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Related Concept Videos

Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

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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...
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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...
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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...
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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...
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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.
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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
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Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis
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Simple water-based tacrolimus enemas for refractory proctitis.

Sasha R Fehily1, Felicity C Martin1, Michael A Kamm1,2

  • 1Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.

JGH Open : an Open Access Journal of Gastroenterology and Hepatology
|August 13, 2020
PubMed
Summary

A simple tap water-based tacrolimus enema formulation is effective and safe for treating refractory ulcerative colitis and Crohn's disease proctitis. This novel treatment offers a well-tolerated option for patients unresponsive to conventional therapies.

Keywords:
basic scienceendoscopyexperimental models and pathophysiologypathology

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Refractory rectal ulcerative colitis (UC) and Crohn's disease (CD) present significant treatment challenges.
  • Conventional therapies and existing tacrolimus formulations (oral, suppository) have limitations in efficacy, tolerability, or formulation complexity.
  • Tacrolimus demonstrates topical activity, water solubility, and minimal systemic toxicity when administered rectally.

Purpose of the Study:

  • To evaluate the efficacy and safety of a simple tap water-based tacrolimus enema for treating refractory rectal UC and CD.
  • To assess endoscopic and clinical outcomes in patients with inflammatory bowel disease (IBD)-related proctitis unresponsive to standard treatments.

Main Methods:

  • A tap water-based enema formulation of tacrolimus was prepared using powder from 1 mg capsules and delivered rectally in 60 mL syringes.
  • Patients received initial enemas with 1-4 mg tacrolimus daily, followed by 1-3 mg maintenance doses three times weekly for a median of 20 weeks.
  • Primary endpoint was endoscopic response; secondary endpoints included remission, clinical response, stool frequency, and rectal bleeding.

Main Results:

  • Seventeen patients (12 UC, 5 CD) with refractory rectal disease, most having failed prior immunosuppressive and biologic therapies, were treated.
  • Ninety-four percent of patients tolerated the tacrolimus enema therapy.
  • In UC patients, 67% achieved endoscopic remission and 11% endoscopic response. In CD patients, 40% achieved endoscopic remission and 60% endoscopic response. Significant improvements were observed in stool frequency, rectal bleeding, and endoscopic stricture patency. No major adverse events were reported.

Conclusions:

  • Tacrolimus enemas are easily prepared, well-tolerated, effective, and safe for treating refractory proctitis in UC and CD.
  • This formulation represents a valuable addition to the therapeutic options for inflammatory bowel disease management.
  • The findings support the inclusion of tacrolimus enemas in the treatment armamentarium for refractory proctitis.