This page contains a Flash digital edition of a book.
BACKGROUND


Since there is no cure for CD as of yet, the short-term


goal of medical treatment is to reduce or bring symptoms under control, (or remission), by suppressing the inflammatory response to induce a remission. Remission leads to normalization of quality of life, and is hopefully associated with healing of the damaged bowel. The long-term goal is to maintain this remission, that is, to use medical therapy to decrease the frequency of disease flares and to prevent complications.


Several groups of drugs are used to treat CD today, including:


• Corticosteroids: Prednisone and budesonide, among other steroids, are available orally and rectally. Corticosteroids can also be given intravenously (methylprednisolone). They non-specifically suppress the immune system and are used to treat moderately to severely active CD. They are very effective agents but may be associated with significant short- and long-term side effects. They should not be used as a maintenance medication.


• Immune modifiers: Azathioprine, 6-Mercaptopurine (6-MP), methotrexate and cyclosporine, sometimes called immunomodulators, are used to help decrease corticosteroid dependency. In addition, immune modifiers may help maintain disease remission.


• Antibiotics: Metronidazole and ciprofloxacin are used to treat anal fistulas and Crohn’s colitis.


• 5-Aminosalicylates (5-ASA): This class of anti-inflammatory drugs includes sulfasalazine and oral formulations of mesalamine and 5-ASA drugs; also may be administered rectally. These medications typically are used to treat mild symptoms of proctocolitis.


• Biological therapies: Infliximab and adalimumab are currently approved in Canada for moderately to severely active CD in patients who have not responded adequately to conventional therapy, infliximab is currently approved for UC as well. Given by infusion or injection, these drugs are produced by live cells (hence the name ‘biologicals’). They work by blocking the immune system’s production of tumour necrosis factor-alpha (TNF-alpha), a cytokine (chemical) that intensifies inflammation. Other biologic agents for both CD and UC have been shown, in some cases, to be effective in clinical trials (for example, certolizumab or natalizumab). These therapies have been approved for use in other countries and may be approved by Canadian regulatory authorities over the next few years.


Surgery


Historically, two thirds to three quarters of patients with CD have required surgery at some point during their lives,4


although surgery has become less frequent with modern medical


management (Nguyen 2011, Benchimol 2011, Bernstein 2012). Surgery becomes necessary when medications are not working (medically refractory disease) and if complications arise such as fistulas, abscesses or scarring and narrowing of the bowel, or if dysplasia (precancerous cells) or cancer of the colon is detected. In most cases, the diseased segment of bowel and any associated abscess is removed (resection). The two ends of healthy bowel are then joined together in a procedure called an anastomosis. While resection and anastomosis may allow many symptom-free years, the disease frequently recurs at or near the site where the bowel is joined together.


An ostomy may be required when surgery is performed for CD when there is no healthy bowel


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 20


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96