Toxic Megacolon And Other Complications Of Severe Uc
Toxic megacolon may be defined as colonic dilatation of more than 5.5 cm along with signs of systemic toxicity. Lifetime incidence of toxic megacolon in patients with UC varies from 1%-2.5% and approximately 5% severe UC patients who are hospitalized may develop toxic megacolon. Risk factors include dyselectrolytemia, full bowel preparation and medications . Earlier identification of this condition, prompt institution of medical therapy and low threshold of surgery in cases of non-response to medical therapy within 48 h will decrease the morbidity and mortality of this condition.
Other complications include perforation which is the most serious complication of severe UC. Risk factors include inappropriate total colonoscopy and delaying treatment of toxic megacolon. Diagnosis of perforation can often be delayed as abdominal signs can be masked when patient is on steroids. Therefore, patients with severe UC should be monitored closely for abdominal signs and on the slightest suspicion abdominal radiographs should be obtained. Other complication includes severe hemorrhage.
Eating Diet And Nutrition
Drinking plenty of fluids is important when diarrhea or frequent passage of loose or liquid stools occurs.
Avoiding caffeine and foods that are greasy, high in fiber, or sweet may lessen diarrhea symptoms. Some people also have problems digesting lactosethe sugar found in milk and milk productsduring or after a bout of diarrhea. Yogurt, which has less lactose than milk, is often better tolerated. Yogurt with active, live bacterial cultures may even help people recover from diarrhea more quickly.
If diarrhea symptoms improve, soft, bland foods can be added to the diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. If the diarrhea stops, a normal diet may be resumed if tolerated.
The Potential Downsides Of Biologics
While biologics may be a promising option for treating your ulcerative colitis, not every drug is suited to every patient.
We will work with patients for a while to tailor a treatment plan that is right for them, says Dr. Raffals. That may mean trying different biologics and small-molecule drugs, and, of course, taking into account what the patients insurance will cover.
A persons lifestyle, demographic factors, and the severity of the disease are all considerations in the choice of whether or not to use biologics, and which of them is the best option.
Some potential downsides of taking biologics include:
If youre considering biologics for treatment, speak to your doctor to find out whats best for you. As Tsynman says, At the heart of the decision is the relationship between the patient and the physician and specifically exploring what works best for each individual.
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Infusions Every 8 Weeks After 3 Starter Doses
REMICADE® is given as an intravenous infusion by a healthcare professional through a needle placed in a vein in your arm.
Given over a period of about 2 hours
Weeks 0, 2, and 6
After starter doses, 1 maintenance dose is infused every 8 weeks
Your doctor will determine the right dosage of REMICADE® for you.
Symptoms Of Rheumatoid Arthritis:
Rheumatoid Arthritis is a chronic disease characterized by periods of disease flares and remissions. Early rheumatoid arthritis tends to affect your smaller joints first particularly the joints that attach your fingers to your hands and your toes to your feet. Rheumatoid arthritis symptoms vary in severity and include:
- Joint pain, such as in the joints of the feet, hands, and knees
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Corticosteroids Vs Anabolic Steroids
Though corticosteroids are referred to as steroids, they are not the same as the steroids some athletes use for performance enhancement. These steroids, known as anabolic steroids, are human-made versions of testosterone. Taking corticosteroids for UC does not have any testosterone-producing effects on the body.
Side Effects Of Ulcerative Colitis
Side effects are based on the biologic medication that youre receiving. While some are minor, others may be life-threatening. You should talk to your doctor before receiving infusion therapy to ensure that you are getting the best option for your UC. The most common side effects include:
- Serious allergic reactions
- Lymphoma and other cancers including skin and cervical cancer
- Heart problems including failure
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For The 620000 Americans Who Have Ulcerative Colitis Metro Infusion Center Offers Infusion Therapies That Can Help
While half of ulcerative colitis patients symptoms are manageable, the other half of patients experience moderate to severe symptoms, including cramping, bloody stool, and persistent diarrhea.
Metro Infusion Center offers a variety of options to help you treat symptoms of Ulcerative Colitis, including corticosteroids and aminosalicylates, immune system suppressors and other drugs
Diagnosis And Treatment Of Ulcerative Colitis
There is no cure for ulcerative colitis, but lifestyle changes and medications can help manage flare-ups. To confirm a diagnosis of ulcerative colitis and rule out other conditions with similar symptoms, a patient may undergo one or more of the following tests:
- Blood work: A blood test may be used to check for anemia or signs of infection.
- Stool sample test: A lab test of a patients stool sample can check for inflammation in the colon, as well as rule out infection caused by bacteria, a parasite, or virus.
- Colonoscopy: In this test, a doctor uses a thin, lighted tube to examine the colon lining to check for ulcers, bleeding, or abnormal growths.
- Biopsy: A biopsy can be performed as part of an endoscopy or colonoscopy procedure to examine a tissue sample.
- Imaging tests: An X-ray or a CT scan may be recommended to rule out other conditions and check for inflammation in the colon.
A number of medications can help treat ulcerative colitis. These include:
- Anti-inflammatory drugs
- Anti-diarrheal medications
- Antispasmodic pills, which reduce cramps
Patients with more severe ulcerative colitis who do not respond to medication may be candidates for surgery. Two surgical procedures are commonly performed to treat ulcerative colitis:
Certain lifestyle modifications can help mitigate the symptoms of ulcerative colitis, such as:
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What Is Ulcerative Colitis
Since UC causes sores to occur in your digestive tract, it can be a debilitating disease. The cause remains unknown, but some causes such as diet, stress, family history, and health of the immune system may play a role. In rare cases, it can lead to life-threatening complications. There is currently no cure for ulcerative colitis, but treatments have been found to alleviate symptoms and can even lead to long-term remission. UC develops slowly over time and produces symptoms such as:
- Diarrhea often with blood or pus
What Is Biological Treatment
Biological treatment administers biologics using an IV. Its the best option for individuals who have issues taking medications orally or havent experienced the desired results from medications. It can also be a less risky alternative for those looking to avoid surgery. Biological therapy treatment targets the parts of the body that are triggering inflammation. The most common biologics for UC are:
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Worth It As Someone With Ulcerative Colitis
The word infusion can make the treatment sound unpleasant and, honestly, terrifying especially if the patient has never experienced an IV drip. But the actual experience is quite effortless, especially since it doesnt come with the same sleepiness as the Remicade infusions’ pre-meds cause me.
Getting an iron infusion mostly requires patience and communication with the nurses, plus a tiny bit of pain tolerance for the IV pinch. The possibility of giving my body more resources to heal and function makes the whole process worth it for me.
What Are The Outcomes Of Remicade Infusion
Remicade works differently than other medications by targeting a specific protein in the bodys immune system which helps control inflammation. Remicade can reduce signs and symptoms, induce and maintain remission, promote intestinal healing and reduce or stop the need for steroids. People who take Remicade for their IBD symptoms usually experience a period of remission, an inactive time in the disease process.
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Important Safety Informationabout Entyvio
Please see the full Prescribing Information, including the Medication Guide, for ENTYVIO and talk with your healthcare provider.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call .
Symptoms Of Pagets Disease Of The Bone:
People who have Pagets disease of bone typically have no symptoms. When symptoms do occur, the most common complaint is bone pain.
Because this disease causes your body to generate new bone faster than normal, the rapid remodeling produces bone thats softer and weaker than normal bone, which can lead to bone pain, deformities and fractures.
The disease might affect only one or two areas of your body or might be widespread. Enlarged and misshapen bones can put extra stress on nearby joints, which may cause further pain and complications. Symptoms, depend on the affected part of your body.
- Pelvis. Pagets disease of bone in the pelvis can cause hip pain.
- Skull. An overgrowth of bone in the skull can cause hearing loss or headaches.
- Spine. When the spine is affected nerve roots can become compressed. This can cause pain, tingling and numbness in an arm or leg.
- Leg. As the bones weaken, they may bend causing you to become bowlegged.
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Risk Factors For Ulcerative Colitis
While the exact cause of ulcerative colitis is unknown, certain factors may play a role. These include:
- Family history: Patients who have a close relative with ulcerative colitis are at higher risk for developing the disease themselves.
- Age: While ulcerative colitis can occur at any age, it usually begins before the age of 30.
- Race and ethnicity: Rates of ulcerative colitis are highest among patients who are white and/or of Ashkenazi Jewish descent.
- History of smoking: Patients who smoke or used to smoke have higher rates of ulcerative colitis than non-smokers.
- Geography: According to the National Center for Biotechnology Information, ulcerative colitis rates are highest in Northern Europe and North America.
Diet and stress are not necessarily risk factors for ulcerative colitis, but they may exacerbate symptoms. Sex does not appear to be a risk factor rates of ulcerative colitis are similar among male and female patients.
Different Types Of Biologic Drugs For Ibd
There are currently five different biologic medicines available to treat moderate to severe Crohns Disease or Ulcerative Colitis, the two primary forms of IBD. These are Infliximab, Adalimumab, Vedolizumab and Ustekinumab, and Golimumab. Please click on each to get to know more about Infusion Therapy for the Treatment of IBD:
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Is Remicade A Form Of Chemotherapy
No, Remicade isnt a form of chemotherapy. Remicade is a biologic, which means its made from living organisms. Specifically, Remicade is monoclonal antibody thats made from immune system cells in a lab. Monoclonal antibodies only block the activity of certain proteins in the body.
Chemotherapy, on the other hand, is a chemical drug that destroys rapidly growing cells throughout the body. Its typically used to treat cancer. Chemotherapy medications affect many types of cells and organs. This is different from the very specific actions of monoclonal antibodies, such as Remicade.
How Common Are These Side Effects
Common: Somewhere between 1 in every 10 people to 1 in every 100 people taking infliximab may develop this side effect.
Uncommon: Somewhere between 1 in every 100 people to 1 in every 1000 people taking infliximab may develop this side effect.
Rare: Somewhere between 1 in every 1000 people to 1 in every 10,000 people taking infliximab may develop this side effect.
This is not a full list of side effects. For more information see the Patient Information Leaflet provided with your medicine or visit medicines.org.uk/emc/.
Wed encourage you to report any side effects to the Medicines and Healthcare Products Regulatory Agency through the Yellow Card scheme. Your doctor should also report it. Report your side effect at yellowcard.mhra.gov.uk
Its not safe to have live vaccines while taking infliximab. It can take up to six months after your last dose for infliximab to completely leave your body. However, its safe to have live vaccines 3 months after your last dose of infliximab. Ask your IBD team to make sure your vaccinations are up to date before you start infliximab, or if youre planning to travel. If youve recently had a live vaccine you may have to wait 4 weeks before starting infliximab.
In the UK, live vaccines include:
Everyone with Crohns or Colitis taking a biologic medicine should have the yearly flu jab. This is not a live vaccine and is safe to have while taking infliximab.
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What Is Your Infusion Center Like
Our goal is to provide you with a comfortable and easy experience from start to finish. You can expect personal, compassionate treatment in a clean, relaxing environment. We provide small comforts like reclining chairs and Wi-Fi so you can watch movies or work during your treatment. We want to make your time with us pleasant and convenient.
Telling Other Health Professionals
Tell any doctor, dentist or health professional treating you that you are taking infliximab. Always carry the alert card that comes with the medicine while you are taking it and for up to six months after your last dose.
Its not safe to have live vaccines while taking infliximab. It can take up to six months after your last dose for infliximab to completely leave your body. However, its safe to have live vaccines 3 months after your last dose of infliximab. Ask your IBD team to make sure your vaccinations are up to date before you start infliximab, or if youre planning to travel. If youve recently had a live vaccine you may have to wait 4 weeks before starting infliximab.
In the UK, live vaccines include:
- Flu nasal spray
Everyone with Crohns or Colitis taking a biologic medicine should have the yearly flu jab. This is not a live vaccine and is safe to have while taking infliximab.
If someone you live with is due to have a live vaccine, ask your IBD team if you need to take any precautions.
Infliximab does not affect fertility. If you dont want to get pregnant you should use contraception.
You must tell your babys healthcare team you were taking infliximab while pregnant. It is advised that if you take infliximab during your pregnancy your baby should avoid live vaccines until they are at least six months old. This includes the BCG for tuberculosis and the rotavirus vaccine. It should not affect the rest of your babys vaccination schedule.
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How Often Will I Be Having Biologic Infusions For Crohns Disease And Ulcerative Colitis
Infliximab
When you have your initial infusion, your dose is worked out based on your weight, usually 5mg for every kilogram you weigh. You will have a second and third infusion two and six weeks later. Then, if you are responding well to your biologic medicine, you will have maintenance infusions every eight weeks.
Vedolizumab
You will have your initial infusion which is usually a standard 300mg dose. You will then have a second and third infusion two and six weeks later. Depending on how well you respond, you may have a further infusion at week 10 if you have Crohns disease. You will then have maintenance infusions every eight weeks.
Sometimes your IBD team may increase your treatment to infusions every four weeks if your symptoms have not improved enough.
Ustekinumab
You will have your initial dose of ustekinumab as an infusion, worked out according to your weight, approximately 6mg for every kilogram you weigh. Your next dose will be eight weeks later, and will be delivered by subcutaneous injection. This will be a standard dose of 90mg. From then on you will usually continue to have ustekinumab by injection every eight or 12 weeks.
If you do not appear to be responding after your first few doses of biologic medicine, or are experiencing significant side effects, your IBD team may decide to stop your treatment, or try another type of biologic medicine.
Different From Biologic Infusion For Uc
Once the IV is in, though, were ready to start the iron drip. Unlike with my biologic infusion, I’m not given any pre-medications no Benadryl, Tylenol, or prednisone. According to my nurses, this is because the doctors are less worried about an allergic reaction, although they remind me to call them if I feel any kind of shortness of breath or itchiness.
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Ethics Approval And Consent To Participate
This study was performed in accordance with relevant guidelines and regulations, and the Tokyo Medical and Dental University Institutional Review Board approved the study . All patients provided written informed consent and for patients under 18 years, patients parent and/or legal guardian provided written informed consent.
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