- What Are They
- Azathioprine, 6-M and TPMT
What are Crohn's disease medications?
There is no cure for Crohn's disease, a chronic inflammatory disease that causes ulcerations of the small and large intestines (colon). The symptoms of abdominal pain, diarrhea, rectal bleeding, and weight loss caused by Crohn's can come and go, which are typically managed with medications and treatments.
Medications for Crohn's disease are aimed at putting it into remission, maintaining remission, minimizing side effects of treatment, and improving the person's quality of life.
While surgery can significantly improve the quality of life for some, the disease often recurs after surgery.
As researchers continue to investigate the role of genetics and environmental factors in Crohn's disease, we may see better treatment options and maybe even one day be able to prevent the disease.
What are anti-inflammatory medications for Crohn's and their side effects?
Anti-inflammatory medications that decrease intestinal inflammation are similar to arthritis medications that decrease joint inflammation. Examples of types of anti-inflammatory medications used in the treatment of Crohn's disease are:
- 5 aminosalicylic acid (5-ASA) compounds, for example, sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowasa enema, Canasa suppository).
- Corticosteroids that act systemically (without the need for direct contact with the inflamed tissue) to decrease inflammation throughout the body. Systemic corticosteroids have important and predictable side effects if used long-term.
- Topical corticosteroids, for example, budesonide (Entocort EC). This class of corticosteroids has fewer side effects than systemic corticosteroids, which are absorbed into the body.
- Antibiotics that decrease inflammation, for example, metronidazole (Flagyl) and ciprofloxacin (Cipro).
What are 5-ASA oral and rectal medications and their side effects?
- 5-aminosalicylic acid (5-ASA), also called mesalamine, is similar chemically to aspirin. Aspirin is an anti-inflammatory drug that has been used for many years for treating arthritis, bursitis, and tendonitis (conditions of tissue inflammation). Aspirin, however, is not effective in treating Crohn's disease and ulcerative colitis and may even worsen the inflammation. Recent studies suggest that aspirin might actually decrease future risk of developing colorectal cancer in the general population.
- On the other hand, 5-ASA can be effective in treating Crohn's disease and ulcerative colitis if the drug can be delivered topically onto the inflamed intestinal lining. For example, mesalamine (Rowasa) is an enema containing 5-ASA that is effective in treating inflammation in the rectum. However, the enema solution cannot reach high enough to treat inflammation in the upper colon and the small intestine. Therefore, most patients with Crohn's disease involving both the ileum (distal small intestine) and colon, must take 5-ASA orally.
- If pure 5-ASA is taken orally, however, most of the 5-ASA would be absorbed in the stomach and the upper small intestine, and very little 5-ASA would reach the ileum and colon. To be effective as an oral agent in treating Crohn's disease, 5-ASA has to be modified chemically to escape absorption by the stomach and the upper intestines.
- Sulfasalazine (Azulfidine) was the first modified 5-ASA compound used in the treatment of Crohn's colitis and ulcerative colitis. It has been used successfully for many years to induce remissions among patients with mild to moderate ulcerative colitis. Sulfasalazine also has been used for prolonged periods for maintaining remissions.
- Most of the side effects of sulfasalazine include nausea, heartburn, headache, anemia, skin rashes, and, in rare instances, hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count. The reduction in sperm count is reversible, and the count usually becomes normal after the sulfasalazine is discontinued or changed to a different 5- ASA compound.
- Some 5-ASA compounds, for example, mesalamine (Asacol and Pentasa), do not have the sulfapyridine component and have fewer side effects than sulfasalazine, and are used more frequently for treating Crohn's disease and ulcerative colitis.
- Asacol is effective in inducing remissions in patients with mild to moderate ulcerative colitis. It also is effective when used in the longer term to maintain remissions. Some studies have shown that Asacol also is effective in treating Crohn's ileitis and ileo-colitis, as well as in maintaining remission in patients with Crohn's disease.
- Pentasa is a capsule consisting of small spheres containing 5-ASA. Pentasa is sulfa-free. As the capsule travels down the intestines, the 5-ASA inside the spheres is released slowly into the intestine. Unlike Asacol, the active drug 5-ASA in Pentasa is released into the small intestine as well as the colon. Pentasa can be effective in treating inflammation in the small intestine and is currently the most commonly used 5-ASA compound for treating mild to moderate Crohn's disease in the small intestine.
- Patients with Crohn's disease occasionally undergo surgery to relieve small intestinal obstruction, drain abscesses, or remove fistulae. Usually, the diseased portions of the intestines are removed during surgery. After successful surgery, patients can be free of disease and symptoms (in remission) for a while. In many patients, however, Crohn's disease eventually returns. Pentasa helps maintain remissions and reduces the chances of the recurrence of Crohn's disease after surgery.
- Olsalazine (Dipentum) is a capsule filled with a drug in which two molecules of 5-ASA are joined together by a chemical bond. In this form, the 5-ASA cannot be absorbed from the stomach and intestine. Intestinal bacteria are able to break apart the two molecules releasing the active individual 5-ASA molecules into the intestine.
- Since intestinal bacteria are more abundant in the ileum and colon, most of the active 5-ASA is released in these areas. Therefore, olsalazine is most effective for disease that is limited to the ileum or colon. Although clinical studies have shown that olsalazine is effective for maintenance of remission in ulcerative colitis, some patients experience diarrhea when taking olsalazine. Because of this, olsalazine is not often used.
- Balsalazide (Colazal) is a capsule in which the 5-ASA is linked by a chemical bond to another molecule that is inert (without an effect on the intestine) and prevents the 5-ASA from being absorbed.
- This drug is able to travel through the intestine unchanged until it reaches the end of the small bowel (terminal ileum) and colon. There, intestinal bacteria split the 5-ASA and the inert molecule releasing the 5-ASA. Because intestinal bacteria are most abundant in the terminal ileum and colon, balsalazide is used to treat inflammation predominantly localized to the colon.
Side effects of oral 5-ASA compounds
- The 5-ASA compounds have fewer side effects than Azulfidine and do not reduce sperm counts. They are safe medications for long-term use and are well-tolerated.
- Patients allergic to aspirin should avoid 5-ASA compounds because they are similar chemically to aspirin.
- Rarely, kidney and lung inflammation has been reported with the use of 5-ASA compounds. 5-ASA should be used with caution in patients with kidney disease. It also is recommended that blood tests of kidney function be done before starting and periodically during treatment.
- Rare instances of worsening of diarrhea, cramps, and abdominal pain, at times accompanied by fever, rash, and malaise, may occur. This reaction is believed to represent an allergy to the 5-ASA compound.
What are 5-ASA rectal medications (Rowasa, Canasa) and their side effects?
- Rowasa is 5-ASA in enema form and is used in treating Crohn's disease in which there is inflammation in and near the rectum. The enema usually is administered at bedtime, and patients are encouraged to retain the enema through the night. The enema contains sulfite and should not be used by patients with sulfite allergy. Otherwise, Rowasa enemas are safe and well tolerated.
- Both enemas and suppositories have been shown to be effective in maintaining remission in patients with ulcerative colitis limited to the distal colon and rectum.
What are corticosteroids for Crohn's and their side effects?
- Corticosteroids (for example, prednisone, prednisolone, hydrocortisone, etc.) have been used for many years to treat patients with moderate to severe Crohn's disease and ulcerative colitis and to treat patients who fail to respond to 5-ASA. Unlike 5-ASA, corticosteroids do not require direct contact with the inflamed intestinal tissues to be effective.
- Oral corticosteroids are potent anti-inflammatory medications. After absorption, corticosteroids exert prompt anti-inflammatory actions throughout the body, including the intestines. Consequently, they are used in treating Crohn's disease anywhere in the small intestine, as well as ulcerative and Crohn's colitis.
- In critically ill patients, intravenous corticosteroids (such as hydrocortisone) can be given in the hospital. For patients with proctitis, hydrocortisone enemas (Cortenema) can be used to deliver the corticosteroid directly to the inflamed tissue. By using the corticosteroid topically, less of it is absorbed into the body and the frequency and severity of side effects are lessened (but not eliminated) as compared with systemic corticosteroids.
- Corticosteroids are faster-acting than 5-ASA, and patients frequently experience improvement in their symptoms within days of beginning them. Corticosteroids, however, do not appear to be useful in maintaining remission in Crohn's disease and ulcerative colitis or in preventing the return of Crohn's disease after surgery.
Side effects of corticosteroids
The frequency and severity of side effects of corticosteroids depend on the dose and duration of their use. Short courses of corticosteroids usually are well tolerated with few and mild side effects. Examples of side effects of short-course corticosteroids include
- rounding of the face (moon face),
- increased body hair,
- weight gain,
- high blood pressure,
- increased susceptibility to infections,
- muscle weakness,
- mood swings,
- personality changes,
- irritability, and
- thinning of the bones (osteoporosis) with fractures of the spine.
Children receiving corticosteroids experience stunted growth.
Long-term use of high doses of corticosteroids usually produces predictable and potentially serious side effects for example, stunted growth in children, aseptic necrosis of the hip joints, and osteoporosis.
Budesonide (Entocort EC)
- Budesonide (Entocort EC) is another form of corticosteroid used for treating Crohn's disease. Like the systemic corticosteroids, budesonide is a potent anti-inflammatory medication. Unlike systemic corticosteroids, budesonide acts only via direct contact with the inflamed tissues (topically) and not systemically.
- Budesonide capsules contain granules that allow a slow release of the drug into the ileum and the colon. In a double-blind multicenter study (published in 1998), 182 patients with Crohn's ileitis and/or Crohn's disease of the right colon were treated with either budesonide (9 mg daily) or Pentasa (2 grams twice daily). Budesonide was more effective than Pentasa in inducing remissions while the side effects were similar to Pentasa. In another study comparing the effectiveness of budesonide with corticosteroids, budesonide was not better than systemic corticosteroids in treating Crohn's disease but had fewer side effects.
- Because budesonide is broken down by the liver into inactive chemicals, it has fewer side effects than systemic corticosteroids. It also suppresses the adrenal glands less than systemic corticosteroids. Budesonide also is available as an enema for the treatment of proctitis.
- Budesonide has not been shown to be effective in maintaining remission in patients with Crohn's disease. If used long-term, budesonide also may cause some of the same side effects as corticosteroids. Because of this, the use of budesonide should be limited to short-term treatment for inducing remission. As most budesonide is released in the terminal ileum, it will have its best results in Crohn's disease limited to the terminal ileum.
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What antibiotics treat Crohn's disease and what are their side effects?
Antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) have been used for treating Crohn's colitis. Flagyl also has been useful in treating anal fistulae in patients with Crohn's disease. The mechanism of action of these antibiotics in Crohn's disease is not well understood.
- Metronidazole (Flagyl) is an antibiotic that is used for treating several infections caused by parasites (for example, giardia) and bacteria (for example, infections caused by anaerobic bacteria, and vaginal infections). It might have some activity in the treatment of Crohn's colitis and is particularly useful in treating patients with anal fistulae.
- Chronic use of metronidazole in doses higher than 1 gram daily can be associated with permanent nerve damage (peripheral neuropathy).
- The early symptoms of peripheral neuropathy are numbness and tingling in the fingertips, toes, and other parts of the extremities. Metronidazole should be stopped promptly if these symptoms appear.
- Metronidazole and alcohol together can cause severe nausea, vomiting, cramps, flushing, and headache. Patients taking metronidazole should avoid alcohol.
- Other side effects of metronidazole include nausea, headaches, loss of appetite, a metallic taste, and, rarely, a rash.
- Ciprofloxacin (Cipro) is another antibiotic used in the treatment of Crohn's disease. It can be used in combination with metronidazole.
What are immuno-modulator medications for Crohn's?
Immuno-modulator drugs decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins. Decreasing the activity of the immune system with immuno-modulators increases the risk of infections; however, the benefits of controlling moderate to severe Crohn's disease usually outweigh the risks of infection due to weakened immunity. Examples of immuno-modulators are:
- 6-mercaptopurine (6-MP),
- azathioprine (Imuran),
- methotrexate (Rheumatrex, Trexall, MTX, Mexate),
- infliximab (Remicade),
- adalimumab (Humira),
- certolizumab (Cimzia), and
- natalizumab (Tysabri).
How safe is azathioprine and 6-M, what are TPMT genetics?
- Azathioprine is converted into 6-MP in the body and 6-MP then is partially converted in the body into inactive and non-marrow toxic chemicals by an enzyme called thiopurine methyltransferase (TPMT). These chemicals then are eliminated from the body.
- The activity of TPMT enzyme (the ability of the enzyme to convert 6-MP into inactive and non-marrow toxic chemicals) is genetically determined, and approximately 10% of the population in the Untied States has a reduced or absent TPMT activity. In this 10% of patients, 6-MP accumulates and is converted into chemicals that are toxic to the bone marrow where blood cells are produced. Thus, when given normal doses of azathioprine or 6-MP, these patients with reduced or absent TPMT activities can develop seriously low white blood cell counts for prolonged periods of time, exposing them to serious life-threatening infections.
- The U.S. Food and Drug Administration recommends doctors check TPMT levels prior to starting treatment with azathioprine or 6-MP. Patients found to have genes associated with reduced or absent TPMT activity are treated with alternative medications or are prescribed substantially lower than normal doses of 6-MP or azathioprine.
- Having normal TPMT genes is no guarantee against azathioprine or 6-MP toxicity. Rarely, a patient with normal TPMT genes can develop severe toxicity in the bone marrow and a low white blood cell count even with normal doses of 6-MP or azathioprine. Also, hepatotoxicity in the presence of normal TPMT levels has been reported. All patients taking 6-MP or azathioprine (regardless of TPMT genetics) have to be closely monitored by periodic blood counts and liver enzyme tests for as long as the medication is taken.
- Allopurinol (Zyloprim), used in treating high blood uric acids levels, can induce bone marrow toxicity when used together with azathioprine or 6-MP. Allopurinol (Zyloprim) used together with azathioprine or 6-MP has similar effect as having reduced TPMT activity, causing increased accumulation of the 6-MP metabolite that is toxic to the bone marrow.
What are 6-MP metabolite levels?
In addition to monitoring blood cell counts and liver tests, doctors also may measure blood levels of the chemicals that are formed from 6-MP (6-MP metabolites), which can be helpful in several situations such as if a patient's disease:
- is not responding to standard doses of 6-MP or azathioprine and his/her 6-MP blood metabolite levels are low, doctors may increase the 6-MP or azathioprine dose;
- is not responding to treatment and his/her 6-MP blood metabolite levels are zero, he/she is not taking his/her medication. The lack of response in this case is due to patient non-compliance.
Patients have been maintained on 6-MP or azathioprine for years without significant long-term side effects. Patients on long-term azathioprine or 6-MP, however, should be closely monitored by their doctors.
There are data suggesting that patients on long-term maintenance fare better than those who stop these medications. Thus, those who stop azathioprine or 6-MP are more likely to experience recurrence of their disease and are more likely to need corticosteroids or undergo surgery.
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What is azathioprine (Imuran, Azasan) and its side effects?
Azathioprine (Imuran, Azasan) and 6-mercaptopurine (6-MP, Purinethol) are medications that weaken the body's immune system by reducing the population of a class of immune cells called lymphocytes.
Azathioprine and 6-MP are related chemically. In high doses, these two drugs have been useful in preventing rejection of transplanted organs and in treating leukemia. In low doses, they have been used for many years to treat patients with moderate to severe Crohn's disease and ulcerative colitis.
Azathioprine and 6-MP are increasingly recognized as valuable drugs in treating Crohn's disease and ulcerative colitis. A majority of patients with moderate to severe disease will benefit from these drugs. Azathioprine and 6-MP are used primarily in the following situations:
- Severe Crohn's disease and ulcerative colitis not responding to corticosteroids.
- The presence of undesirable corticosteroid-related side effects.
- Corticosteroid dependency, a condition in which patients are unable to discontinue corticosteroids without developing relapses of their disease.
- Maintenance of remission.
Side effects of azathioprine and 6-MP include increased vulnerability to infections, inflammation of the liver (hepatitis) and the pancreas (pancreatitis), and bone marrow toxicity (interference with the formation of cells that circulate in the blood).
One problem with 6-MP and azathioprine is their slow onset of action. Typically, full benefit of these drugs is not realized for three months or longer. During this time, corticosteroids frequently have to be maintained at high levels to control inflammation.
Studies have shown that giving higher doses of 6-MP early can hasten the benefit of 6-MP without increasing the toxicity in most patients, but some patients do develop severe bone marrow toxicity.
Scientists now believe that an individual's vulnerability to 6-MP toxicity is genetically inherited. Blood tests can be performed to identify those individuals with increased vulnerability to 6-MP toxicity. Blood tests also can be performed to measure the levels of certain by-products of 6-MP. The levels of these by-products in the blood help doctors to more quickly determine whether the dose of 6-MP is right for the patient.
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What is infliximab (Remicade) and its side effects?
- Infliximab is approved for the short-term treatment of moderate to severe Crohn's disease patients who respond inadequately to corticosteroids, azathioprine, or 6-MP.
- Infliximab (Remicade) is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is one of the proteins produced by immune cells during activation of the immune system. TNF-alpha, in turn, stimulates other cells of the immune system to produce and release other proteins that promote inflammation. In Crohn's disease, there is continued production of TNF-alpha as part of the immune activation. Infliximab, by attaching to TNF-alpha, blocks its activity and in so doing decreases the inflammation.
- Infliximab generally is well tolerated. There have been rare reports of side effects during infusions, including chest pain, shortness of breath, and nausea. These effects usually resolve spontaneously within minutes if the infusion is stopped. Other commonly reported side effects include headache and upper respiratory tract infection.
- TNF-alpha is an important protein for defending the body against infections. Infliximab, like immunomodulators, increases the risk for infection. One case of salmonella colitis and several cases of pneumonia have been reported with the use of infliximab. There also have been cases of tuberculosis (TB) reported after the use of infliximab.
- More recently, a rare form lymphoma called hepatosplenic T-cell lymphoma has been described associated with azathioprine therapy for Crohn's disease either alone or in combination with infliximab. Although there is not much known about this disease, it appears to be aggressive and poorly responsive to treatment.
- Because infliximab is partly a mouse protein, it may induce an immune reaction when given to humans, especially with repeated infusions. In addition to the side effects that occur while the infusion is being given, patients also may develop a delayed allergic reaction that occurs 7 to 10 days after receiving the infliximab. This type of reaction may cause flu-like symptoms with fever, joint pain and swelling, and a worsening of Crohn's disease symptoms. It can be serious, and if it occurs, a physician should be contacted. Paradoxically, those patients who have more frequent infusions of infliximab are less likely to develop this type of delayed reaction compared to those patients who receive infusions separated by long intervals (6-12 months).
- Rare cases of nerve inflammation such as optic neuritis (inflammation of the nerve of the eye) and motor neuropathy also have been reported with the use of infliximab.
- Infliximab can aggravate and cause the spread of an existing infection. It should not be given to patients with pneumonia, urinary tract infections, or abscess (localized collection of pus). It is recommended that patients be tested for TB prior to receiving infliximab. Patients who previously had TB should inform their physician of this before they receive infliximab. Infliximab also can cause the spread of cancer cells and it should not be given to patients with cancer.
- Infliximab can promote intestinal scarring (part of the process of healing) and can worsen strictures (narrowed areas of the intestine caused by inflammation and subsequent scaring) and lead to intestinal obstruction. It also can cause partial healing (partial closure) of anal fistulae. Partial closure of fistulae impedes drainage of fluid through the fistulae, and may result in collections of fluid in which bacteria multiply, which can result in abscesses.
- The effects of infliximab on the fetus are not known, although the literature suggests this medication is safe for women to continue until week 32 of pregnancy. At that time, the risk of exposure of the fetus to this medication via placental transfer is increased. Infliximab is listed as a pregnancy category B drug by the FDA (meaning that animal studies show no increased risk, but there are no human studies).
- Because infliximab is partly a mouse protein, some patients can develop antibodies against infliximab with repeated infusions. Such antibodies can decrease the effectiveness of the drug. The chance of developing such antibodies can be decreased by the concomitant use of 6-MP and corticosteroids.
- There are some reports of worsening heart disease in patients who have received infliximab (Remicade). The precise mechanism and role of infliximab in the development of this side effect is unclear. As a precaution, individuals with heart disease should inform their physician of this condition before receiving infliximab.
- The long-term safety and effectiveness is not yet known although recent 10 year data from patients who received at least 1 dose of infliximab for CD showed the safety profile similar to what was previously known. In that data set, the treated patients seemed to have an increased risk of developing infections, infusion reactions, autoimmune reactions, and malignancy.
What are adalimumab (Humira), Cimzia, and Tysabri and their side effects?
- Humira (adalimumab) is used to treat adult patients with moderately to severely active Crohn's disease. Adalimumab (Humira) is an anti-TNF agent similar to infliximab and decreases inflammation by blocking tumor necrosis factor (TNF-alpha).
- Adalimumab generally is well tolerated. The most common side effect is skin reactions at the site of injection with swelling, itching, or redness. Other common side effects include upper respiratory infections, sinusitis, and nausea.
- Serious side effects of Humira include infections, tuberculosis, lymphoma, nervous system inflammation, lupus symptoms, worsening heart disease such as heart failure, and rarely, severe allergic reactions with rash, difficulty breathing, and severe low blood pressure or shock.
Certolizumab pegol (Cimzia)
- Certolizumab pegol (Cimzia) is used for the treatment of moderate to severe Crohn's disease in patients who do not respond sufficiently or adequately to standard medical therapy.
- Certolizumab is generally well-tolerated. Common side effects of Cimzia include runny or stuffy nose, injection site pain or other injection site reaction, upper respiratory tract infections, urinary tract infections, or a rash.
- Serious side effects of Cimzia include possible increase in the risk for serious infections including tuberculosis, worsening of heart failure, and
- hypersensitivity reactions, for example, angioedema, hives allergic dermatitis, dizziness, shortness of breath, hot flushes, low blood pressure, malaise, and fainting (syncope). Patients experiencing symptoms of severe allergic reactions should seek emergency care immediately.
- Natalizumab (Tysabri) is a humanized monoclonal antibody to alpha-4 integrin and is effective in treatment of patients with moderate to severe CD and evidence of inflammation who have not responded to aminosalicylates, antibiotics, corticosteroids, immunomodulators, or TNF inhibitors. Doctors who are registered through the CD TOUCH prescribing program may prescribe this medication to patients. Natalizumab has also been used for some forms of multiple sclerosis.
- The most common side effects reported include headache, fatigue, upper respiratory infections, and nausea. The most serious adverse events reported have been hypersensitivity, immunosuppression/infections and progressive multifocal leukoencephalopathy.
What are vedolizumab (Entyvio), ustekinumab (Stelara), and methotrexate (Rheumatrex,Trexall) and their side effects?
- Vedolizumab (Entyvio) is a type of monoclonal antibody called an integrin receptor antagonist indicated for adults with moderate to severe ulcerative colitis (UC) or moderate to severe Crohn's disease (CD) when certain other UC or CD medicines have not worked well enough or cannot be tolerated.
- Entyvio may help to reduce some symptoms, achieve remission, and reduce or stop the use of corticosteroids. Entyvio works to block the movement of certain gut directed white blood cells into the gastrointestinal (GI) tract, which helps control inflammation and may reduce the symptoms of UC and CD.
- The most common side effects of Entyvio include common cold symptoms (runny or stuffy nose, sinus pain, sneezing, cough), headache, joint pain, nausea, fever, infections of the nose and throat, tiredness, fatigue, upper respiratory tract infection, bronchitis, flu symptoms, back pain, rash, itching, sinus infection, sore throat, and pain in your arms or legs.
- Serious side effects of Entyvio include infusion reactions, serious allergic reactions, infections, progressive multifocal leukoencephalopathy (PML), and liver problems.
- Ustekinumab (Stelara) is a human interleukin-12 and -23 antagonist indicated for the treatment of adult patients with moderately to severely active Crohn’s disease (CD) who have failed or were intolerant to treatment with immunomodulators or corticosteroids, but never failed a tumor necrosis factor (TNF) blocker; or failed or were intolerant to treatment with one or more TNF blockers. Stelara is also used to treat plaque psoriasis and psoriatic arthritis.
- The most common side effects of Stelara include injection site reactions (bruising, itching, pain, redness, swelling, and hardening of the skin), cold symptoms (stuffy nose, sneezing, sore throat), headache, tired feeling, diarrhea, or skin rash or itching.
- Serious side effects of Stelara include serious allergic reactions including feeling faint; swelling of your face, eyelids, tongue, or throat; chest tightness, or skin rash.
Methotrexate (Rheumatrex, Trexall)
- Methotrexate (Rheumatrex, Trexall, MTX) is both an immunomodulator and anti-inflammatory medication. Methotrexate has been used for many years in the treatment of severe rheumatoid arthritis and psoriasis. It has been helpful in treating patients with moderate to severe Crohn's disease who are either not responding to azathioprine and 6-MP or are intolerant of them. Methotrexate also may be effective in patients with moderate to severe ulcerative colitis who are not responding to corticosteroids, azathioprine, or 6-MP.
- One major complication of methotrexate is the development of liver cirrhosis when the medication is given over a prolonged period of time (years). The risk of liver damage is higher in patients who also abuse alcohol or are severely obese. Other serious side effects of methotrexate include low white blood cell counts and inflammation of the lungs.
- Methotrexate should not be used in pregnant women because of toxic effects on the fetus.
What are 5-ASA (mesalamine) oral medications and their side effects?
- The drug 5-aminosalicylic acid (5-ASA), also called mesalamine, is similar chemically to aspirin.
- Aspirin is an anti-inflammatory drug that has been used for many years for treating arthritis, bursitis, and tendonitis (conditions of tissue inflammation). Aspirin is not effective in treating Crohn's disease and ulcerative colitis and may even worsen the inflammation.
- Studies suggest that aspirin might actually decrease future risk of developing colorectal cancer in the general population.
- On the other hand, 5-ASA can be effective in treating Crohn's disease and ulcerative colitis if the drug can be delivered topically onto the inflamed intestinal lining.
What are biosimilar medications and their side effects?
A biosimilar medication is a drug product that is made to be similar to another already-approved drug. It is tested to be the same as its reference drug in terms of clinical uses, effectiveness, and product safety. A biosimilar medication must meet specific strict standards to be approved by the FDA.
A biosimilar is not a generic form of a drug. A generic drug contains the same compounds as the original drug, while a biosimilar drug is highly similar to the reference drug, but not identical. Examples of biosimilars are Infliximab-abda (Renflexis) and Infliximab-dyyb (Inflectra).
Infliximab-abda (Renflexis) is biosimilar to infliximab (Remicade). Renflexis is a tumor necrosis factor (TNF) blocker used to reduce:
- Signs and symptoms of Crohn’s disease and induce and maintain clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
- The number of draining enterocutaneous and recto-vaginal fistulas and maintain fistula closure in adult patients with fistulizing disease.
- The signs and symptoms of Crohn’s disease in children and induce and maintain clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
Renfexis is also used to treat ulcerative colitis, rheumatoid arthritis (in combination with methotrexate), ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.
Common side effects
- The most common side effects of Renflexis include infections (upper respiratory infection, sinus infection, throat infection, bronchitis, urinary tract infection), infusion-related reactions, headache, abdominal pain, fever or chills, cardiopulmonary reactions (chest pain, high or low blood pressure, shortness of breath), itching, hives, nausea, diarrhea, indigestion, cough, rash, fatigue, yeast infection, and joint pain.
Serious side effects
- Serious side effects of Renflexis include serious infections, heart failure, liver injury, blood problems, nervous system disorders, allergic reactions, Lupus-like syndrome, and psoriasis.
- Infliximab-dyyb (Inflectra) is biosimilar to infliximab (Remicade). Inflectra is a tumor necrosis factor (TNF) blocker used for reducing signs and symptoms of Crohn’s disease and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
- Inflectra also is used to:
- Reduce the number of draining enterocutaneous and recto-vaginal fistulas and maintain fistula closure in adult patients with fistulizing disease.
- Reduce the signs and symptoms of pediatric Crohn’s disease and induce and maintain clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy.
- Treat ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and plaque psoriasis.
Common side effects
- The most common side effects of Inflectra include respiratory infections, bronchitis, sinus infections and sore throat, runny or stuffy nose, headache, coughing, stomach/abdominal pain, nausea, diarrhea, indigestion, fatigue, pain, oral thrush, joint pain, and urinary tract infection (UTI).
Serious side effects
- Serious side effects of Inflectra include serious infections, heart failure, liver injury, blood problems, nervous system disorders, allergic reactions, Lupus-like syndrome, and psoriasis.
- Infusion reactions can happen up to two hours after an infusion. Symptoms of infusion reactions may include fever, chills, chest pain, low blood pressure (hypotension) or high blood pressure (hypertension), shortness of breath, rash, and itching.
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Colorectal Cancer: What to Expect With a Colonoscopy
Learn more about what happens during a colonoscopy, how to prepare for it, and how you’ll feel afterward.
Irritable Bowel Syndrome (IBS) Quiz
What are symptoms of irritable bowel syndrome (IBS)? Take this quiz and get quick facts on causes and treatment options for this...
Inflammatory Bowel Disease (IBD) Causes, Symptoms, Treatment
What is inflammatory bowel disease? IBD can include Crohn's disease and ulcerative colitis. Learn more about testing, treatments,...
Colorectal (Colon) Cancer Quiz: Test Your Medical IQ
What is colorectal (colon) cancer and who gets it? Take this quiz to find out how this disease may be prevented.
Ulcerative Colitis Quiz: Diet, Symptoms & Treatment
What is ulcerative colitis and what risks are associated with suffering over the long term? Take this Ulcerative Colitis Quiz to...
Crohn's Disease Quiz
What causes Crohn's disease? What are the symptoms of Crohn's disease? How is Crohn's treated? Take this quiz to get the facts...
Picture of Colon
The long, coiled, tubelike organ that removes water from digested food. See a picture of the Colon and learn more about the...
Picture of Colon
The part of the large intestine that serves to remove water from digested food and let the remaining material, solid waste called...
Picture of Colon Cancer
Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer....
What Is a Polyp? Nasal, Colon, and Other Polyps
Do you know what a polyp is? Learn the definition of a polyp, which can be found in the sinuses, stomach, colon, gallbladder, and...
Related Disease Conditions
10 Natural Remedies for Colon Cleansing
A colon cleanse is the act of flushing out or cleaning the large intestine. They may be performed by professionals called colonic hygienists. In spite of insufficient research to support its benefits, the goal of colon cleansing is to clear the colon of any stagnant, supposedly toxic waste encrusted on the walls of the large intestine.
Colon polyps are fleshy growths inside the colon lining that may become cancerous. Symptoms include rectal bleeding. Learn about causes, signs, treatment, and how to prevent colon cancer.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome or IBS is a GI disorder with symptoms of constipation, abdominal pain, bloating, and gas. IBS treatment includes medications, dietary changes, and lifestyle changes.
Ulcerative Colitis Diet Plan
An ulcerative colitis diet plan can help a person with the disease avoid foods and drinks that trigger flares. There also are foods that can soothe ulcerative colitis symptoms during a flare. Types of ulcerative colitis plans include a high-calorie diet, a lactose-free diet, a low-fat diet, a low-fiber diet (low-residue diet), or a low-salt diet. Self-management of ulcerative colitis using healthy lifestyle habits and a nutrient rich diet can be effective in management of the disease. Learn what foods to avoid that aggravate, and what foods help symptoms of the disease and increase bowel inflammation.
Colon Cancer (Colorectal Cancer)
Colon Cancer (Colorectal Cancer) is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers, develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Second Source WebMD Medical Reference
Second Source article from Government
Where Is Colon Cancer Pain Felt?
Colon cancer is cancer of the last part of the large intestine. Colon cancer pain is generally felt as vague abdominal pain or cramps.
Can I Normally Eat 2 Days Before Colonoscopy?
In general, it is recommended to eat a low-fiber diet along with laxatives about 2-3 days before a colonoscopy so that your doctor can see potential problems more clearly.
Colon Cancer: 8 Early Warning Signs & 4 Stages
Colon cancer usually does not cause signs or symptoms in the early stages. As the cancer grows, signs may include blood in the stool, bowel habit changes, abdominal pain, and fatigue. Learn about stages and treatment of colon cancer.
How Long Before a Colonoscopy Should I Stop Drinking Water?
A colonoscopy is a test to look at the inside of the colon. Usually, doctors recommend patients undergoing a colonoscopy to stop drinking clear liquid or water at least three to four hours before the procedure. However, patients with diabetes and who are dehydrated may take a few sips of water after consulting their doctor.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms and signs include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
What Does a Colon Spasm Feel Like?
The colon spasm is a symptom. It's a momentary tightening of the muscles of the gut that causes pain. This may be due to underlying causes, both benign and dangerous.
IBS-D (Irritable Bowel Syndrome with Diarrhea)
IBS-D or irritable bowel syndrome with diarrhea refers to IBS with diarrhea. Symptoms of IBS-D include intestinal gas (flatulence), loose stools, frequent stools, abdominal pain, diarrhea, and nausea. New non-FDA approved IBS tests may help diagnose IBS and IBS-D. Treatment of IBS-D is geared to toward managing symptoms with diet, medication, and lifestyle changes.
Can I Eat Mashed Potatoes 2 Days Before Colonoscopy?
Colonoscopy is a procedure used to detect abnormalities in the large intestine (colon). One day before the procedure, it is advised not to eat any solid or semi-solid food, such as mashed potatoes, applesauce, oatmeal, etc. A clear liquid diet must be taken 24 to 72 hours before the procedure.
How Is Crohn's Different From IBS?
While Crohn’s disease and IBS both share similar symptoms, the two conditions are distinct with different causes, diagnostic criteria and treatments.
Inflammatory Bowel Disease (IBD)
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Crohn's Disease vs. Ulcerative Colitis
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or ulcerative colitis only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease or IBD. Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example, nausea, loss of appetite, fatigue, weight loss, episodic and/or persistent diarrhea, fever, abdominal pain and cramping, rectal bleeding, bloody stools, joint pain and soreness, eye redness, or pain. Symptoms unique to Crohn’s disease include anemia and skin changes. Symptoms of unique to ulcerative colitis include certain rashes, and an urgency to defecate (have a bowel movement). Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or ulcerative colitis with medication, diet, nutritional supplements, and/or surgery.
Crohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms and signs.
IBS vs. IBD: Differences and Similarities
IBS (irritable bowel syndrome) and IBD (inflammatory bowel disease) are both problems with the digestive tract (gastrointestinal or GI tract), but they are not the same disease. Check out the center below for more medical references on IBS and IBD, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.
IBS Triggers (Prevention)
Irritable bowel syndrome (IBS) is a functional disease that can affect the quality of those who suffer from this condition. People with IBS can make lifestyle changes that may modify or control the number and severity of episodes. Certain foods, medications, and hormone levels may trigger IBS episodes, for example fatty foods, dairy products, eating foods in large quantities, foods that contain high levels of sorbitol, foods that produce intestinal gas (broccoli, onions, cabbage, and beans), chocolate, caffeine, physiological stress, some antibiotics, some antidepressants, medicine with sorbitol, and menstrual pain. Exercise, diet, and other lifestyle changes can decrease IBS flares, and prevent the number and severity of IBS episodes of diarrhea and constipation.
Inflammatory Bowel Disease (IBD) Diet
Inflammatory bowel disease (IBD) is a name for a group of diseases in which there is inflammation of the digestive tract (gastrointestinal tract). Crohn's disease and ulcerative colitis (UC) are the most common types of inflammatory bowel disease. While there is no specific recommended diet for a person with IBD, doctors and specialists recommend a low-residue (low fiber) diet for people with inflammatory bowel disease. Nutritionists, registered dieticians, and other health-care professionals can recommend specific foods, create meal plans, and recommend vitamins and other nutritional supplements.Foods to avoid with IBDExamples of foods to avoid that may trigger symptoms include if you have IBD include products alcohol, diary products, fatty, fried, and spicy foods, beans, and creamy sauces. Foods to eat with IBD Examples of a low-residue (low-fiber) diet that may help relieve symptoms after a flares of the disease are plain cereals, canned fruit, rice, oatmeal, and bananas.
What Is the Life Expectancy of Someone with Crohn's Disease?
Crohn’s disease is a chronic condition that causes inflammation in the gut (digestive tract).Crohn’s disease belongs to a group of conditions known as inflammatory bowel disease (IBD). With appropriate management, patients with Crohn’s disease may expect a normal life expectancy and a good quality of life.
How Long Does an Ulcerative Colitis Flare-Up Last?
An ulcerative colitis flare-up can last a few days or a few weeks and then be followed by a remission that lasts for months or even years. How long a flare-up lasts depends on the severity of the disease, triggers, and medication compliance.
Bowel Incontinence (Fecal Incontinence)
Bowel or fecal incontinence refers to the loss of voluntary control of stool, or bowel movements. The condition can include partial incontinence, in which a person loses only a small amount of liquid waste, to complete incontinence, in which the entire bowel movement cannot be controlled. Diet changes and elimination of certain medications can help patients to regain bowel control. Treatment involves a combination of medication, biofeedback, and exercise.
What Is the Life Expectancy of Someone With Ulcerative Colitis?
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel) leading to erosion and ulcers. It is a lifelong illness with no specific cause or cure.
Who Is at a High Risk of Colon Cancer?
Colon cancer affects men and women equally. It is more common among people who are 50 years and older but can rarely occur in teenagers as well. Although some factors can increase the risk of colon cancer, over 75 percent of colon cancer occurs in people with no known risk factors. Risk factors for colon cancer are described below.
Early Signs of Colon Cancer
Colon or colorectal cancer may not cause any symptoms during the early stages of the disease. A person may have polyps or colon cancer but may not have any symptoms till the late stages of the disease.
What Does a Crohn’s Disease Attack Feel Like?
Crohn’s disease is an inflammatory bowel disease featuring chronic inflammation of the inner of the gastrointestinal (GI) tract. Patients experience periods of symptomatic relapse and remission. What initiates the autoimmune reaction in Crohn’s disease is unclear, but genetic and environmental factors play roles. Crohn’s disease is a lifelong, progressive disease with no cure.
What Does Your Stool Look Like With Ulcerative Colitis?
Ulcerative colitis (UC) is a disease that involves the inner lining of the large bowel. It causes abdominal pain and bleeds due to erosions and ulcers all over the large intestine and rectum.
How Do You Treat Small Bowel Narrowing?
Strictureplasty can be used to treat simple or short strictures. In this procedure, the damaged portion of the intestine is cut open and reshaped.
Is Crohn's Disease Contagious?
Crohn's disease, a form of inflammatory bowel disease (IBD), and is characterized by symptoms and signs that include diarrhea, fever, weight loss, vomiting, and abdominal pain. Though Crohn's disease is not contagious it can spread throughout a person's gastrointestinal tract. An increase in the above symptoms and signs warrants a visit to a doctor's office.
What Is The First Sign Of Bowel Cancer?
A change in bowel habits that continues for several weeks may often be the first noticeable sign of cancer. Colon cancer is another name for bowel cancer.
Is Ulcerative Colitis an Autoimmune Disease?
Ulcerative colitis (UC) is considered to be an autoimmune disease. With autoimmune disorders, your immune system goes awry and attacks your own body instead of defending it from infections and illnesses.
Does Crohn’s Disease Weaken Your Immune System?
Studies show that Crohn’s disease is the result of a weakened immune system; however, the extent of that weakness varies by patient.
Can Blood Tests Detect Colon Cancer?
Colon cancer begins in the large intestine, which is the final part of the digestive tract. The functions of the intestine are reabsorbing fluids, processing waste products and eliminating solid waste from the body. Colon cancer is characterized by the development of malignant tumors arising in the inner wall of the colon or rectum. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time these polyps can develop into colon cancers.
Is Ulcerative Colitis Curable?
Ulcerative colitis is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel or colon) leading to erosion and ulcers. It is also associated with various manifestations outside of the colon, such as inflammation of the eyes, joints, skin, and lungs. Ulcerative colitis is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and disappearance of the disease.
What Happens if Crohn’s Is Left Untreated?
Crohn's disease worsens without treatment. When left untreated, Crohn's spreads throughout the intestinal tract, causing severe symptoms and a bleaker outlook to treatment. Colon cancer is more likely to develop in people with untreated Crohn’s in their large intestine.
Colon Cancer Prevention
Colorectal cancer is both curable and preventable if it is detected early and completely removed before the cancerous cells metastasize to other parts of the body. Colonoscopy and flexible sigmoidoscopy (along with digital rectal examination and stool occult blood testing) are both effective at preventing colo-rectal cancers and detecting early colo-rectal cancers.
Is Crohn's Disease Related to Rheumatoid Arthritis?
Since Crohn’s disease causes inflammation of the body, including the joints, sufferers are at a greater risk of developing rheumatoid arthritis.
What Are the First Signs of Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a common intestinal disorder that is characterized by abdominal pain and changes in bowel habits. IBS is a chronic condition that may cause either diarrhea or constipation, depending on the person.
Is Pancolitis the Same as Ulcerative Colitis?
Pancolitis is a form of ulcerative colitis (UC) that inflames the entire large intestine. Living with pancolitis often requires medical treatment and lifestyle changes.
What Are the Signs of a Blocked Bowel?
What is a blocked bowel, and how do you fix it? Learn the signs, what causes a blockage, how it is diagnosed, and how it is treated.
Is Crohn’s Disease a Disability?
Crohn’s disease can be debilitating, negatively affecting the digestive system and hampering the ability to eat or have normal bowel movements. It therefore qualifies as a disability under the ADA.
How Serious Is Crohn’s Disease?
Crohn’s disease is a chronic inflammatory condition that causes inflammation in the gut (the digestive tract) and belongs to a group of conditions known as inflammatory bowel disease (IBD).
What Are the First Symptoms of Ulcerative Colitis?
The first symptoms and signs of ulcerative colitis (UC) may include persistent diarrhea, loose or bloody stools, cramp-like abdominal pain, and general feelings of being unwell, bloated, or constipated.
What Are the Best Foods to Eat With Crohn’s Disease?
Your diet for Crohn’s disease will vary depending on the food triggers that result in your symptoms.
What Is the Best Treatment for Ulcerative Colitis?
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel) leading to erosion and ulcers. It is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and remission with potential extraintestinal (beyond the bowel) manifestations, such as joint pain, eye pain, and skin rashes.
How Do You Use a Colon?
The colon is the longest part of the large bowel or large intestine, measuring around 60 inch (1.5 m). The large bowel is a tube-like organ that begins from the small intestine and ends at the anus.
Colon Cleansing: All You Need to Know
Colon cleansing is also called colon/colonic irrigation. It is the act of irrigating or flushing out the colon or large intestine.
How Do They Check Your Colon?
The colon is the longest part of the large bowel or large intestine, measuring around 60 inch (around 1.5 meters). The large bowel is a tube-like organ that begins from the small intestine and ends at the anus. The colon extends from a pouch-like structure called the cecum and ends at the rectum (the part of the large bowel where stools are stored).
Colon Cleansing: Is It Helpful or Harmful?
The risks of colon cleansing overweigh the benefits. Frequent colon cleansing without medical indications and a healthcare professional is associated with several minor and serious side effects.
What Are the Five Types of Crohn's Disease?
The five types of Crohn's disease are ileocolitis, ileitis, gastroduodenal Crohn’s disease, jejunoileitis, Crohn's (granulomatous) colitis. Each have different characteristic symptoms and signs.
Can Ulcerative Colitis Be Cured With Surgery?
Ulcerative colitis is a chronic inflammatory condition of the colon (the large bowel) characterized by frequent bloody diarrhea (10-30 episodes) throughout the day. Medicines can only reduce the intensity of its symptoms and surgery is the only option to cure it.
How Do You Check Your Colon?
Colon screening may be done in several ways. Screening exams are powerful tools to detect colorectal cancer. Regular screenings enable physicians to detect cancer early. They can also identify and remove polyps and growths of tissue on the lining of the colon or rectum that can potentially become cancerous.
What Is the Best Medicine for Ulcerative Colitis?
Treatment strategies for ulcerative colitis (UC) vary from person to person. Your doctor will base recommendations for medication on the intensity of your symptoms and severity of the disease.
How Serious Is Ulcerative Colitis?
Ulcerative colitis (UC) is a lifelong disease with constant periods of flare-ups and remissions (periods without symptoms, which may last for weeks or years). Presently, there is no permanent medical cure for it, but there are various medications that can provide symptomatic relief, reduce inflammation and manage flare-ups.
What Are the Symptoms of Crohn’s Disease in a Child?
Crohn’s disease can develop in children younger than 15 years old. Here are the symptoms of the disease to look out for in your child.
Irritable Bowel Syndrome Foods To Avoid
Irritable bowel syndrome or IBS is a medical condition affecting the large bowel. It is a group of symptoms occurring together, including repeated pain in the abdomen, cramping, bloating and changes in the bowel movements, which may be diarrhea, constipation or both.
What Are the Warning Signs of Crohn’s Disease?
Crohn’s disease can cause these signs and symptoms; however, only a doctor can properly diagnose you with the condition.
How Do You Diagnose Ulcerative Colitis?
Ulcerative colitis is a condition that causes blood stool, diarrhea, rectal pain, and other symptoms. Ulcerative colitis is diagnosed with blood tests, stool tests, and imaging tests.
What Is the Difference Between IBD and IBS?
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are diseases of the intestine. Both the diseases share common symptoms such as fatigue, distressing bowel movements, tummy pain, and the need to pass motions right away.
What Happens When You Have Ulcerative Colitis?
Ulcerative colitis is a systemic disease that mainly manifests as intestinal ulcers. The ulcers may result in bleeding and cause bloody stools. Excessive bleeding can lead to anemia.
Treatment & Diagnosis
- Colonoscopy Procedure and Preparation
- Can I Eat 24 Hours Before a Colonoscopy?
- Is A Colon Resection A Major Surgery?
- Virtual Colonoscopy
- Colon and Colorectal Cancer Screening
- Sigmoidoscopy vs. Colonoscopy
- Endoscopy vs. Colonoscopy
- How Painful Is a Colonoscopy?
- Cologuard Test vs Colonoscopy
- What Is A Colon Resection?
- Can Crohn's Disease Be Cured With Surgery?
- What Is Whole-Bowel Irrigation?
- Ulcerative Colitis Surgery
- Ulcerative Colitis FAQs
- Crohn's Disease FAQs
- Irritable Bowel Syndrome IBS FAQs
- Colorectal (Colon) Cancer FAQs
- Stage IV Colon Cancer That Has Spread to the Liver
- Tegaserod (Zelnorm)...New Drug for Irritable Bowel Syndrome
- Colon Cancer Silences Howard Keel
- Colon Cancer, The Genetic Factor
- Rifaximin (Xifaxan) for Irritable Bowel Syndrome (IBS) Treatment
- Colonoscopy With No Sedation
- Irritable Bowel Syndrome & Abdominal Pain - Common in Teens
- Colon Cancer Prevention And Fiber?
- Colon Cancer and Polyp Screening Guidelines
- Alosetron-New Drug for Irritable Bowel
- IBS: Doing The Right Thing
- Irritable Bowel Drug Lotronex Yanked By FDA - Warning
- How Long Do You Live After Being Diagnosed with Colon Cancer?
- What Are the Early Signs of Colon Cancer?
- Is Crohn's Disease Sexually Transmitted?
- Can virtual colonoscopy replace actual colonoscopy
- What Is the Best Way to Prevent Colon Cancer?
- What Is the Survival Rate for Colon Cancer?
- Is Sarcoidosis Related to Crohn's or Prednisone?
- Do Antibiotics Treat Crohn's Disease?
- What Is the Treatment for Anal Fissures?
- Do Crohn's Patients Get a Specific Type of Arthritis?
- Does Crohn's Disease Cause Arthritis?
- Can Diet and Stress Cause Crohn's Disease?
- Does Stress Cause Ulcerative Colitis?
- Does IBS Cause Crohn's Disease or Ulcerative Colitis?
- Avoid Red Jell-O Before a Colonoscopy
- How Does Colon Cancer Affect a Person's Body?
- Can Diet Cause UC or Crohn's Disease?
- How Often Should I Have a Colonoscopy with Celiac?
- How Soon Should I Have a Followup Colonoscopy?
- Can Crohn's Cause Constipation?
- Why Do Cigarettes Worsen Crohn's and Help UC?
- Irritable Bowel Syndrome (IBS): What Do I Eat?
Medications & Supplements
- CDC Warns of Potentially Fatal Bacterial Illness on U.S. Gulf Coast
- Helping Others as Volunteers Helps Kids 'Flourish': Study
- FDA Approves Pfizer's RSV Shot for Older Adults
- What to Do When Tough-to-Treat Lymphoma Strikes During Pregnancy
- Rate of Pregnant U.S. Women Who Have Diabetes Keeps Rising
- More Health News »
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