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Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide generation. 
Drugs for Treatment of Diarrhea-Predominant IBS01:17

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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
Drugs for Treatment of Constipation-Predominant IBS01:21

Drugs for Treatment of Constipation-Predominant IBS

Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents01:18

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Acute diarrhea, a common gastrointestinal disturbance, is characterized by the rapid evacuation of fluid stools, leading to an excessive weight in fluid. This condition typically arises from disorders affecting intestinal water and electrolyte transport. It can be triggered by an increased osmotic load within the intestine, excessive secretion of electrolytes and water, mucosal exudation of protein and fluid, or altered intestinal motility. The primary risks of acute diarrhea are dehydration...
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
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Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...

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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
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Intracolonic vancomycin for severe Clostridium difficile colitis.

Peter K Kim1, Heesun C Huh, Hillel W Cohen

  • 11 Department of Surgery, Albert Einstein College of Medicine and Jacobi Medical Center , Bronx, New York.

Surgical Infections
|April 9, 2013
PubMed
Summary
This summary is machine-generated.

Adjunct intracolonic vancomycin (ICV) enemas effectively treated severe Clostridium difficile colitis in 70% of patients, avoiding surgery. This study explored ICV efficacy in community versus nursing home patients, finding it safe and effective.

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Published on: December 10, 2016

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pharmacology

Background:

  • Clostridium difficile colitis is a significant healthcare-associated infection, particularly in elderly patients with a history of antibiotic use and hospitalization.
  • Severe cases refractory to standard medical treatment may necessitate surgical intervention, such as subtotal colectomy, carrying substantial morbidity and mortality.
  • An intracolonic vancomycin (ICV) enema protocol was developed as an adjuvant therapy for severe C. difficile colitis.

Purpose of the Study:

  • To evaluate the efficacy and safety of an adjuvant intracolonic vancomycin (ICV) enema protocol in patients with severe Clostridium difficile colitis.
  • To compare the treatment response to ICV therapy between patients residing in the community and those in nursing homes.
  • To identify patient characteristics associated with treatment response, need for surgery, and mortality.

Main Methods:

  • A retrospective chart review of 47 consecutive inpatients with C. difficile colitis treated with ICV (1 g/500 mL normal saline q6h) between January 2007 and October 2009.
  • Outcomes assessed included response to ICV, need for subtotal colectomy, and death.
  • Bivariate and multivariable logistic regression analyses were used to examine associations between patient characteristics (age, hypoalbuminemia, acidosis, nursing-home status) and outcomes.

Main Results:

  • Adjunct ICV therapy resulted in complete resolution of severe C. difficile colitis without surgery in 70% (33/47) of patients.
  • Overall survival after ICV therapy was 79% (37/47). Patients requiring surgery had a higher survival rate compared to those who did not undergo surgery (p<0.01).
  • Acidosis, older age, and hypoalbuminemia were significantly associated with incomplete response or death, while nursing-home residence and hypoalbuminemia showed trends toward association with death. No ICV-related complications were reported.

Conclusions:

  • Adjunct intracolonic vancomycin (ICV) enema therapy achieved complete resolution without surgery in 70% of patients with severe C. difficile colitis.
  • ICV therapy demonstrated a favorable safety profile with no attributable complications.
  • Further clinical trials are warranted to compare ICV with standard therapy to determine its non-inferior or superior efficacy in reducing surgical intervention and improving outcomes.