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An Evidence-Based Systematic Review on Medical Therapies for Inflammatory Bowel Disease

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Crohn's Disease
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Posted 12/6/2011 10:39 PM (GMT 0)
In April 2011, the American Journal of Gastroenterology published this article.  I thought it was really interesting and we discussed it for a while here on the forum.  I found a link for the whole text and thought it might be helpful to brign up again:

http://s3-patients.gi.org/files/2011/10/AJG-IBD-supplement-0411.pdf

Posted 12/6/2011 10:55 PM (GMT 0)
The tables on page 17 tell a pretty sad story about the state of research into treating Crohn's.

The only treatment that gets a solid recommendation for inducing remission is biologics, and that is only for moderate to severe disease. The recommendation is less strong for fistulizing disease. For maintaining remission, again biologics are the only treatment modality that gets a strong recommendation.

I suppose one reason why this would be true is that biologic meds are complicated, expensive and risky and so the research to back them up has been pretty extensive.

Other treatments are recommended, but less strongly, or the evidence used in the analysis was considered weak or biased. sigh.
Posted 12/6/2011 11:19 PM (GMT 0)
It's fun to see that the only thing good for mild crohn's from this study is something that damagable. Yes my mild crohn that is doing almost gave me no symptome is fight by something getting me cancer or infection.
And by fun I mean it is actualy really NOT.
Posted 12/6/2011 11:31 PM (GMT 0)
Well, that's one way to read it. Another way is to use your own experience to see what works. I've been using 5-ASAs for years and while they aren't given a strong recommendation in the study it isn't because they don't work. It's because the evidence is poor, either because the studies were designed poorly or they are potentially biased due to inappropriate relationships among the researchers and drug companies, etc.

It is hard, though, when you're struggling and you're trying to find good research to help you understand and then you realize there really isn't much out there. Those trying to work on dietary approaches have it even worse.

I thought the discussion in the front of the article about research into the causes of the disease was really interesting too. I especially liked the graph depicting the differences in gut flora among IBD patients and the normal population.
Posted 12/6/2011 11:56 PM (GMT 0)
Wow, that sounds really interesting, Kaz. Thanks for posting that. I'm looking forward to reading it when I have a chance.

You're a treasure!
Posted 12/7/2011 12:09 AM (GMT 0)
I second Ivy! I appreciate you posting this link. Awesome compilation and analysis of the various world-wide studies.
Posted 12/7/2011 2:29 AM (GMT 0)
You're welcome! It's a long article and honestly I haven't read it completely [yet]. The UC discussion is a little more satisfying than the Crohn's.
Posted 12/7/2011 3:36 AM (GMT 0)
I am severely allergic to 5ASA...my GI started me out on Asacol when I first became ill and that shtuff nearly killed me. Only after the first does of 4 pills, within an hour, full body rash, fever, chills, nausea, super weak and major bloody D.
Posted 12/7/2011 3:49 AM (GMT 0)
The only thing that has been tolerated for me has been antibiotic therapy and predisone...I seem to react to everything else including antibiotic therapy at times..I have never been on biologics due to my disease is not considered moderate to severe..5ASAS the doctor tries and after about a week I can't take the side effects anymore..This was the most frustrating part of my disease the medication made me feel even worse than I already felt!! With the number of people suffering with this DD, you would think they would come up with something better!
Cindy
Posted 12/7/2011 3:51 AM (GMT 0)
gosh, cindy, if you're intolerant of 5-ASAs and you've already had one resection it surprises me that your dr won't consider the biologics!
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