Month: August 2018

Crohns and Ulcerative Colitis

Here is a 20 minute talk by a British gastroenterologist about the role of diet in Crohn’s disease:

Below are some useful links to learn more about your disease:

  1. Crohn’s & Colitis Foundation of Canada
  2. Crohn’s & Colitis Foundation of America
  3. Mayo Clinic IBD Information
  4. Database to look up information about drugs here.

Click here to learn about medications commonly used in Crohn’s and ulcerative colitis and their side-effects.

While the role of diet in Crohn’s & Ulcerative Colitis is currently unclear, it is POSSIBLE that avoidance of emulsifiers and highly processed carbohydrates such as maltodextrin could be helpful in preventing disease.  However until further studies are done, clear recommendations for patients cannot be made. Here is an excellent article about the probable role of processed foods in IBD and how to avoid them.

Here is an excellent article about food additives which may make our gut leaky. Also see the following videos:

  1. Preventing Crohn’s Disease with Diet (6 min)
  2. Are Emulsifiers like Carboxymethylcellulose and Polysorbate 80 safe ? (5 min)
  3. Ultra-Processed Junk Food Put to the Test (8 min)

Medications used in Crohn’s and Ulcerative Colitis

Below is a list of medications commonly used for Crohn’s and ulcerative colitis with information on their side-effects:

5 ASA (mesalamine, Asacol, Pentasa, Salofalk)

Side-effects: 5 % worsening of colitis, renal failure (< 1/1000)

Metronidazole (Flagyl)

Side-effects: vomiting if take alcohol, nausea, altered taste, dark urine.  Chronic use may result in peripheral neuropathy (permanent)

Prednisone  (steroids)

Side-effects:Risks of longterm use include osteoporosis, cataracts, avascular necrosis (< 1 in 10,000 but may need hip or knee replacement).  Click here to use FRAX – a tool developed by the World Health Organisation to predict your 10 year risk of a bone fracture.

Azathioprine (Imuran), 6 mercaptopurine

Side-effects: Pancreatitis (3-5%, rarely fatal), liver test abnormalities, lymphoma (1:1000), ongoing risk of bone marrow suppression (if you have a fever for more than 6 hours, do NOT take another pill until your blood count is checked).

A recent publication also looked at the risk of non-melanoma skin cancer in patients treated with azathioprine in 14,527 patients with a follow-up of 8.1 years (median).  There was an overall twofold increased risk in developing non-melanoma skin cancer which increased with duration of use.  The rate (per 1000 person-years) was 3.7 for non-users versus 5.8, 7.9, 8.3, 7.8, and 13.6 for the 1st, 2nd, 3rd, 4th, and 5th year of thiopurine use.  Implications of this include the use of sun-protection and consideration of regular (? annual) review by a dermatologist. Another publication confirmed that the risk was 1.85 times baseline (P<0.05).

A prospective cohort study of 19,486 French patients followed for a median of 35 months showed a significantly increased hazard ratio of developing lymphoma of 5.28 (P<0.01).  The rate of lymphoma per 1000 patient years was 0.26 in those who had never received the drug and 0.90 in those who had.  Thus the increased risk was 0.64 per 1000 patient years.  In other words if a person took the drug for 50 years, there would be a 1 in 31 risk of getting lymphoma.