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Treatment of Inflammatory Bowel Disease: 5-ASA Compounds

by Carlo Raj, MD
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    The Anti–TNF Therapy Monoclonal antibody, you've heard of Infliximab. Speaking of "ab", you also have Adalimumab and Certolizumab. The three preparations available in the US. Do not forget about Adalimumab. Better response in Crohn's disease; used for both induction and maintenance here for anti–TNF. Effective for the fistulizing disease. Remember in Crohn's disease, much more fistule–like because of transmural involvement. There's increased risk, of course, anytime that you use anti–TNF therapy. Remember with TNF, Tumor Necrosis Factor, it's responsible for inducing and maintaining your granuloma that's importantly required to contain the TB organism. And if this granuloma has been lost due to anti–TNF therapy, out comes the bacteria, reactivation TB. In addition, lymphoma is also a possibility as being a major side effect in anti–TNF therapy. Azathioprine or 6–Mercaptopurine, immunosuppressive medication here for maintenance of remission and steroid sparing effect. Long half life. Side effect: Pancreatitis, bone marrow suppression and hepatitis. Also keep in mind that you're also worried about administering 6–MP and Allopurinol because remember xanthine oxidase is required for proper metabolism of 6–MP. Azathioprine will be the precursor for 6–MP. Antibiotics: Cipro and Metronidazole, commonly used for Crohn's. Not useful on Ulcerative colitis, antibioitics. Long term use of Metronidazole associated with peripheral neuropathy, do not forget that. And also with Metronidazole, do not forget about Disulfiram–like effects. TPN and bowel rest not useful in UC but in Crohn's. Diversion of fecal stream, Colostomy, in perianal disease especially. And Total Parenteral Nutrition used pre–operatively for Crohn's to improve nutritional status. Surgery Colectomy is curative for Ulcerative colitis and indicated for intractable disease, megacolon, colon cancer. And the site of anastomosis most likely recurrence to Crohn's disease. Frequent re–operation among patients with Crohn's can lead to short gut syndrome. Remember, the more that you end up taking out of your...

    About the Lecture

    The lecture Treatment of Inflammatory Bowel Disease: 5-ASA Compounds by Carlo Raj, MD is from the course Small and Large Intestine Diseases.


    Author of lecture Treatment of Inflammatory Bowel Disease: 5-ASA Compounds

     Carlo Raj, MD

    Carlo Raj, MD


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