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Abdominal pain 85 |
Weight loss 52 |
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Growth retardation 46 |
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Anorexia 75 |
Perianal abnormality 46 |
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Tender abdomen 34 |
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Finger clubbing 8 |
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Tenesmus 25 |
Mouth ulcers 8 |
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Perianal symptoms 25 |
Abdominal mass 6 |
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Nausea/vomiting 22 |
Erythema nodosum 6 |
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Fever 22 |
Peripheral oedema 6 |
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Constipation 20 |
Uveitis 4 |
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Joint pains 10 |
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Smoking and IBD
An article in the NZ Herald was brought to our attention by CCSG member Jan Fiolitakis and we thought it was worth a response. For those of you that didn't see it the first paragraph was as follows...
"Doctors in Britain have discovered that nicotine patches, usually used to wean people off cigarettes, may be able to relieve symptoms of the bowel inflammation known as ulcerative colitis."
Half of the patients receiving the treatment (the equivalent of 15 to 25 cigarettes a day) reported a reduction in colitis symptoms after 6 weeks. However, they continued to take their normal colitis medication during the test and this could also have been responsible for their improved state of health.
There were some side effects of taking the patch medication. Patients who had never been smokers found the treatment difficult to tolerate and altered their dose accordingly. However, none of the patients reported craving a cigarette or feeling any withdrawal symptoms after the end of the trial.
This use of nicotine treatment for colitis is disputed. An editorial in the New England Journal of Medicine (Vol 330, No 12, 1994) suggests that there is "less than compelling proof of an anti-inflammatory effect of nicotine." The continued use of regular colitis drugs and the absence of a dose effect means the mechanism of the effect of nicotine is difficult to establish.
Conclusion: The "smoking gun" clue to the mysteries of
ulcerative colitis remains well hidden.
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Interferon alpha in Ulcerative
Colitis
First-line therapy with the immunosuppressant interferon-alpha-2a 'dramatically' improved the condition of 26/28 patients with refractory moderate or severe chronic ulcerative colitis in a Turkish study. All the patients in the study had previously failed to respond to Pentasa (mesalasine) or corticosteroids such as prednisone. In the Turkish study, the patients received subcutaneous injections of interferon-alpha-2a 3 times a week for 6-12 months.
Clinical remission was achieved within 6 months of beginning therapy in 26 of the patients. Symptoms began to improve as early as 7 days after the initiation of therapy. Not only were symptoms improved, but endoscopic examination of the colon showed that the mucosa (lining) was almost normal in appearance. The 2 patients who did not respond to interferon-alpha-2a also did not respond to subsequent treatment with other immunosuppressants. No serious or unexpected side effects were observed during the study, and no patient had a relapse in the 6-30 months after completion of interferon-alpha-2a therapy in patients with complete remission.
Although these results sound positive, other studies have not had such good results with interferon in patients with ulcerative colitis. In addition, the drug needs to be given by injection, which may not appeal to all patients. Interferon-alpha is also expensive. Nevertheless, patients who do not respond to other treatments may be treated successfully with this immunosuppressant agent.
Pregnancy and Crohn's Disease
The incidence of Crohn's disease peaks in the second and third decades of life. Pregnancy does not appear to affect Crohn's disease, but disease activity before and during the pregnancy has been shown to directly influence the outcome of the pregnancy.
In a recent US study, 3/17 pregnant Crohn's disease patients delivered their babies prematurely (before 33 weeks' gestation); 2 of these had had no disease activity during pregnancy. Overall 7 patients had disease flare-ups during pregnancy or soon after delivery. This consisted of recurrent diarrhoea in 5 patients. Seven patients took medication during pregnancy, including prednisone, with no adverse effect on the baby.
There was concern about possible complications with a normal delivery in the patients with perianal disease. In the only patient with perianal disease who had a normal delivery, disease was unaffected. None of the other 7 patients with normal delivery developed perianal disease. Caesarean section was performed in 9 patients, 4 of whom had perianal disease. However, recurrent perianal symptoms developed in 3 of these patients after delivery. Thus, the route of delivery should be based on obstetric indications and not merely on Crohn's disease history recommend the authors of the study. Their other advice is that disease symptoms should be brought under control to minimise the risk of premature delivery and problems during pregnancy.
Crohn's Disease on Increase
The results of a retrospective study of the incidence of paediatric IBD over an 11 year period have recently been made public. The research, undertaken at the University Hospital of Wales in Cardiff, revealed that the incidence of Crohn's disease more than doubled from 1.3 cases per 100,000 childhood population per year in the period 1983-1988, to 3.11 cases per 100,000 population per year in the period 1989-1993. In contrast, the incidence of ulcerative colitis remained the same throughout the the study period at 0.71 per 100,000 per year. Results from an English study in 1983 showed similar trends.
These findings are in direct contrast to figures published in the mid-80s on children in Scandanavia. The annual incidence of Crohn's disease was only 2.5 per 100,00 per year, but the incidence of ulcerative colitis was much greater at 4.3 per 100,000 per year. In Norway and Sweden the incidence of ulcerative colitis was greater than that of Crohn's disease. The reasons for such a variation in the incidence of Crohn's disease in some areas is unknown.
In 1993 the prevalence of Crohn's disease in the childhood population of Wales was 16.6 per 100,000 and of ulcerative colitis, 3.42 per 100,000.
What is the role of nutrition in ulcerative
colitis ?
A contribution to the current status of diet therapy in treatment of inflammatory bowel diseases
Nutritional therapy for ulcerative colitis (UC) is controversial. Studies are usually designed to investigate total parenteral (TPN) or total enteral nutrition (TEN), and before these can be compared it is necessary to differentiate between the different therapeutic aims. The aims of artificial nutritional support in patients with UC are the readjustment of the nutritional status, possible remission of disease activity, and decrease in the incidence of surgical intervention or postoperative complication.
Owing to the heterogeneity of the results published so far, it is still difficult to compare studies. Nevertheless, they indicate that the extent and severity of the colitis and the patient selection are of paramount importance in the implementation of nutritional therapy. Positive effects of TPN reported from non-controlled studies were not confirmed by controlled trials. Moreover, TPN was no more effective than an oral diet.
Regarding remission rates or operative interventions needed, TPN had more side effects than and no defined advantages over TEN. TEN seems to be useful for certain patients. In some patients with UC, it seems to be accompanied by fewer postoperative complications. However, a definitive conclusion on the effects of TEN or TPN is not yet possible.
In this context, certain fatty acids may have an important role in the treatment of UC. In prospective, randomised and controlled studies omega-3 fatty acids were found to be therapeutically useful. A reduction of the steroid doses needed is particularly important.
Another therapeutic approach in distal UC is seen in the rectal administration of short chain fatty acids.
Fish Oil in the Treatment of Crohn's
Disease
Enteric-coated capsules of fish oil appear to reduce the frequency of relapse in patients with Crohn's disease, according to a report in The New England Journal of Medicine June 13, 1996.
Researchers led by Dr. Andrea Belluzzi of the University of Bologna in Italy conducted a double-blind, placebo-controlled trial that involved 78 Crohn's disease patients who were especially prone to relapse. Subjects were assigned to take nine capsules of the fish oil or placebo daily for one year. The daily dose of n-3 fatty acids in the fish oil was 2.7 grams.
Dr. Belluzzi reported that 28% of patients in the fish-oil group versus 69% in the placebo group experienced relapses. And, after one year of therapy, 59% of patients taking the "novel" fish-oil preparation, versus 26% in the placebo group, remained in remission.
It remains speculation as to how the fish oil may actually work, although the Italian researchers have several theories which are to be tested in the future.
The enteric coating remains intact for about 30 minutes after ingestion, which spares exposure of the capsule contents to gastric acid and allows the fish oil to reach the inflamed bowel area. Some patients, Dr. Belluzzi notes, developed diarrhoea - possibly because the enteric coating did not dissolve until after it had reached the distal colon, where the fish oil seemed to have a laxative effect.
In an accompanying editorial, Dr. Humphrey J. Hodgson, of Hammersmith Hospital in London, U.K. points out that the patients in this study had low-grade inflammatory activity even though they were in remission. He thinks it's possible that the fish oil treated the inflammation rather than prevented relapse.
However, Dr. Hodgson expects that Dr. Belluzzi's report will spark a high demand for the preparation by informed Crohn's disease patients eager to find "natural" ways to treat their disease. (Note: enteric-coated fish oil is not yet available in NZ).
Promising Results with New Crohn's Disease
Treatment
The cause or causes of Crohn's disease are unknown. Therefore, current treatments are aimed at reducing symptoms and the underlying inflammation. However, as anyone who has taken long term prednisone therapy will know, these treatments are often associated with significant side effects.
New research has demonstrated success with taking a new approach to treating inflammation in Crohn's disease patients. One mediator that enhances inflammation in these patients is called tumour necrosis factor (TNF). The US drug company Centocor has developed an antibody to TNF that has shown promise in treating Crohn's patients who do not respond to steroids. The drug, called cA2 (CenTNFTM) is undergoing research and development for a number of diseases, including Crohn's disease and rheumatoid arthritis.
In the latest study results, presented at a big conference in the USA recently, cA2 was shown to decrease symptoms and disease activity, maintain remission, and to help heal fistulae in patients with Crohn's disease. The last result is even more significant in light of the fact that there is currently no treatment effective against fistulae, a painful complication of Crohn's disease. The promising results were observed after infusion of just a single drug dose (because cA2 is an antibody it must be given by intravenous (IV) infusion).
Centocor plans to start another trial in the next few months to investigate the optimal dose and duration of cA2 therapy in patients with Crohn's disease. They are also in the process of gathering information to present to various worldwide health authorities in support of a commercial licensing application.
However, even if cA2 continues to be successful in clinical trials, it may be a while before the treatment is widely available, particularly in NZ. Agents such as cA2 are usually very expensive.
Refs: Klumpe, DE. Centocor Inc., personal communication; BioWorld Today 8: 1&5, 13 May 1997; Gastroenterology 109: 129-135, No. 1, 1995.
Nicotine Patches in UC
The media is full of stories about the health hazards associated with smoking. However, a recent study by researchers in the US indicates that patients with mild to moderate active colitis may benefit from nicotine - one of the components of cigarettes.
In the study, patients stuck patches containing nicotine on their skin for a month. They also continued to take their normal anti-inflammatory medication (including drugs like Pentasa and prednisone).
At the end of the study, the number of patients who had improved symptoms and decreased disease activity was greater among those who had applied the nicotine patches compared with those who used 'fake' placebo patches. However, the news was not all good. Just over three quarters of patients who used the nicotine patches reported side effects including skin problems, feeling sick and dizziness. These side effects were severe enough to cause 5 patients to withdraw from the study.
The beneficial effects of nicotine patches observed in this study concur with the observation that the rate of ulcerative colitis is lower in smokers. However, smokers have a higher rate of Crohn's disease. In addition, the slight beneficial effects of nicotine certainly do not outweigh the many health risks associated with cigarette smoking.
Refs: Annals of Internal Medicine 126: 364-371, 1 Mar 1997; Sunday Star-Times 2/3/97.
Short-Chain Fatty Acids in UC
'There is a case for short chain fatty acid (SCFA) enemas'
in the treatment of patients with ulcerative colitis,
according to Dr John Cummings from Addenbrookes Hospital in
the UK.
SCFAs are normally present in the distal colonic mucosa, and it has been suggested that defective metabolism of one of the SCFAs (butyrate) may be involved in the development of colitis.
Dr Cummings reviewed 9 studies looking at the use of SCFA enemas in patients with ulcerative colitis. One of them showed that SCFAs may play a role in protecting against colon cancer in colitis patients. However, in the same study, inflammation parameters were not affected by the SCFA treatment.
In general, analysis of the studies showed that twice-daily use of the SCFA enemas was more beneficial that once-daily treatment, and that a treatment period of 6 weeks was appropriate.
Dr Cummings commented that although the benefit of SCFA enemas in the first-line treatment of ulcerative colitis is undetermined, they would be cheap to make and free from adverse effects.
Reference: Cummings, JH. European Journal of
Gastroenterology and Hepatology 9: 149-153, Feb, 1997.
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Cost of Maintaining Remission in Crohn's
Disease
Some patients with Crohn's disease are lucky enough to go
into remission, which means their disease is no longer
active. Obviously this is something worth achieving and
maintaining. A number of drugs have been shown to increase
the chances of a patient going into remission, but doctors
still don't agree on whether long term drug treatment should
be used to prevent recurrence of disease in Crohn's disease
patients who are already in remission. Drugs containing
5-aminosalicylic acid (5-ASA) such as Pentasa® and
Asacol® have been shown to be effective for these
patients, and are considered to be the only real alternative
to no treatment. A recently published study has investigated
the costs and benefits of using the 5-ASA drug mesalasine to
maintain remission in patients with Crohn's disease.
Firstly the authors presented data from a previous study that showed the costs associated with Crohn's disease. For example, the cost per month of a relapse not requiring hospitalisation was $US1,150 (approx. $NZ1,770), and if the relapse required hospitalisation, or hospitalisation with surgery the associated costs per month were $US13,000 (approx. $NZ20,000) and $US43,000 (approx. $NZ66,150), respectively. The monthly cost of maintenance therapy with mesalasine was $US91 (approx. $NZ140).
As well as looking at costs, the authors assessed quality of life variables, and adjusted their resulted accordingly.
After all the variables had been examined, the results showed that both the costs and quality parameters were similar in patients treated with mesalasine and in those receiving no active treatment. Overall, the cost of mesalasine therapy was $US5,000 (approx. $NZ7,692) for each year of life gained (adjusted for quality variables).
The authors of the study therefore concluded that 'chronic maintenance therapy with mesalasine in patients with inactive Crohn's disease should not be discouraged on the basis of preliminary cost-utility considerations'. However, they added that more studies are needed to look at the long term use of mesalasine for Crohn's patients in remission.
Reference: PharmacoEconomics 11: 444-453, May 1997.
Measles and Crohn's - Fact &
Fiction
Recent media reports have highlighted a study that suggests there is a link between the combined measles-mumps-rubella (MMR) vaccine and the incidence of the inflammatory bowel disease (IBD) Crohn's disease. A more detailed examination of the most recent scientific evidence does not support this view.
Background on Crohn's Disease
Crohn's disease is a condition involving the swelling, thickening and inflammation of one or more parts of the gastrointestinal tract. Symptoms most commonly include abdominal pain, fever, loss of appetite (anorexia) and weight loss. It is a chronic condition which, depending on the severity, requires treatment with drugs and possibly surgery.
The cause of Crohn's disease remains a mystery and as a result many theories have been suggested. Current 'favourites' include infection by Mycobacterium paratuberculosis, the bacteria which causes intestinal tuberculosis and paratuberculosis. Another involves the possibility that IBD occurs when bacteria in the intestine cause an abnormal immune response in people who have genes which make them susceptible to Crohn's disease or ulcerative colitis. This implies of course that there are certain genes that make people susceptible to IBD, and the search for these is also ongoing (see below). It is these theories that most scientists in the field believe will result in a greater understanding of IBDs and the development of new treatments for Crohn's disease and ulcerative colitis.
Is There a Link with MMR Vaccination?
The suggestion of a link between the MMR vaccine and Crohn's disease first surfaced in about 1995. That study was criticised for having serious problems with how the work was carried out. At the time, the British government commissioned an independent review which found no evidence to support the link.
The recent publicity for this link arose from media releases about incomplete trials, rather than completed scientific studies, and has been played down by New Zealand medical officials. "The information was incomplete and unsupported by scientific data" said Dr Mel Brieseman, Canterbury's medical officer of health in the Christchurch Press (31/7/97).
Data collected in New Zealand over the last 10 years by the Ministry of Health show a stable number of new cases of Crohn's disease despite a rise in the use of the MMR vaccine. As a result, Director of the Public Health Group in NZ, Gillian Durham, has defended the Ministry's promotion of the use of this vaccine. In addition, the most recent study published on this topic, in the British medical journal, the Lancet, (13 Sept., 1997: 350, 764-766) shows no evidence for a link between the MMR vaccine and Crohn's disease.
The New Zealand Herald ran a front page story about the first media releases proposing a link between MMR vaccination and Crohn's disease (and autism - a completely unrelated condition). They also published follow-up articles later in the week. However, a further article about a study refuting the original claims was only briefly reported and was buried within a section of the newspaper, and certainly did not receive same the media 'hype''.
An in depth article in the New Zealand Listener (August 23, 1997) gave plenty of fuel to the 'Immunisation Awareness' group's opposition to the national vaccination programme. The problem with this sort of selective reporting is that it exaggerates the situation, raising concerns among people who have Crohn's disease, as well as parents who are considering vaccinating their children.
At the end of the day, this publicity has focussed attention on the negative aspects of immunisation as well as raised unjustified fears in people with Crohn's disease. While the theory of a link with the measles vaccine has not been established at this stage future work should provide an answer one way or the other. We will be monitoring future developments in this area and as always will pass any new information on via the CCSG News.
Balsalazide in Ulcerative Colitis
Balsalazide is a promising new drug for patients with ulcerative colitis. It is 'related' to available agents such as mesalazine (Pentasa®), because it releases 5-aminosalicylic acid (5-ASA). For balsalazide, this release occurs in the colon in response to specific colonic bacteria. Another potential 'plus' for balsalazide, is that animal studies have indicated that it may help prevent colon cancer.
In a British study, balsalazide was more effective than mesalazine for inducing remission in newly diagnosed patients with ulcerative colitis.
In another study, this time performed in the USA, balsalazide recipients showed a greater decrease in symptoms than those treated with mesalazine. The patients in this study had had colitis for longer than those in the first study.
Other trials have shown balsalazide to be more effective and have fewer side effects than sulfasalazine (Salazopyrin®), another 5-ASA drug.
The good news for UK patients with colitis is that balsalazide was recently launched there as Colazide® by licensee company Astra. Balsalazide was developed by a company called Biorex, who have licensed the drug rights to a number of different companies worldwide. US licensee company Salix is also seeking approval for balsalazide in the USA.
Scrip 2273: 19, 7 Oct 1997; Adis R&D Insight CD-ROM, Sep 1997; Canada Newswire [online]: 16 May 1997, available from http:\\www.newspage.com
Australian IBD gene register
Genetic research into the cause of Crohn's disease and ulcerative colitis has identified several candidate genes that people with an IBD are more likely to have. One of these genes (called IBD-1) is being studied in depth by a group working at Canberra Hospital in Australia.
The CCSG Inc has been invited to contribute to this research by asking for volunteers for inclusion on the Australian IBD Family Register. They are particularly interested in families where two or more members have an IBD, and also in twins in which one or both have an IBD. If you fit the bill and would like to be placed on the Register please contact the CCSG.
This is your chance to be part of the
cure!
Entocort® is a cost-effective choice for
maintaining remission in Crohn's Disease
As mentioned in previous newsletters, Entocort® is a new drug for the treatment of Crohn's disease. Entocort® is a steroid like prednisone, but 50% fewer people taking Entocort® experience side effects compared with prednisone.
In addition to being very effective for treating flare-ups of Crohn's disease, Entocort® may also be useful for helping to maintain remission.
A recently published European study (1) investigated whether using Entocort® to maintain remission was a cost-effective option in a theoretical group of patients with Crohn's disease who were in remission after a disease flare-up 10-12 weeks previously. They found that it cost approximately NZ$21.50 for each additional day in remission associated with Entocort® use. Because Entocort® increases the time in remission compared with no treatment, it decreases healthcare costs overall as the cost of the drug is lower than the cost of managing flare-ups of Crohn's disease (including gastroenterologist fees, hospital stays and possible surgery).
1. Noble I, et al. Clinical Drug Investigation 15: 123-136, Feb 1998.
Don't forget that Entocort® is now available in New Zealand - So, if you have a prescription for Entocort®, or are thinking of requesting it from your doctor because you can't tolerate prednisone, be sure to contact the CCSG for information about the CCSG Entocort® programme and ask for details about how you might be able to save yourself some money and get Entocort® at the lowest price possible.
Yamanouchi IBD Symposium (1998)
The IBD Symposium was organised and sponsored by long-time CCSG supporters Pharmaco (the NZ agents for Yamanouchi, who produce Pentasa), and is held every second year. This time around, CCSG president and secretary Stuart and Nicola Ryan were lucky enough to be invited to the Auckland event.
As well as CCSG patron Professor Graham Hill, other speakers at the symposium included gastroenterologist Dr Mark Lane, IBD researcher Dr Vint Chadwick from Wellington, and IBD expert from London, Dr Michael Kamm.
The first topic of the day was 'An Update on the Aetiology of IBD', by Dr Chadwick. We were told that research into what causes IBD is becoming easier because of the development of good animal models to use in research. After recent animal and human research was discussed, the conclusion was that to develop IBD you must have some sort of genetic 'defect' or predisposition. If you have a 'defect' then the potential for immune dysregulation is there, and this requires some sort of 'kick-start' - which is usually an event in the first months of life, and probably some sort of infection.
Next, Dr Kamm spoke about 'Recent Advances in the Medical Management of IBD'. One of the most discussed drugs in this section was azathioprine, which was spoken of quite highly by the doctors at the symposium. Azathioprine (Imuran®) is an immunosuppressant agent which takes 3-6 months to achieve full therapeutic effect. Dr Kamm reported that all well-conducted studies had shown a positive effect of azathioprine in both ulcerative colitis and Crohn's disease. With respect to Entocort® (budesonide), Dr Kamm called this a 'helpful addition' to the choice of drugs for Crohn's disease, particularly for young patients with disease in the terminal ileum. In terms of new therapies, 2 companies are developing anti-TNF antibodies (one of these, cA2 - now known as infliximab - has been featured in the Research News section of previous issues of the CCSG News). Studies with infliximab and similar agent CDP 571 have been encouraging. 67% of patients with treatment-resistant Crohn's disease have been shown to respond to infliximab. However, these agents are very new and, because of the technology involved in their development and production, are likely to be very expensive - so don't expect to see them in New Zealand soon!
Professor Hill presented the next section on the 'Surgical Management of IBD'. The 'pouch' operation for colitis was discussed, and we learnt that most patients in NZ receive a J-pouch. With respect to Crohn's disease, Prof. Hill said that > 50% of patients will need at least 1 operation, for medical failure, obstruction with pain, or sepsis.
After some questions and case presentations, the afternoon ended with a lovely dinner at the Sheraton, Auckland.
The CCSG is grateful to Pharmaco both for the invitation to the symposium and their ongoing support of the group.
Cyclosporin - An Alternative to Surgery in
Severe Colitis
A patient presenting with a severe attack of ulcerative colitis is usually hospitalised, and treated with fluids, electrolytes and high dosages of IV corticosteroids. The remission rate with this approach is about 70%. Another 15-20% of patients have a partial response to treatment, and total colectomy has been the only option in the remaining 10-15%.
Over recent years immunosuppression with intravenous cyclosporin has been used as an alternative to surgery with varied, but notable, success, particularly in the short term.
Clinical experience with IV cyclosporin in Belgium showed that 69% of patients avoided colectomy after treatment for 4-41 (median 10) days. After a follow-up of 12 months, the proportion of patients who had still not undergone colectomy was 45%. Only 25% of patients who received maintenance therapy with azathioprine required colectomy compared with 50% of those who did not receive azathioprine [Acta Gastroenterologica Belgica 60: 197-200, Jul-Sep, 1997].
The short term remission rate was 56% in patients treated with IV cyclosporin for 1-10 (mean 4.5) days in a UK hospital. Patients who achieved remission during this treatment went on to receive oral cyclosporin for 3-6 months, with a long term remission rate of 40%. Response to cyclosporin was not related to the extent of disease or patient age [European Journal of Gastroenterology and Hepatology 10: 411-413, May 1998].
When cyclosporin was initiated as oral therapy in patients with severe refractory ulcerative colitis or Crohn's disease, there were groups of patients that appeared to benefit more than others. Treatment was not effective in those with small intestinal Crohn's disease, or in those with azathioprine-resistant IBD at baseline [Australian and New Zealand Journal of Medicine 28: 179-183, Apr 1998].
It could be said that using cyclosporin in severe refractory ulcerative colitis is merely delaying the inevitable. The long term outcome for many patients will still be proctocolectomy. However, if patients have experienced a period of relative good health they may be in a better position to tolerate surgery than if they had been operated on previously. The issue of trying to maintain remission for as long as possible and the best way of achieving this is also important. In one of the studies reported above, patients receiving azathioprine were less likely to undergo colectomy than those who didn't. This requires planning ahead as azathioprine takes many weeks to reach full therapeutic effect.
Oral cyclosporin is obviously another alternative for patients who cannon maintain remission on corticosteroids and/or salicylates (such as Pentasa®). However, there are obvious issues with the side effects of long term immunosuppression. In addition, cost considerations are important in some countries. For example, the cost of oral cyclosporin in New York, USA is $US25 per day.
Although there are many factors to take into account when deciding to use cyclosporin in IBD, the success rates achieved in patients who are refractory to all other medical treatment, and would otherwise be looking at certain surgery, are not insignificant. From a patient point of view, many would prefer medical therapy to surgery, even though there are now surgical options other than colostomy and ileostomy (the 'pouch' operation. Cyclosporin will therefore continue to be used and studied in this clinical setting.
Alternative Therapies used by CCSG
Members
130 CCSG members completed and sent back the questionnaire which was included with a previous issue of the CCSG News - thankyou for sharing your personal experiences. The information will help respond to queries. In this issue (and the next few) we will be examining your answers more fully. Below is a report about alternative therapies that members have tried (and their results!).
Many members have tried an alternative therapy
38% of members reported trying alternative treatments (ATs)with a further 5% explicitly indicating their interest. It was common for members to have tried more than 1 AT.
Dietary Factors
3% of members reported using fibre supplements such as psyllium and metamucil. The use of oats and millet was also reported. 19% explicityly reported adjusting their diet in some way, and it was not uncommon for this to be part of naturopathic treatment. There is probably a higher incidence of dietary modification than this, much of it not being considered as part of treatment, or specifically reported. Some form of dietary adjustment was found to be useful by 72% of members. The top 10 foods eliminated were: dairy products, wheat, sugar, yeast products, alcohol, high fat foods, spicy foods, tomatoes, cabbage/cauliflower, and some fruits.
Supplements
These were taken by 21% of members, often with a herbal product as well. This makes it hard to comment on the effectiveness of supplements alone, however 63% of members trying supplements as part of their treatment found them helpful. The 10 most helpful supplements were: acidophilus (supplement or yoghurt), fish oil, evening primrose oil, folic acid, zinc, magnesium, B vitamins, vitamin C, multivitamin tablets, and food digestion pills.
Herbs
31% reported taking herbal preparations, including those specifically mentioning herbs as part of other treatments such as naturopathy. 65% of members taking herbal preparations found them helpful. Helpful herbal preparations included slippery elm, spirulina, chorella, aloe vera, St John's wort and echinacea.
Naturopathy and Homeopathy
Homeopathy and Naturopathy were tried by10% and 5% of members, respectively. The number of members finding these 'helpful' was was 77% for homeopathy and 33% for naturapathy. Looking at the results in the Supplements and Herbs sections, it looks like members are inclined to get advice on these from someone other than a homeopath or naturopath, with reasonably good success.
Acupuncture, meditation and exercise
6% of members had tried acupuncture, with 25% of these having some benefit. 2.3% had tried meditation techniques and all reported being able to reduce their medication doses. Exercise was helpful in 1.5%.
Other alternative treatments
8% of members reported trying other treatments. The most helpful of these included Tibetan medicine, osteopathy, reflexology, reiki, crystal healing, and experiencing a period of remission after child birth.
Degree of benefit from treatments
Of the treatments that helped, most reproted a reduction in symptoms. A smaller number (about 15%) reported a reduction in medication dosages, and only a few cases of total remission were documented (<3%).