Inflammatory bowel disease: Therapy Flashcards
What are the main aims in the treatment of IBD?
Control inflammation and heal the mucosa
Restore normal bowel habit
Improve the quality of life
Balance the effects of disease with side effects of treatment
Avoid long term complications
What different theaptutic strategies could you do?
Lifestyle advice
Drugs
Surgery
What lifestyle advice would you give to someone with IBD?
Crohns - STOP SMOKING, worse outcome, more rapid recurrence post-surgery
Diet - is not implicated in the pathogenesis but can influence some symptoms
What do all drug therapies for IBD have?
anti-inflammatory effects
What are the drug options for UC?
5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy
What are the drug options for Crohns disease?
Steroids
Immunosuppressants
Anti-TNF therapy
What is the mechanisms of action of 5ASA drugs used in UC?
Topical effect
Anti-inflammatory properties
Reduces risk of colon cancer
What are the side effects of 5ASA drugs?
Diarrhoea, idiosyncratic nephritis
Nav some examples of 5-ASA drugs?
Mesalazine
Sulphasalazine
Balsalazide
What can 5ASA drugs do in terms of mechanism of actions?
They have delayed release - pH dependent
Prodrugs
Describe the use of suppositories?
They coat <20cm but have better mucosal adherence than enemas do
Describe the use of enemas?
Reflex contration aids proximal spread of foam or liquid enemas
<10% of enemas remain in the rectum
Describe the use of corticosteroids?
systemic anti-inflammatory properties
Induces remission
Short course - high dose initially reduce over 6-8 weeks
Give some examples of corticosteroids?
Prednisolone
Budesonide
What are the side effects of steroids?
Osteoporosis
Weight gain
Diabetes
Hypertension
Cataracts
Acne
When do you need to use immunosuppression in IBD?
When more potent suppression of inflammation is required
What are immuosuppresants used for in UC and Crohns?
UC - steroid sparing agents
Crohns - maintenance therapy
Give some examples of immunosuppressants used?
Azathioprine
Methotrexate
Describe azathioprine?
Immunosuppressant
Slow onset of action (16 weeks)
TPMT activity contributes to toxicity
Regular blood monitoring needed
What are the side effects of azathriprine?
Pancreatitis
Leucopenia
Hepatitis
Small risk of lymphoma - skin cancer
Describe anti-TNF therapy?
Tumour necrosis Factor alpha = pro inflammatory cytokine
Antibodies to TNF
Promotes apoptosis of activated T-lymphocutres
Rapid onset of action
Give an example of anti-TNF therapy?
IV infliximab
What does re-treatment of anti-TNF do?
Maintains mission
Reduces hospitalisation and need for surgery
(only used in UC mod-severe)
When should you used Anti-TNF according to NICE guidelines?
As part of long terms strategy, including immune suppression, surgery(crohns) and supportive therapy
Refractory/fistulising disease
Make sure to recluse current infection/TB
Describe emergency surgery in IBD?
Failure to respond to medical therapy, small bowel obstruction, abscess, fistulae
Describe elective surgery in IBD?
Failure to respond to medical therapy
Dysplasia of colon mucosa
Describe surgery in crohns?
Minimise amount of bowel resected
Not curative
Repeated resection of small intestine can result in ‘short gut syndrome’ and requirement of lifelong total parenteral nutrition (reduced life expectancy)
Describe surgery for UC?
Curative
Option of permanent ileostomy OR restorative proctocoloectomy and pouch
Describe the mechanism of Anti-TNF therapy - detail?
Anti-TNF therapy: a type of biological therapy; blocking the actions of TNF alpha, which is secreted by macrophages and dendrites during antigen presentation phase, preventing them from producing other inflammatory cytokines, does so by promoting apoptosis of effector T cells
