (UC), but our current repertoire is limited in potency. Fecal microbiota therapy (FMT) is an emerging treatment for several gastrointestinal and metabolic disorders. It has demonstrated efficacy in treating refractory Clostridium difficile infection, and there are case reports of FMT successfully treating UC(82).

6. Etc.

A.1.2. Surgical treatments
In certain cases, surgical treatment may be necessary depending to type of colitis and patient's condition.
1. Colectomy
Colectomy  is a surgical treatment in removing the colon. In the study using the University of Manitoba Inflammatory Bowel Disease Epidemiology Database, a population-based data set including UC patients with up to 25 years of post diagnosis follow-up, found that the cumulative incidence of colectomy in UC is lower than previously reported, and appears to be decreasing further among more recently diagnosed cohorts of patients. Male sex and hospitalization at the time of diagnosis are major risk factors for EC and LC(83)
But according to the study by Division of Gastroenterology and Hepatology, Mayo Clinic, patients with moderately to severely active ulcerative colitis treated with infliximab were less likely to undergo colectomy through 54 weeks than those receiving placebo(84).

2. Proctocolectomy and Ileostomy
Proctocolectomy is a surgical procedure to remove the entire colon and rectum. Ileostomy is a surgical opening constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin(85). According to the study by the University of Chicago Medical Center, totally laparoscopic total proctocolectomy is therefore considered a safe alternative to open surgery for selected IBD patients not candidates for a restorative procedure(86).
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(77) http://www.ncbi.nlm.nih.gov/pubmed/21688350
(78) http://www.ncbi.nlm.nih.gov/pubmed/22759851
(78a) http://www.ncbi.nlm.nih.gov/pubmed/21094682
(79a) http://www.ncbi.nlm.nih.gov/pubmed/23163864
(79) http://www.ncbi.nlm.nih.gov/pubmed/20064220
(80) http://www.ncbi.nlm.nih.gov/pubmed/21175228
(80a) http://www.ncbi.nlm.nih.gov/pubmed/23322995
(81) http://www.ncbi.nlm.nih.gov/pubmed/22767007
(81a) http://www.ncbi.nlm.nih.gov/pubmed/11588541
(82) http://www.ncbi.nlm.nih.gov/pubmed/23034604
(83) http://www.ncbi.nlm.nih.gov/pubmed/22613902
(84) http://www.ncbi.nlm.nih.gov/pubmed/19596014
(85) http://en.wikipedia.org/wiki/Ileostomy
(86) http://www.ncbi.nlm.nih.gov/pubmed/21761510

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