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#TBT: A Window into IBD..the causes and effective treatments

By Sabina Rebis —

Trying out new posh restaurants, Thanksgiving dinner with the fam, or a summer vacation in Tahiti tend to bring on excitement rather than the sensation of paralyzing anxiety. Patients with inflammatory bowel disease, like Crohn’s and ulcerative colitis however, face a new set of challenges even during times of pleasure. Experiences that spill a little color into the ordinary moments of life can become a nightmare during IBD flare-ups when the focus is not the escargot or the dinner table gossip or the crystal clear ocean, but the cramps, the pain, and frequent trips to the bathroom.

Inflammatory bowel disease occurs most often in young people between 15 and 35 and about 30 to 40 thousand cases occur each year.

So what causes it?

Factors may be genetic. About 20% of those diagnosed with IBD have a relative with the disease. The most popular word on the block these days though, is that both Crohn’s and ulcerative colitis are caused by a dysregulated immune response in the intestinal mucosa (the skin of your intestine). Some environmental insult, whether a bug, a virus, or other invader incompatible with what the preferences of your body are, signals it to naturally respond by vamping up the T-cell response in the gut. These T cells, your body’s protector cells, secrete molecules called cytokines (think of these as T-cell hormones) that attract and stimulate additional immune cells to fight whatever invader is present…. But for some reason, in those suffering from IBD, this response just does not turn off leading to a perpetuating inflammatory reaction during IBD flare-ups.

Treatment of IBD is designer, or in other words tailored to each individual patient. This means that each patient’s treatment should consist of a unique combination that works best for them depending on the location of the inflammation in the intestine. There are drugs that keep IBD under control, keeping flare-ups in check, and those that bring it under control, reducing flare-ups when they actually happen. Here are 6 current categories of drugs used in the treatment of IBD:

–       Aminosalicylates (mesalamine, balsalazide, osalazine, sulfasalazine) work similarly to aspirin by reducing inflammation in the gut and are the most frequently used.

–       Corticosteroids (prednisone, predinsolone) are fast acting and mostly used during the acute flare-ups. They reduce inflammation and tone down the activity of your immune system.

–       Antibiotics (metronidazole and ciprofloxacin) are used to balance out the bacteria in the gut by wiping out some of the bacteria that may be causing an increase in inflammation in the intestine.

–       Immunomodulators (6-MP, azathioprine, methotrexate) work to decrease inflammation and regulate the immune response by making adjustments to the way the cells of the immune system behave.

–       Immunosupressants (cyclosporine and tacrolimus) tend to put the breaks on the T cell and immune response when there is too much inflammation, by decreasing multiplication of these cells.

–       Infliximab is an antibody against TNF-a, a cytokine (or “hormone” of the T-cell) that attracts other immune cells to stimulate the infmammatory response.

Although poor nutrition or stress do not cause IBD, various foods and lifestyle choices may make flare-ups worse so it is important to pay attention to these triggers as well. Check out Pulp Nature’s food section for some great recipes.

Sabina Rebis, M.D.- Autoimmune Ally


Source: Crohn’s and Colitis Foundation of America

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