Inflammatory Bowel Disease

Nov 23, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"You killed Oliver!" Rounds ricocheted around the room. The plan was coming apart. Chaos, confusion and corpses. The hostage extraction detail was pinned down under heavy fire. Oliver was down. Eric was screaming commands into his headset. It was turning into a blood bath. The hostages were not going to be rescued as planned. In fact, they seemed to be destined to pay for their rescuers' blunders with their lives. And then worst of all, Eric's Dad told him he had to turn off the video game and eat supper.

I got successfully extracted from the pharmacy last week. I made a road trip to Gilbert Plains. I was invited to give a talk about inflammatory bowel to a senior's group. It was great fun and the audience was very enthusiastic and engaged. I can't fit the whole talk here, but since there was such interest in Gilbert Plains, I thought I'd go over some high lights.

What is inflammatory bowel disease? It is an immune-mediated chronic intestinal condition. That means the body's own immune system mistakenly attacks the intestines. The most common forms of inflammatory bowel disease are Crohn's Disease and Ulcerative Colitis. Inflammatory bowel disease is most common in Western countries and Canada has one of the highest rates of inflammatory bowel disease in the world. Right now about 0.6% of the entire Canadian population has inflammatory bowel disease. There are 8704 people in Manitoba with IBD. There are 270,000 people in Canada with IBD. People 65 and over are the fastest growing segment of IBD patients. Over 7000 children in Canada have IBD and that is a 50% increase in the past 10 years.

Crohn's disease can happen anywhere in the GI tract from the mouth to the anus. It is characterized by patches of inflammation in the gut surrounded by patches of healthy tissue. Symptoms will vary depending on where the patches of inflammation are located. Common symptoms include diarrhea, abdominal pain, cramping, nausea, vomiting, and weight loss. More serious complications can be painful skin tags that look like hemorrhoids but aren't, abscesses and fistulas. Abscesses are sacks of pus inside the body from an infection. Fistulas are tunnels that form from an abscess to another part of the body like the rectum or vagina. Fistulas often need surgical treatment.

Ulcerative Colitis is more localized than Crohn's. It usually just effects the large bowel. Ulcerative Colitis often has severe and bloody diarrhea, abdominal pain and cramping. A hallmark symptom of Ulcerative Colitis is feeling like you have to urgently move your bowels, but when you get to the bathroom find that you didn't really need to go.

Both Crohn's and Colitis have periods when the disease symptoms flare up and periods of time when the symptoms go quiet or go into remission.

There are many medications used to treat Crohn's and Colitis. But IBD is a chronic condition meaning it is life long and there is no cure. IBD is an autoimmune disease where the body's immune system attacks itself, so most treatments are anti-inflammatory. On the milder end are 5-ASA and sulfasalazine. Moderately strong steroid medications like prednisone and hydrocortisone do a better job at reducing the inflammation and symptoms, but also have more side effects. Biologics like adalimumab or Humira have revolutionized symptoms control for some patients. However, drugs like Humira are very expensive costing thousands of dollars per month.

Surgery can be a treatment option for people with Crohn's and Colitis. It can range from fistula repair to removing sections of bowel to ostomies.

Looking down the road at future treatments, two interesting things came up: cannabis and fecal transplants. There have been small studies showing cannabis reduces symptoms of both Crohn's and Colitis. But I do mean small. The ones I found had 20-40 test subjects. That makes cannabis interesting but in need of further study. Fecal transplants also interesting but not proven. The bowels of a subject are cleared out and the bowel bacteria from a healthy person are put back into a subject via an enema. The theory is with the "right" bacteria in the gut, inflammation might go away and so might all the symptoms. So very interesting, but far from proven.

Getting extracted from the pharmacy to talk to people is always fun. I miss the days when Eric was just playing Minecraft and building tunnels. If I was a better parent, I guess I should have better control over the amount of ultra-violent video games he plays. But, video games seems to be where Eric does all his socializing. They all have headsets on and are talking to each other while playing. In fact, while gaming, Eric was the first one in our family to hear about the boil water advisory in Dauphin a couple weeks ago. So at least he is talking to people while gaming. Instead of banning violent video games, as a parent I will just say this. Don't kill Oliver. He's a nice boy.

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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