The anti-TNF therapy. Monoclonal antibody you have heard in 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 a fistulizing disease. Remember in Crohn?s disease much more fistulate,
because of transmural involvement.
There is increase risk of course, any time that you use anti-TNF therapy,
remember what TNF ? tumor necrosis factor.
It is responsible for inducing and maintaining your granuloma
that is 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. Immunosuppressant medication,
here for maintenance of remission and steroid sparing effect.
A long half life. Side effect: pancreatitis, bone marrow suppression and hepatitis.
Also keep in mind that you are also worried about administering 6MP
and allopurinol because remember xanthine oxidase is required for proper metabolism of 6MP.
Azathioprine would be the precursor for 6MP.
Antibiotics. Cipro and metronidazole, commonly used for Crohn?s.
Not useful on ulcerative colitis antibiotics.
Long term use of metronidazole associated with peripheral neuropathy,
do not forget that, and also with metronidazole do not forget about the disulfiram like effects.
TPN and bowel rest, not useful in UC but in Crohn?s, diversion of fecal stream,
colostomy, in perianal diseases especially, and total parenteral nutrition
use preoperatively with Crohn?s, to improve nutritional status.
Surgery. Colectomy, is curative for ulcerative colitis
and indicated for intractable disease, megacolon, colon cancer,
and at the site of anastomosis, most likely with Crohn?s to Crohn?s disease.
Frequent reoperations among patients with Crohn?s, can lead to short gut syndrome.
Remember the more that you end up taken out of your intestine,
the more that you have or the less that you have left,
therefore may manifest as malabsorption. Short gut syndrome.