Date post: | 16-Jul-2015 |
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Healthcare |
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Developed nation 10-40 yrs Fast food, animal fat, refined
carbohydrate Smoking NSAIDs Stress Microflora
……???
1. 16TH chromosome……CARD15/NOD2
2. IL-23 R gene
……..+Mutations
Inflammatory bowel disease
How to treat….
Crohn’s disease
Ulcerative colitis
Pathogenesis
Actual cause unknown Immune mediated
Chronic inappropriate inflammatory response with relapse and remissions
Treatment …
1. Nutritional therapy
2. Drug treatment
Nutritional treatment
Fe and Ca supplements Vitamins Minerals Low fibre diet Low lactose diet Total parenteral nutrition regimen
(severe cases)
Mode of treatment
Active cases (for inducing remission) – steroids
Maintenance of remission phase-aminosalicylates, azathioprine
Drug treatment
1. Steroids2. Aminosalicylates3. Purine analogues
Steroids Prednisolone 40mg/day Highly effective in controlling
symptoms/inducing remission in both ulcerative colitis and crohn’s disease
DOC in moderately severe exacerbations
Hydrocortisone enema/foam---topical treatment of proctitis and distal ulcerative colitis
Steroids are discontinued after remission is induced
Mesalazine is started during steroid therapy is continued to prevent relapses
Aminosalicylates
1. Sulfasalazine 2. Mesalazine
3. Olsalazine4. Balsalazine
Sulfasalazine
5-ASA + Sulfapyridine Low solubility Poorly absorbed from
ileum Sulfapyridine-only helps
to carry 5ASA to colon without being absorbed proximally
MOA
Inhibits COX,LOX. ….Cytokines,PAF,TNF-alpha,nuclear
transcription factor(NFKB) Reduce migration of inflammatory
cells Reduce mucosal secretions
Effects
Reduce no. of stools,abdominla cramps,and fever
Use
Mild to moderate exacerbations 3-4g/day……..induce remission for
few weeks Relapse common after stoppage Maintenance therapy-1.5-2g/day…
postpones relapse as long as taken Main use –maintaining
remission
ADR
Due to sulfapyridine absorbed1. Rashes2. Fever3. Joint pain4. Hemolysis5. Blood dyscrasias6. NV,headache,malaise also7. Oligospermia8. Male infertility
Mesalazine/mesalamine
5-ASA Not effective orally- Delayed release preparations by
coating with acrylic polymer Effectively deliver to distal small
bowel and colon
Daily dose-2.4g for ulcerative colitis Primary use —maintenance of
remission Mild to moderate exacerbations
ADR
Nephrotoxic Contraindicated in renal and hepatic
impairment DI- coated mesalazine may
enhance the gastric toxicity of steroids and hypoglycemicaction of sulphonylureas
5-ASA enemas 1-2g once /twice daily…..distal
ulcerative colitis, including refractory cases
Olsalazine
2 molecules of 5-ASA linked by an azo bond
Most reliable preparation of delivery of 5-ASA to the colon
But it aggravates diarrhoea
Azathioprine
Delayed response occurs after weeks or months
Lower toxicity Moderate to severe crohn’s disease
and ulcerative colitis Useful in steroid resistant cases Good remission maintenance
property
Azathioprine---6mercapto purne in liver
Inhibit purine nucleotide----inhibit lymphocyte function esp. Tcells
Thank u……….
Gopisankar.M.G.2008 MBBS