Category Prednisone Side Effect

The Whipping Boys Are Back

<h1>The Whipping Boys Are Back</h1>

The Whipping Boys Are Back

IN late 2007 Scott Stapp, the frontman of the rock band Creed, walked into the bathroom of his Boca Raton, Fla., home, grabbed a razor and did the unthinkable: He shaved his head. His band had split up three years earlier, and ever since Mr. Stap…

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Shoulder Update !

<h1>Shoulder Update !</h1>

Shoulder Update !

Hey guys. I went to talk to my doctor about my shoulder and he said I can send you to a orthopedic but I said I won’t be able to go because I’m starting college next week and who knows what’s my schedule is going to be like. Anyways.. I asked him what should I do now I finish Prednisone the10 tablet he gave me. So he prescribed me to Diclofenac Sodium 75 MG 2 tablets a day. I read about the new medication he gave me and they can be some serious side effects but I’m only on this for 2 weeks no refills! One side effect can be rash or any allergy etc… so when I took 1 tablet today I started to itch here and there threw out the day I don’t know if that’s from the medication. What do you guys think ??

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He’s on prednisone. It’s so bad, I feel awful for him. They aren’t positive what happened. We adopted him in April and he was a healthy puppy until October. One morning chasing the cat he fell down the stairs. We thought he just tripped over his long legs because he was not at all coordinated and is very lanky. That day he wasn’t himself at all so we took him to the vet thinking he was hurt from the fall. They treated him for the pain (I can’t recall what they gave him). The next day he was worse and wouldn’t eat or drink. We went back to the vet and they knew something larger must be wrong. Blood count showed he was severely anemic and having an immune response. He was so anemic he almost died and it came on so fast, he was acting fine days before. Him falling we found out was a side effect of being anemic, as he kept falling and being unsteady on his feet for a while. Anyway, fast forward to now and he is still being weaned off of the prednisone slowly and is on another immunosuppressant to help the weaning process. He gets regular blood work to make sure his levels stay ok while being weaned. The vets best guess is it was a reaction to the canine influenza vaccine he received a couple weeks prior but there is no way to know for sure what happened.

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IgE: A Novel Target in Lupus?

<h1>IgE: A Novel Target in Lupus?</h1>

IgE: A Novel Target in Lupus?

IgE: A Novel Target in Lupus? Asthma drug showed preliminary promise as add-on therapy MedpageToday by Nancy Walsh Senior Staff Writer, MedPage Today January 10, 2019
Omalizumab (Xolair), the monoclonal antibody targeting immunoglobulin E (IgE), showed some possible utility as an add-on treatment for systemic lupus erythematosus (SLE) in a phase Ib study conducted by the National Institutes of Health.
At week 16, patients who had received omalizumab plus background therapy had statistically significant improvements on the SLE Disease Activity Index (SLEDAI), although the reduction was only an average of two points, which might not be considered clinically meaningful, according to Sarfaraz Hasni, MD, of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and colleagues.
The drug was well tolerated, with no systemic or local allergic reactions during 36 weeks of follow-up, the researchers reported online in Arthritis & Rheumatology .
“Omalizumab is a humanized IgG1 monoclonal antibody against human IgE that blocks the ability of IgE to bind FcεRI,” the investigators explained. The resulting depletion of IgE is thought to reduce the level of autoantibodies and to block the production of type I interferon. It has been approved by the FDA for the treatment of chronic idiopathic urticaria and asthma.
It was previously thought that most of the pathogenic autoantibodies that typify SLE belonged to the IgG subclass, but the NIH researchers recently demonstrated the presence of IgE antibodies against double-stranded (ds) DNA in a murine model.
Therefore, to explore the possibility that omalizumab might be useful in SLE, the investigators enrolled 16 patients, randomizing them to receive subcutaneous omalizumab or placebo for 16 weeks, followed by all patients receiving the active treatment for an additional 16 weeks. Patients were then followed off the drug for another month.
Omalizumab was given as a 600 mg loading dose and then 300 mg every 4 weeks.
Participants were required to have elevated levels of IgE-anti-dsDNA, anti-Sm, or anti-SSA autoantibodies, and moderate disease as defined by a SLEDAI of 4 to 14. Stable background immunosuppressives were permitted; all patients were taking hydroxychloroquine, and most also were on prednisone with an average daily dose of 7 mg.
Ten of the patients were randomized to have active treatment and six to placebo.
Among those in the omalizumab group for the entire study, the improvement in SLEDAI was maintained through week 32, and there was a trend toward worsening during the 4 weeks after treatment cessation. For those who were initially on placebo but switched to the active treatment after the first 16 weeks, improvements in SLEDAI were seen during the subsequent 16 weeks. Most improvements were in arthritis, rash, and serologic findings.
Three patients achieved a composite SLE Responder Index score of 4, two initially randomized to omalizumab by week 16 and one who switched from placebo by week 32. This low level of response may reflect the small sample size and participants’ relatively mild disease, according to the researchers.
There also was a trend toward improvement in patients’ interferon signature, particularly among those with a high signature at baseline. “This suggests that omalizumab may modulate type I interferon pathways by blocking self-reactive IgE,” Hasni and co-authors noted.
During the study and follow-up, a total of 52 adverse events were reported, most of which were mild or moderate.
In the first 16 weeks, there were nine adverse events in the omalizumab group and 12 in the placebo group. No pattern of organ involvement was identified for adverse events.
Three serious adverse events were reported. One was a patient on placebo who had bronchitis and developed chest pain, the second was a patient on omalizumab from West Africa who had no evidence of immunity to chicken pox and developed varicella infection after exposure to the disease, and the third had a pulmonary embolism shortly after the switch from placebo to omalizumab.
“A potential advantage of omalizumab in SLE is a side effect profile different from immunosuppressive drugs and a convenient once-a-month subcutaneous administration schedule,” Hasni and colleagues wrote.
In a 5-year study of this agent among patients with asthma, a potential risk for cardiovascular and cerebrovascular events was observed, which raises the question of whether the occurrence of a pulmonary embolism in one patient after receiving omalizumab could have resulted from the treatment or the increased background thromboembolic risk among patients with SLE, the researchers said. They added that future studies should address this question through measurements of vascular risk markers and evaluation of vascular function.
“Overall, this is the first trial to test the safety and potential efficacy of blocking IgE autoantibodies as a novel non-immunosuppressive agent in treatment of SLE,” Hasni and co-authors concluded. Additional larger studies will be needed to more fully evaluate the efficacy and safety of this agent.
The study was supported by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. 2019-01-10T13:00:00-0500 Primary Source Arthritis & Rheumatology

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Supraclavical fat pads | Polymyalgia Rheumatica and GCA | Bones, joints and muscles | Community | Patient

<h1>Supraclavical fat pads | Polymyalgia Rheumatica and GCA | Bones, joints and muscles | Community | Patient</h1>

Supraclavical fat pads | Polymyalgia Rheumatica and GCA | Bones, joints and muscles | Community | Patient

Visit to my GP today to check on tingling numbness in hands feet and face — apparently it’s a side effect of PMR and/or prednisone, and nothing more serious. But I mentioned also a soft swelling above my collarbone — he’s ordered an urgent scan of my neck, which made me a little worried. Fast forward, and I’ve been Dr Googling, and I think it could be supraclavical fat pads, another side effect of taking prednisone — does anyone else have experience of this?
I thought that starting off on 10mg last September I might escape some of the side effects, and am still so grateful for the pain relief I have, I wonder how those on higher doses cope….
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Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis

<h1>Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis</h1>

Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis

8 Foods to Avoid with IBS Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis Sign Up for Our Digestive Health Newsletter Thanks for signing up! You might also like these other newsletters:
Did you know that the symptoms of irritable bowel syndrome, Crohn’s disease and ulcerative colitis can be so similar that misdiagnoses and incorrect treatment occur all too often?
Join us as we speak with top gastroenterologists about the symptoms unique to each of these bowel diseases, the best tests to accurately diagnose your condition, and why a correct diagnosis is so important for getting the right treatment. You’ll find out which symptoms you should be sure to mention to your doctor, and how to go about getting a second opinion and further testing if you’re not satisfied with your diagnosis.
As always, our expert guests answer questions from the audience.
Announcer:
Welcome to this HealthTalk webcast. Before we begin, we remind you that the opinions expressed on this webcast are solely the views of our guests. They are not necessarily the views of HealthTalk, our sponsors or any outside organization. And, as always, please consult your own physician for the medical advice most appropriate for you.
Now here’s your host.
Rick Turner:
The symptoms of irritable bowel syndrome, IBS, can be very similar to inflammatory bowel disease, IBD. So how do doctors tell the difference between the two when making a diagnosis? Hello and welcome to this HealthTalk webcast, Irritable Bowel Syndrome: How to Avoid an Incorrect Diagnosis. I’m Rick Turner. And in this hour, our guests will clarify the differences between IBS and IBD, walk us through the diagnostic process, and discuss treatment for IBS, Crohn’s disease and ulcerative colitis.
With us on the phone from Seattle, Washington is Dr. Stephen Wangen, a naturopathic doctor and medical director and founder of the IBS Treatment Center in Seattle. Welcome to HealthTalk, Dr. Wangen.
Dr. Stephen Wangen:
Thank you, Rick. It’s a pleasure being here.
Rick:
And before we move on, can you tell us what is a naturopathic doctor?
Dr. Wangen:
Well, a naturopathic doctor is, certainly in the state of Washington and in many other states, a licensed and board-certified physician, and the difference really being often in the types of treatments that are selected. I could certainly prescribe many drugs and medications, although I often choose not to. I have a real emphasis on trying to find the root cause of the problem so that we don’t need to resort to medications. And it’s a really fascinating field, and I am sure we could spend the whole hour just talking about that, but I will try not to.
Rick:
I am sure. Good. Well, it’s nice to have you with us today.
Dr. Wangen:
Thank you.
Rick:
Also joining us from Milwaukee is Dr. Lilani P. Perera, assistant professor of medicine in the division of gastroenterology and hepatology at the Medical College of Wisconsin. Dr. Perera, welcome to you.
Dr. Lilani P. Perera:
Oh, Rick, thanks for inviting me.
Rick:
So, Dr. Perera, beginning with you, the question we posed at the outset, what is the difference between inflammatory bowel disease and irritable bowel syndrome?
Dr. Perera:
Inflammatory bowel disease, or IBD, is a chronic, relapsing inflammation of the gastrointestinal tract. It can both be broadly classified into Crohn’s disease and ulcerative colitis. Usually, IBD develops due to genetically susceptible individuals being exposed to environmental triggers resulting in disregulation of the immune response in the gut, which leads to chronic inflammation. Due to chronic inflammation in both Crohn’s disease and ulcerative colitis, there can be blood loss from the intestine, diarrhea and changes in the intestinal wall. Some of the abnormal blood tests include low hemoglobin, high inflammatory markers and abnormal electrolytes due to diarrhea. The abnormalities in the intestinal wall usually can be seen during endoscopy, X-rays or CT scan.
On the other hand, the irritable bowel disease, or IBS, is a common, chronic, functional bowel disorder. This means there is a disordered functioning of the bowel in relation to functions of the intestines. These include movement or motility of the intestine, the sensitivity of the nerves of the intestine. They seem to be hypersensitive, or they seem to feel at a lower threshold of a stimulus compared to a normal person. And the way in which the brain controls some of these functions can also be altered in IBS patients.
Rick:
So I hear a couple of distinctions between IBD and IBS. I didn’t hear you say that irritable bowel syndrome happens in people who are genetically predisposed to that. Is that correct?
Dr. Perera:
Yes. As far as we know, there is no hereditary or genetic susceptibility in patients who develop IBS, unlike in IBD.
Rick:
All right. And the other part I picked up on is that it’s more of a sensitivity issue. It’s not that there is inflammation going on with someone with IBS, but somehow they are feeling their gut more sensitively than the rest of us. Is that right?
Dr. Perera:
Yes. So it seems that they are more responsive to any stimulus, including even natural stimulus. If there is a rigorous contraction, or trying to push through after the meal, they can feel it much more, or actually they can feel it when it comes to a person who does not have IBS would not even realize that it’s happening inside the body.
Rick:
That’s interesting. So, Dr. Perera, how tough is it to distinguish between the two, IBS and IBD, when you make that initial diagnosis?
Dr. Perera:
Usually, it’s not difficult because in IBS there are no structural abnormalities that can be seen in X-rays or endoscopy or lab tests, so we usually diagnose IBS using constellation of symptoms. And IBD, usually the main diagnostic gold standard is doing an endoscopy and taking biopsies and looking under a microscope at these tissue pieces and looking for a particular kind of inflammation and cell type.
Rick:
Is it any more difficult to diagnose children?
Dr. Perera:
You mean the children with IBS?
Rick:
Or IBD and making sure you get the correct diagnosis with a child?
Dr. Perera:
It can be difficult in children simply because sometimes you might not be able to get a detailed history.
Rick:
Right.
Dr. Perera:
So the initial presentation could be a similar presentation. They both can have diarrhea. They can have abdominal pain. And then if you do not suspect and they do not have alarm symptoms and signs, those can attribute as IBS.
Rick:
And, Dr. Perera, what about the demographic distribution of IBS, is it more common in men or women, for example, or a particular age group?
Dr. Perera:
I believe it affects about 25 to 45 million people in the United States. Approximately 60 to 65 percent of this group is female.
Rick:
Okay.
Dr. Perera:
And 35 to 40 percent is male. And IBS can affect people of all age groups, including children, but it’s more commonly seen in middle-aged females.
Rick:
And is it possible for both to exist in the same patient, IBS and IBD?
Dr. Perera:
I think it’s unclear because there are some studies in the early ‘90s that suggested that IBS co-exists in IBD patients. But in that area, to support the IBS-like symptoms seen in patients with IBD, who are in remission may be actually due to changes that occurred in the intestinal nerves during the periods of active inflammation. And this notion is actually supported by the fact that sometimes IBS can develop after an acute viral or bacterial infection of the intestine.
Rick:
Interesting. Dr. Wangen, I want to bring you back into the conversation because you were diagnosed with IBS back in 1994. Tell us how that came about.
Dr. Wangen:
Well, I suffered from, for a few year from primarily it would be best described as really embarrassing gas, although I would get abdominal pains or get loose stools and diarrhea that wasn’t really life-altering. It was just kind of one of those things.
Rick:
A nuisance.
Dr. Wangen:
Yes. Just a hassle. And well, here it is, and I wouldn’t really have such an urgency usually that there would be a problem. But I just knew that my digestion wasn’t functioning appropriately and that things were not working right in that area and wasn’t really getting any answers anywhere either.
Rick:
So how did the diagnosis of IBS come about?
Dr. Wangen:
Well, essentially going to the doctor before I was a doctor and saying, “Well, I have these symptoms,” and basically ruling out any other more significant problems, and then essentially you are left with this syndrome that doesn’t really offer you much explanation for why you are having these symptoms but gives you a classification that puts you with these 45 million Americans, which is a huge percentage of people that are suffering from these digestive problems that get lumped into this syndrome.
Rick:
Yes. At least it gives a name to it.
Dr. Wangen:
Yes.
Rick:
And it’s interesting, though, I have read that you said your diagnosis had no impact on your health. What did you mean by that?
Dr. Wangen:
Well, I don’t know. I guess that probably came around just from me saying that it was only somewhat embarrassing, but it wasn’t exactly causing me to not be able to live my life the way I wanted to, which will happen with many patients I will see that actually they cannot do the social activities they want to do. They can’t take part in the things they want to take part in. Or oftentimes, I have had many patients who have even lost their jobs because of their IBS.
Rick:
Really? And a bit off topic for a second, but you specialize in IBS.
Dr. Wangen:
And can you define what makes IBS a syndrome and not a disease?
Dr. Wangen:
Well, I think we use those words rather loosely, syndrome versus disease. But I think the syndrome part of it is just that what we’ve done is taken a whole bunch of different symptoms, whether it’s constipation or diarrhea or just loose stools or gas or bloating or abdominal pain, and we have created this category really, this artificial area to place these people, and then given that name a syndrome just called it irritable bowel syndrome. But we don’t always use those two words. There is no real good standard definition for that.
Rick:
Okay. And, Dr. Perera, listening to Dr. Wangen describe his personal experience, does that sound typical to you?
Dr. Perera:
Yes. I mean, some patients can function normally with IBS symptoms, but it depends on how severe are their symptoms. Sometimes actually IBS symptoms can be so serious, and it can have a great impact on their overall well-being.
Rick:
Oh, good to say. So we don’t want to downplay those symptoms.
Dr. Perera:
Yes.
Rick:
Now, Dr. Perera, I spoke with a GI doctor who said that sometimes people go to the emergency room complaining of abdominal pain, and they are told that they have IBS, not to worry, but then their symptoms persist, and it eventually turns out that in fact they have IBD. How commonly does that happen?
Dr. Perera:
There is often a timeline between the onset of IBD symptoms and the actual diagnosis, but there are no large studies that I am aware of addressing the specific issue that you raise right now. But there may well be a time when the patients initially present not only to the ER but actually to their primary physician. Sometimes they just think it may be some transient thing and wait and see.
Rick:
So then for someone who is in that situation who goes to the ER, what sort of follow-up should they pursue if they want to make sure that they have been correctly diagnosed?
Dr. Perera:
Well, I think it’s important for them to follow-up with their primary care physician or a gastroenterologist if they continue to have abdominal pain or they develop alarming symptoms like weight loss or symptoms at nighttime of blood in their stool, of fever, or they have a family history of IBD. So during this follow-up, it’s important that they have the results of the investigations that were performed in the ER. That way, you can prevent unnecessary repetitions at the labs. You can compare.
Rick:
Right. And yes. Go ahead. Finish that thought. You can compare those records from the ER.
Dr. Perera:
Yes.
Rick:
Exactly. And is it possible, Dr. Perera, that IBS could ever morph or turn into either colitis or Crohn’s disease?
Dr. Perera:
The short answer is no. There is no evidence that IBS can turn into IBD, and there is no known increase of developing IBD in IBS patients. So the only scenario, a patient who is diagnosed with IBS can be found to have IBD later in life would be initial misdiagnosis.
Rick:
So you are saying that IBD is just not a more severe case of IBS?
Dr. Perera:
So there are different disease processes going on?
Dr. Perera:
Yes.
Rick:
Okay. We get e-mails from listeners who say they have been misdiagnosed with Crohn’s disease when, in fact, they had ulcerative colitis and vice versa. How common is that, to distinguish between those two types of IBD?
Dr. Perera:
Well, in about 10 percent of patients with IBD, the distinction between Crohn’s disease and ulcerative colitis cannot be made as there are overlapping findings. So these patients are usually said to have indeterminate colitis. Similarly, some patients may initially have diagnosis of UC or Crohn’s disease because the initial presentations and findings during the colonoscopy favors one or the other. But with time, they might evolve or manifest symptoms and signs of the opposite diagnosis.
Rick:
And what is it about those 10 percent of cases that make it difficult to distinguish between the two?
Dr. Perera:
So when, especially when the Crohn’s disease involves only the colon, it’s difficult to diagnose it from or differentiate it from ulcerative colitis. So there are several findings that are suggestive of Crohn’s disease in this setting. They include either involvement of the small bowel, involvement of the rectum, absence of gross bleeding, a characteristic finding during colonoscopy, the presence of granulomas, which is only seen in about 30 percent of Crohn’s disease patients. Granulomas are certain types of collection of cells that we would see during biopsies when they are checked under the microscope or if the patient has any fistula or draining sinus tracks near the anal region.
Rick:
And similar to the question I asked earlier, is it possible for colitis to evolve into Crohn’s or vice versa?
Dr. Perera:
So as I mentioned a few minutes ago, first of all, we must be clear that the differentiation of ulcerative colitis and Crohn’s is not always clear-cut.
Rick:
Right.
Dr. Perera:
Both disorders can present with inflammation in the colon, which is the colitis, and that’s the meaning of colitis, the inflammation of the colon. So sometimes it is difficult to distinguish the two types, even you are the best gastroenterologist. So the 10 percent of cases can remain undifferentiated.
Rick:
I see.
Dr. Perera:
In addition, with time it can evolve, and we might be able to differentiate if a patient has Crohn’s disease or ulcerative colitis.
Rick:
So it just takes time to make sure you have the correct diagnosis?
Dr. Perera:
Yes. Sometimes the initial presentation might not be very distinct.
Rick:
And then, Dr. Perera, how do gastroenterologists diagnosis IBS? Tell us about that process. Is it largely a process of elimination, making sure it’s not IBD?
Dr. Perera:
Actually, the diagnosis process in IBS usually starts with a detailed history and physical exam. So the presence of certain symptoms typical of the disorder, which includes abdominal pain or cramping, which improve with defecation, the change in bowel habits, either constipation or diarrhea, or the change in the character of the stools. So the symptom-based diagnostic criteria for IBS actually emphasizes positive diagnosis rather than doing numerous tests to exclude other organic causes.
Rick:
I see.
Dr. Perera:
So you want to do tests only on the presence of alarm symptoms or red flags that I mentioned before.
Rick:
Yes.
Dr. Perera:
And usually patients, even they have the typical constellation of symptoms, they may have basic blood work, including blood count or the CBC and basic chemistry. We are looking for anemia, infection with increase of a white cell count, or changes in electrolytes which can be related to diarrhea. And they will look for inflammatory markers, which are known as C-reactive protein and erythrocyte sedimentation rate. There are studies from the U.K. suggesting that patients with sprue can present with symptoms similar to IBS, so usually I do the sprue panel in these patients. And if the age at presentation of the patient is more than 50 years or they have family history of colon cancer, then I will do a colonoscopy.
Rick:
And, Dr. Wangen, listening to that process, you are a naturopathic doctor, as we mentioned before. How different is the process for you when it comes to screening a patient for IBS? Are your methods radically different from those of traditional medicine?
Dr. Wangen:
Well, I would say that I guess the majority of my patients have already been diagnosed as IBS, and screening them is not something that I focus on. I am not so concerned with diagnosing IBS because it has so little meaning. I am mostly concerned on solving their problem, so whether or not they get classified as an IBS patient or not isn’t important to me. Having ruled out IBD is important, and usually that’s already been done. Or if they need to have that done, I can refer them to a gastroenterologist to have that done. But what you find is that a very large percentage of patients who visit gastroenterologists, and the studies have shown that it’s as many as a quarter, nearly 25 percent of patients who visit a gastroenterologist, end up with a diagnosis of IBS, which, of course, leaves them basically still wondering what the cause of the problem is.
Rick:
And that’s where we really start. My specialty is picking up at that point.
Rick:
So they have already been diagnosed?
Dr. Wangen:
Typically. Although not necessarily always. I mean, there are certainly many patients who just haven’t really needed to see a gastroenterologist because the quality of their symptoms haven’t met that severity, or their age or their risk factors or what have you haven’t really lent them to necessarily being referred to a specialist yet, and they refer themselves. And they say, “I have these digestive problems, and I would just like to have an answer,” whether or not they are truly classified as IBS.
Rick:
So how do you go about helping them, Dr. Wangen? I understand you test DNA.
Dr. Wangen:
Well, we do several things. When you really start to look at digestive problems that are not IBD, and they are just falling into this IBS world or just falling into a no diagnosis world, just sort of chronic abdominal pain or constipation or diarrhea, if you start to really look at all the medical literature out there, all the research that explains the various causes of these things, you would find that there are many hundreds of causes of these kinds of symptoms.
And one of the things that you mentioned, DNA, relates to a particular kind of testing we do with stool. The digestive tract is, of course – or maybe not of course – that’s the wrong term to use, but it is this fantastic ecosystem of organisms. And we tend to underappreciate the value of all these organisms. We hear about good bacteria, for example, such as acidophilus.
Rick:
Right.
Dr. Wangen:
And we have many other bacteria, and there are all kinds of bad bacteria, and we hear about some of the really bad ones such as salmonella.
Rick:
Yes.
Dr. Wangen:
Or some of the bad E. colis. And those make the news, but there are many other bacteria. There are yeasts such as candida. There are many good bacteria, and there are all kinds of parasites, even ones that we generally don’t hear about that can be involved in this ecosystem that’s occurring in the digestive tract. The DNA portion of this gets involved when we can actually use DNA testing now to assess that environment. And we can take a stool sample and run a DNA analysis looking for genetic material from all these different organisms.
Rick:
So you are doing a DNA test on the microbes?
Dr. Wangen:
Exactly. That’s the latest in the technology for testing these organisms that are involved in that ecosystem.
Rick:
And do you have evidence from clinical trials, as an example, that shows this is a valid and clinically meaningful bit of information to have?
Dr. Wangen:
Well, certainly there have been many studies over the years involved on detecting these kinds of organisms in the stool sample, and most of those have been done by traditional stool cultures, which are the more common technique for looking for what’s going on in the digestive tract as far as measuring these organisms. We also do microscopic examinations as the traditional way of looking at these organisms as far as parasites go because you can’t culture those.
With DNA testing, of course, it’s been around for many years, but it hasn’t been available as a tool for the public to use to measure these kinds of organisms. It’s been around in research for many years, and we have all heard about DNA testing with regard to whether or not someone in the legal system when somebody left a blood sample.
Rick:
Right. Right.
Dr. Wangen:
So it’s the same concept, and researchers have been using it, only now it’s available to the rest of us because before there were too many patents and controls on things that made it too expensive to offer to the public.
Rick:
So when you test for these, Dr. Wangen, is there a spectrum of microbes, say, bad microbes on one end and good microbes on the other and sort of neutral microbes in the middle, and you find if they have the proper array of microbes in the gut? Is it something along that process?
Dr. Wangen:
There certainly is a balance. That’s a big issue, the balance of all these organisms. You have many different, what we call probiotics, the good guys, and acidophilus is the most commonly understood one, or in the public’s mind that’s the one we hear about the most. There are all kinds of other organisms that, like you say, there are some that are basically neutral. They are not really causing problems. There is no research demonstrating that they cause problems. And then there are others that you never hear of that there are lots of case studies and lots of research that show that they cause digestive problems, but oftentimes they will even get ignored in medical textbooks. So if you crack open the text, and it will say, oh, this organism is non-pathogenic, meaning it’s not causing problems. But when you dig deeper and you actually look at the research studies and all the case studies, you find often many examples of that organism causing the digestive problems. So, of course, anybody who has a digestive problem wants to know everything there is to know, not just to sort of get chalked up as, well, usually this isn’t a problem.
Rick:
And in general, Dr. Wangen, are these tests covered by insurance?
Dr. Wangen:
That will vary from one plan to another, and it’s really hard to say. Sometimes they are, and sometimes our patients are covered 100 percent, and sometimes they are not covered at all. It’s hard to speak for insurance plans.
Rick:
Sure. Now, you have said also that IBS is primarily caused by food. Why do you say that?
Dr. Wangen:
Well, the other thing, and I haven’t mentioned that I find incredibly important when it comes to digestive problems is, of course, the food that we eat. And most people associate their problems with foods, and they find that they feel much better when they don’t eat, but, of course, you have to eat.
Rick:
Eventually.
Dr. Wangen:
And it turns out that there is certainly a profound effect that food has on us, and food allergies are a major aspect of what I look at to assess what’s going on in a person’s digestive tract. And this is an area that gets really overlooked and underestimated by most of the medical community because we tend to think of food allergies as something very traditional, that if you have an allergy, your tongue swells up, or you get hives, or you have an anaphylactic reaction.
Rick:
Yeah, it’s very dramatic.
Dr. Wangen:
Yeah. But it turns out that in most cases it’s not very dramatic or at least not in the classic sense that we think of it. And food allergies are much more complicated areas than just looking for the traditional IgE antibody reactions that allergists typically are looking at. And again in the research we see, many examples of studies on these same areas, it’s hard for doctors to know everything because there are too many things to know, obviously. And so in my area, that’s what I specialize in is focusing on what is it that impacts a person’s digestive tract that’s not IBD, that’s not cancer, that’s not any of these other things, and there are many, many issues. And the food allergies are a huge one, and it can be literally any food, but those will usually show up on a blood test.
Dr. Wangen:
In general, Dr. Wangen, are there certain factors that tend to exacerbate IBS?
Dr. Wangen:
Well, when you run into any information about IBS, of course, you get the same kinds of information. You are told to reduce your stress. You are told to take more fiber. And probably don’t intake caffeine or alcohol, and certainly all those things will exacerbate a digestive problem. So if you have a health issue regardless of what it is, but certainly if it’s a digestive issue, and then you get stressed on top of that, it’s certainly going to make things worse. It’s not going to make them better. And so, and the fiber might help, but it’s not treating the cause of the problem. It’s pretty rare that people are so deficient in fiber that that’s really the key issue that’s going on. And the same thing I find with the alcohol and the caffeine is that they are irritants, and they will exacerbate an underlying digestive problem but aren’t usually the primary factor that’s causing the problem.
Rick:
Dr. Perera, back to you, and talking about treatment now for IBS, how is treating IBS different than treating IBD?
Dr. Perera:
The treatment of IBS I usually start with, as Dr. Wangen said, asking the patient to avoid the food types that can exacerbate their symptoms and then followed by symptomatic treatments. If a patient has diarrhea, treat it with anti-diarrheal medications. If they have constipation, treat with fiber supplements and laxatives or lubiprostone, a medication that inhibits the chloride channels or the channels that absorb water in the stool. And also we use neuromodulating anti-depressant medications. Those include tricyclic anti-depressants and the selective serotonin reuptake inhibitors. These are not used just thinking the patient depressed. These medications have shown to affect the nerve function in the intestine.
Rick:
Really?
Dr. Perera:
So that the pain can be controlled. And there are studies actually showing that probiotics can improve the abdominal discomfort and the overall symptoms in IBS patients.
Rick:
And then for treating IBD, I guess the key is you have the inflammation to deal with, right?
Dr. Perera:
Yes. So in the treatment in IBD, of course, the treatment depends on the location and the severity of the disease. The goal of treatment, there are two goals. The first thing is to control the symptoms or achieve remission, and then is to maintain the remission. So we use mainly four classes of drugs involved in Crohn’s disease and ulcerative colitis. The first one is 5-aminosalicylic acid or 5-ASA products. So these medications work at the lining of the intestines. They do not suppress the immune system. They are usually used to treat mild to moderate ulcerative colitis or Crohn’s disease.
Rick:
Okay.
Dr. Perera:
But studies have shown that the Crohn’s disease may not respond to the 5-ASAs as well as the ulcerative colitis will.
Then if you think that the patient has more active disease, then we use corticosteroids. So there are several types of corticosteroids that we use, depending on the clinical scenario. If a patient has mild to moderate Crohn’s disease involving just the terminal part of the small intestine or the terminal ileum and the right side of the colon, we can use something called budesonide or the Entocort, which is actually a topical steroid. So it does not get absorbed mainly into the bloodstream, so there is minimal toxicity compared to the other steroids that get absorbed into the blood directly.
Rick:
I see.
Dr. Perera:
Well, but we do use those steroids, the hydrocortisone or the prednisone, which are the most commonly used ones, to achieve remission when the patient has serious symptoms. But because of the toxicity, we usually at the same time start another group of medication called immunomodulators. Those include methotrexate, or azathioprine. And then after we achieve remission, then we continue patients on immunomodulators.
And then the last group of medications are the biologics. So those include the proteins, which are called anti-TNF molecules. Those are the first ones that were available. The first medication that was available was infliximab or Remicade, which has been there about for 11 years, and it is usually given intravenously. We give induction treatment, which is followed by every eight weeks intravenous infusions. And then there are another two types of anti-TNF medications which are approved for Crohn’s disease. Those include Humira (adalimumab) and Tysabri (natalizumab).
Rick:
Tysabri. And, Dr. Perera, do you ever treat IBS with surgery?
Dr. Perera:
No, because all the gastroenterology community agrees that the surgery has no place in treatment of IBS.
Rick:
Dr. Wangen, back to you, you talked about treating the cause of IBS rather than the symptoms. How do you folks at your clinic treat IBS?
Dr. Wangen:
At the IBS Treatment Center, what we do is we really focus on trying to resolve the condition altogether. As Dr. Perera mentioned, many of the medications, well, all of the medications that are used in the treatment of IBS, and many of my patients are on them, are designed to treat symptoms, whether they are anti-spasmodic drugs or they are anti-depressant drugs or they are changing the motility of the gut. They are doing something to treat symptoms, but they don’t cure the problem, and there is no pretense that they are going to cure the problem.
So when a patient comes in, a new patient comes in, of course, we need a detailed history. Oftentimes, there are lots of clues involved, when the problem started, what may have been some of the triggers involved, but really what we need are two big broad panels of information. I need to understand exactly what’s going on in that environment, in that ecosystem in the digestive tract of theirs. What are the organisms like? What’s the balance like? Is there something in there that needs to be treated? And there are many examples of things, whether it’s candida, which is a real problem that actually gets sort of overestimated by the public and underestimated by the medical community, but it really exists. You certainly can see yeast overgrowth, and that’s a common problem. You will see other bacteria that have been missed. Certainly, the DNA testing is far superior, and I have used the other testing traditionally in a much broader sense than most physicians because I have always looked for the good bacteria as well as all kinds of indifferent and bad bacteria, but the DNA test is even much better at capturing those organisms than any technology we have had previously. So I want to see that whole picture.
And then the other thing I want to see is how is their immune system reacting to the foods that they are eating, and not just traditional IgE antibodies, but IgG antibodies as well. And I don’t know if we will have time to get into this whole antibody discussion, but the majority of our immune system actually lines the digestive tract and protects us from invaders in that area. And the immune system has, of course, a lot to do with how we react to food because that’s where we are also coming into contact with food is, of course, ingesting it. And then the immune system has to identify whether or not it’s going to be something that’s okay and safe and nutrition or something that needs to be basically attacked, and antibodies are a great way of measuring that reaction or potential reaction that’s going on. And that will tell me does a particular patient have a problem with dairy or a problem with wheat or eggs or you name it. It could be anything. And I will run a panel of about a hundred foods usually on most people to see what is it in this person that’s going on because it’s so different. There are so many different variables in both environments, whether it’s the immune reaction or the ecosystem, that we need to know. I have no idea how I am going to treat a patient until I get lab results back on these two broad-based kinds of panels because I could tell everybody that came in to stop eating whatever it was, alcohol or caffeine or dairy or something like that, but I could be way off.
Rick:
That would be a stab in the dark, right?
Dr. Wangen:
Right. It would just be a guess. And I think that’s what makes us so successful is that we are very specific to each individual patient. And I always try to guess because it’s just kind of interesting, and I am often wrong when I get the lab results back. But it always is different. It’s just different for everybody, and often there are several variables that are occurring at the same time that make it that much more difficult for a patient to figure out.
Rick:
Okay. And in terms of the treatment, are supplements a big part of that, Dr. Wangen, fish oil, probiotics or anything along those lines?
Dr. Wangen:
Not necessarily. I find that supplements are often used in a lot of the same ways that medications are. They are treating the symptoms usually. And supplements can have good properties, and probiotics certainly can be well-warranted. But in many patients, they aren’t necessary or they aren’t effective, and so you take care of other parts of the picture first. And so that will be a problem. Another problem is that people are often taking their probiotics in a dairy form, which if they have a problem with dairy, whether it’s a dairy allergy or lactose intolerance or whatever it is, oftentimes they can’t tolerate the probiotics until we find out that and then actually get them dairy-free probiotics.
And people often confuse this issue of lactose intolerance and dairy allergy, and there are two completely different things. And I thought it was worth mentioning because if you are allergic to dairy, it doesn’t matter if it’s lactose-free or not, you still have a problem with the dairy products. And people will often mistake those and think they are the same. So you have all these other supplements. Like you say fish oil is often recommended or peppermint oils or there are various things that have good properties and that can help the healing process, but until you know what the cause is and deal with that first those things aren’t going to be very effective. They certainly are not going to cure the problem and not work for very long.
Rick:
Okay. We want to get to questions from our listeners in just a moment here, but, Dr. Perera, before we do, what about the issue of diet and diet supplements from your perspective? Is there a safe and effective way to manage IBD through diet? We get that question a lot from our listeners.
Dr. Perera:
Well, unfortunately diet alone will not be enough to manage the inflammatory bowel disease, but that can certainly affect symptoms of these diseases, and it is shown to play some role in the underlying inflammatory process, but diet is not the major cause of the chronic inflammation that we see in IBD. But at the same time, diet is really important in the overall management of the patient. It is very important that they have a well-balanced, healthy diet because the good nutrition is important for your body to fight against any illness. So it is important that they still take all efforts to prevent becoming malnourished.
Rick:
First we get an e-mail from Columbus, Ohio, “What are the chances that someone diagnosed with ulcerative colitis by endoscopies actually has Crohn’s and vice versa? And also, how reliable is the Prometheus test?”
Dr. Perera, how about fielding that one?
Dr. Perera:
As I mentioned earlier, sometimes the symptoms, not only symptoms, but the biopsy can have just chronic inflammation, which is going to be typical in both conditions, especially if the Crohn’s disease only involves the colon.
Rick:
All right. You mentioned that happened maybe 10 percent of the time?
Dr. Perera:
Yes. Ten percent of the patients at this point, and as I mentioned only 30 percent of patients will have granulomas, those special collections of cells which would differentiate Crohn’s disease from ulcerative colitis. So, and in this situation, we can use those serological markers, but they are not 100 percent. But the more serological markers that are present in each patient are going to help us to decide whether they have Crohn’s disease or ulcerative colitis.
Rick:
And how reliable is that Prometheus test?
Dr. Perera:
Those are the serological markers we use.
Rick:
Those are those. Okay. Got it. All right. Next question comes from Pennsylvania, and this person writes, “How can I prevent losing control of my bowels?” This writer does not say if he or she has IBS or IBD.
Dr. Wangen?
Dr. Wangen:
Well, you bring up a good point. It’s a little difficult I guess based on the information that we know on this person, but certainly loss of bowel control and urgency is something that we see in IBS patients, and that falls into the same kinds of issues I have been discussing. Oftentimes, that’s triggered by any number of things, whether it’s a particular reaction to a food or a combination of foods or a bacterial or a yeast or a parasitic problem. But oftentimes there are things that can be done. I mean, I would actually expect that, assuming they don’t have IBD or something else, that there is a very good chance that something can be done for that.
Rick:
And Dr. Perera, in terms of the issue of urgency, how is that typically treated, be it either IBS or IBD?
Dr. Perera:
Usually, in IBD the urgency is related to the inflammation in the rectum, so that can be treated with 5-ASA products that I mentioned earlier.
Rick:
Right.
Dr. Perera:
They do have different forms of 5-ASA products that you can use into that area. There is Rowasa (mesalamine) enema. Then there are the suppositories that they can use, which is Canasa (mesalamine). And then we have steroid enemas. So those can be used to control the inflammation and which should help with urgency and the incontinence that they do develop secondary to the inflammation.
Rick:
Right. Okay. We have a phone caller joining us. Barbara is on the line from Florida. Welcome, Barbara to HealthTalk. What is your question, please?
Barbara:
Thank you for taking my call. I have ulcerative colitis, and I have two questions. I have been on a low residual diet for six weeks, and I have been feeling pretty good. I haven’t had any accidents. Can I start bringing back some regular foods now? I was told no nuts, no salads, no fruits with skin, no potato with skin. Or do you just start trying everything again once you are feeling well?
Rick:
Okay. And the second question?
Barbara:
And my second question is should you be having your blood tested or liver tested every few months when they say you have ulcerative colitis?
Rick:
Blood tests or liver tests, you say?
Barbara:
Yes. I am on Lialda (mesalamine) now, so that was my question. I wanted to know if you should be having any kind of blood tests?
Rick:
Right. Okay. Dr. Perera, first to you?
Dr. Perera:
Well, regarding the first question, the food diet that she mentioned mainly has increased amount of fiber, so we usually recommend that patients to cut down those if they have strictures like in Crohn’s disease because if they have high fiber diets, sometimes they can completely block and develop symptoms suggesting obstruction or blockage of the small intestine. And, of course, fiber is a laxative, so it can give you loose stools, even when you have ulcerative colitis if you are that type of person.
Rick:
I heard her wondering if she can sort of dive back into the fiber world or if she has to try it gradually?
Dr. Perera:
So, yes. Because she has ulcerative colitis, I mean, she should be able to. Maybe she just had so much of diarrhea because her inflammation is uncontrolled.
And for the second question, just because she has ulcerative colitis, we would not be checking blood work unless the medications that she is using, like if she is on immunomodulators or other biologic agents, then we do have to take complete blood count and liver function test and the basic chemistries to make sure that they are not affecting the liver and they are not suppressing the immune system too much, making her more prone to infection.
Rick:
Got it. And, Dr. Wangen, did you want to add anything?
Dr. Wangen:
I would just say that you, obviously you want to proceed cautiously when you are reintroducing foods. One of the things I will see, and I would say that you can see people who have both IBD and IBS, and the reason I say that is because I have had IBD patients where I don’t expect to be able to solve their IBD, but I do oftentimes find that we can improve their overall digestive health and improve their digestive problems because they often have something else going on as well. And if you have an immune reaction to a particular food and then you reintroduce it, you might find that it causes problems. It causes symptoms. And that can happen even with fiber. For example, fiber has obviously got to come from a food, and I have had patients who were actually allergic to things like psyllium so just keeping that in mind when you are reintroducing foods.
Rick:
Okay. Next up, we have an e-mail question from my former home, Flagstaff, Arizona, and this person writes, “I have IBS.” Another question about fiber here. “Should I take soluble fiber supplements to stop the diarrhea? If so, for how long? I have read for just a few days.”
Dr. Wangen, to you first on this one.
Dr. Wangen:
Well, I guess, yeah. I mean, that’s one of the common treatments I suppose for loose stools is fiber, and soluble fiber is often a good choice. I don’t know that it would necessarily need to be for only a few days. If it helps, that’s wonderful, although I find that for a lot of patients it’s not adequate, and they often resort to things like Imodium (loperamide), over-the-counter remedies. So as far as a best answer for that, without really being able to delve deeper, without the proper kind of testing, that would be the best answer I could give.
Rick:
Sure. Dr. Perera, did you want to add anything?
Dr. Perera:
Well, I mean, I agree. If it helps him, he can continue with that. And if it doesn’t help, of course, he can stop it.
Rick:
That’s right. Next question is about colonoscopies, “How often does a person with colitis need to get a colonoscopy?”
Dr. Perera?
Dr. Perera:
So, of course, you will have a colonoscopy with your initial diagnosis. And the usual recommendations is after that if you have involvement of your colon due to ulcerative colitis, your whole colon is inflamed and involved, then eight years after the onset of the disease, then you should have every one to two years of colonoscopy because of the high risk of developing colon cancer compared to the general population. If they have only left-sided disease, the recommendation is that we start surveillance colonoscopies 15 years after the onset of the disease.
Rick:

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Ulcerative Colitis Treatment 2018 | Global Forecast 2025 | Major Players Bayer pharmaceuticals Corp, Teva pharmaceuticals USA Inc

<h1>Ulcerative Colitis Treatment 2018 | Global Forecast 2025 | Major Players Bayer pharmaceuticals Corp, Teva pharmaceuticals USA Inc</h1>

Ulcerative Colitis Treatment 2018 | Global Forecast 2025 | Major Players Bayer pharmaceuticals Corp, Teva pharmaceuticals USA Inc

Introduction
Ulcerative colitis is a chronic, inflammatory disease that causes sores and inflammation in the innermost lining of large intestine and rectum. Ulcerative colitis causes ulcers, bleeding, mucus and pus. The disease is difficult to diagnose as its symptoms mimic other intestinal disorders such as irritable bowel syndrome (IBS). The main symptoms of ulcerative colitis include diarrhea, rectal bleeding, belly pain, etc. People with the Jewish heritage have higher incidence of this type of disease. It is a lifetime condition until the large intestine is removed surgically. There are three main surgical procedures for the treatment of ulcerative colitis including ileostomy, ileorectal anastomosis and Ileoanal anastomosis. Ulcerative colitis can affect people very differently. Some patients do not require constant treatment with medicines, while some of them might require multiple surgeries and medicines. Both medications and surgery have been used to treat ulcerative colitis. New surgical techniques that allow many patients to keep the muscular layer of the rectum while removing the rectal lining may boost the market over the forecast period.
Evolution of the Market
The treatment of colitis depends upon the cause and nature of the disease. Changing of diet helps to reduce symptoms of the disease, but there is no particular cure for some forms of this disease. Medications plays an important role for improving the symptoms of ulcerative colitis. Most of the drugs are used to prevent inflammation in the intestine. Aminosalicylates is used in most cases to reduce the symptoms of ulcerative colitis. Surgeries may be preferred if the medications are not able to control the symptoms. Alternative therapies such as use of herbal and nutritional supplements are also used to cure the disease. Aloe vera gel also shows anti-inflammatory effect for people suffered with ulcerative colitis. Lifestyle factors such as stress and eating certain foods do not cause ulcerative colitis, but may worsen the symptoms.
Factor Driving and Restrain Ulcerative Colitis Treatment
The global market for ulcerative colitis treatment is driven by increasing risk of chronic disease associated with long-term disease and higher incidence of disease in the Ashkenazi Jewish descent people. Inherited genes are also important factors in the development of ulcerative colitis. Growing number of incidence with ulcerative colitis is another factor driving the demand for ulcerative colitis treatment across the globe. However, emerging countries of Asia Pacific region do not have major incidence of ulcerative colitis, which restricts the market growth in Asia Pacific region. Technological advancements in surgery of ulcerative colitis treatment is the important factor fueling the growth of the ulcerative colitis treatment market. For instance, an introduction of effective drugs and new treatment therapies can also play important role in curing the disease.
Ulcerative Colitis Treatment Drugs
Some of the commonly used drugs for ulcerative colitis treatments are anti-inflammatory medications containing 5-aminosalicylic acid, which include medications such as mesalazine sulfasalazine, and olsalazine. Corticosteroid medications, such as budesonide and prednisone are also used but due to its side effects these are not usually given for long term. Antibiotics may be prescribed if the infection is present in the colon. Moreover, the awareness towards ulcerative colitis treatment is primarily important factor that leads to strong positioning of the drugs in the overall market.
Penetration of Online Pharmacies
Hospital pharmacies, drug stores, and retail pharmacies pose a strong position in the global market due to the easy availability of prescribed medicines. However, online pharmacies such as e-commerce are also increasing the demand for drugs as there are many offers available on the online platform. Growing penetration of atypical antipsychotic drugs on the online pharmacies will provide a remarkable growth opportunity for the manufacturers in underdeveloped economies. Further, the growing trend of online pharmacies would flourish the growth of atypical antipsychotic.
Geographically, the global ulcerative colitis treatment market is segmented into seven key regions viz. North America, Latin America, Western Europe, Eastern Europe, Asia Pacific excluding Japan, Japan and the Middle East & Africa. Europe will continue to dominate the global market, as the region has maximum number of descends from the Ashkenazi Jewish communities. Asia Pacific is expected to hold lucrative market share in the global ulcerative colitis treatment market due to less incidence of the disease.
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key ulcerative colitis treatment market are Bayer pharmaceuticals Corp, Teva pharmaceuticals USA Inc, Cipla Limited, Sanofi Aventis Pharma India, Sun Pharmaceuticals Industries Ltd, Ranbaxy laboratories Inc, Sandoz Inc, etc.

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