Tuesday, 3 December 2013

Microscopic colitis - Treatments in Conventional medicine

Colitis is defined as a condition of inflammation of the large intestine, including the colon, caecum and rectum.
A. In conventional medicine perspective
Microscopic colitis
Since certain medication such as nonsteroidal, anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) may induced the diseases, it is the best of the aptients to exclude them before taking any medicine.
A.2.1. Non surdical treatments
1.  Corticosteroids
The incidence of microscopic colitis and its disease burden are increasing, according to the study by the University of Calgary, both short- and long-term treatment with budesonide is effective and well-tolerated for microscopic colitis. However, the rate of symptom relapse once budesonide is discontinued is high(87). Othe rrecent study indicated that a strong evidence has added new pharmacological options for the treatment of microscopic colitis: the role of steroidal therapy, especially oral budesonide, has gained relevance, as well as immunosuppressive agents such as azathioprine and 6-mercaptopurine(89).

2. Antacids and adsorbents
In the study of thirteen patients with microscopic colitis (7 with subepithelial collagen deposition and 6 without) treated with eight chewable 262-mg bismuth subsalicylate tablets per day for 8 weeks, conducted by Baylor University Medical Center, found that Bismuth subsalicylate treatment for 8 weeks is safe and well tolerated. This regimen appears to be efficacious for the treatment of microscopic colitis and is worthy of further study in a controlled trial(88).

3. Anti-tumor necrosis factor (TNF) agents
The use of anti-tumor necrosis factor-α agents, infliximab and adalimumab, constitutes a new, interesting tool for the treatment of microscopic colitis, but larger, adequately designed studies are needed to confirm existing data(89).

4. Side effects are not limit to
a.  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. 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

c. Antacids and adsorbents
Side effects include a chalky taste, mild constipation or diarrhea, thirst, stomach cramps, etc.

A.2.2. Surgical treatment
In rare case, sugical treatment may be necessary for patients with microscopic colitis if patients are not respond to medication treatment, depending to the patients conditions. 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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(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
(86a) http://www.ncbi.nlm.nih.gov/pubmed/2909876
(86b) http://www.ncbi.nlm.nih.gov/pubmed/1595655
(87) http://www.ncbi.nlm.nih.gov/pubmed/21699817
(88) http://www.ncbi.nlm.nih.gov/pubmed/9428215
(89) http://www.ncbi.nlm.nih.gov/pubmed/23180940

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