The Real Cause of Inflammation/Ulcers In Crohn’s Guts? (SHOCKING)

[JennyT]

This is an interesting hypothesis and I have no problems with it - in fact I may have something that will help. Try something so simple its ridiculous ...... 1 teaspoon of pure baking soda disolved in a glass of water and drink it every day. (Salty!) It turns all that acid to alkaline. Google/youtube it - there is very interesting scientific info out there. I personally can vouch for unexpected and unprecedented results in a heart attack survivor who had an extremely poor quality of life and much pain - all turned around 180degrees now. Just a thought, so simple it cant hurt!

 

[PollyH]

1 teaspoon of pure baking soda dissolved in a glass of water and drink it every day. (Salty!)

Baking soda is sodium bicarbonate. There are also other bicarbonates that you might want to employ with it, depending on your needs, to obtain something more balanced. There is a product called Tri-salts from Ecological Formulas which contains calcium carbonate, magnesium carbonate and potassium bicarbonate. (Notice there is no sodium in that particular product.) There is also a tri-salt product from Biotech that contains calcium carbonate, sodium bicarbonate and potassium bicarbonate. Then there is Alka-Seltzer Gold that contains anhydrous citric acid, potassium bicarbonate and sodium bicarbonate. (There are other Alka-Selzer products that contain aspirin or aspartame. So be careful to get the Gold form.)

Unless your kidneys have trouble removing salt, salt in the diet is very good for you. Without enough salt, changes occur in the body that are bad for the heart -- even for your immediate life function if you have weak adrenals. (My Aunt in-law died from a lack of salt.)

 

[JennyT]

Thanks Polly, that is really interesting. The research I did for my friend didn't mention other bicarbonate alternatives so I never considered them. It was originally looking for help for a cancer patient that led me there - it is purported to be very effective so thats worth researching if you are curious about cancer cures - but another friend just stated taking it because it touched on other benefits and honestly - both myself and his Dr are blown away by the results. (The Doc said "I didnt prescribe that!! LOL Like he would prescribe a common leavening agent dirt cheap at the supermarket)

 

[PollyH]

Not enough salt is very stressful for the body. For instance, without enough salt, you have trouble retaining your magnesium.

Carbonates are very good for you. Carbon dioxide actually helps your red blood cells release oxygen to the cells. That is why the slow breathing techniques are so helpful. With slow breathing, your body isn't getting rid of carbon dioxide quite so quickly. When your cells are healthy, they are producing more carbon dioxide. Thyroid helps your cells produce more carbon dioxide. That is one reason it can be so helpful. Cancer cells produce lactic acid, which interferes with the carbon dioxide.

 

[PollyH]

Benefits of Salt

The following few paragraphs on salt are an excerpt from a little booklet I wrote about fibromyalgia. However, the principles apply to almost any disease.

A reasonable amount of salt in the diet may be helpful in the treatment of fibromyalgia. I’ve chosen a few bits of information from one of Raymond Peat’s newsletters on the benefits of salt and have shown here how it relates to fibromyalgia. [111]

1. Energy. Salt helps remove excess calcium from cells. This improves the cells’ ability to produce energy. Salt also helps produce ATP, the energy molecule.

2. Osteoporosis. Salt is a good buffering agent. This spares calcium. Without salt, more calcium may be taken from bones to buffer the acids in the blood.

3. Sleep. Sleep is often a problem in fibromyalgia. Salt taken at bedtime can reduce adrenaline levels and thus help a person get to sleep.

4. Magnesium. Magnesium is often deficient in fibromyalgia. Adequate sodium prevents urinary magnesium loss.

5. Hypothyroidism. Many fibromyalgia patients are hypothyroid. Hypothyroidism makes it difficult to retain salt.

6. Serotonin Release. When sodium is restricted, there is a sharp increase in serotonin secretion.

Many people avoid table salt in their diet because they think it will lower their blood pressure. This is a questionable practice. A recent study showed that changing from a high salt diet to a low salt diet lowers the average systolic pressure by 6.7mm. [111] That is a rather extreme change in dietary salt for so little improvement. Another study showed that salt restriction lowered mean arterial pressure only in untreated hypothyroid patients, not in hyperthyroid or control patients. [112] In other words, if a person finds that salt restriction lowers their blood pressure, then perhaps the real problem is that they are hypothyroid.

Restricting salt is not going to prevent heart disease. Michael H. Alderman of the Albert Einstein College of Medicine in New York points out that previous studies show that salt restriction can trigger changes in insulin, nerve activity, and other factors that may lead to the vascular damage that underlies heart attacks. [111] However, if you already have a heart condition, and are restricting your salt intake, please be careful. When a person first starts increasing salt intake, it increases water retention and this make things harder on the heart. Time is needed for the body to adjust to any change in salt intake. Also, if one has poor kidney function, any increase in salt must be done carefully. If you have insulin resistance, your body may have been able to compensate by producing more insulin. High insulin levels increase salt retention. [113]

111. Peat, Raymond, PhD, “Recharging the System” Ray Peat’s Newsletter, 1998 and Peat R, “Tryptophan, serotonin, and aging” Ray Peat’s Newsletter, 2002

112. J. Raloff, “Salt trial provokes DASH of skepticism,” Science News, volume 157, May 27, 2000

113. Marcisz, C. Am J Hypertens 2001;14:995-1002 as referenced in this article http://diabetes.medscape.com/44892.rhtml?srcmp=endo-110901

 

[Sarah50]

You may want to ask your GI what he thinks about this Cochrane review that suggests that mesalamine (the active ingredient in Pentasa) is no better than placebo.

Conversely, there are a variety of studies showcasing the efficacy of medical marijuana and the science behind medical marijuana is pretty darn good.

Interesting about "mesalamine" .... but the fact remains that ALL of my Crohn's symptoms - very bad stomach aches daily, vomiting, night sweats (nightly), loss of appetite, extreme weight loss, fatigue, achy joints, etc .... ALL disappeared after being on Asacol (mesalamine) AND a low residue diet (full of carbs and junk food - well, that's on my part... LOL) ......... after about 6 weeks... now going on 4 months of remission.

"Splain that one, Lucy! I don't get it either (especially the 'junk food')!!!

Edited to add that before Crohn's symptoms... I ate very healthy (for the most part) - high fiber bread and cereal, tons of raw veggies/salads, mostly chicken and turkey protein - and low carbs! :eek2:

 

[David]

Hi Sarah,

I see that you have a stricture. I assume you have disease in your small intestine?

 

[David]

Polly, I wasn't aware of sodium helping retain magnesium. That doesn't actually make sense to me actually considering salt is used to remove magnesium from water (hard water treatment systems). But I'm definitely open to it! Do you by chance have a source that showcases that?

Thank you

 

[Sarah50]

Hi Sarah,

I see that you have a stricture. I assume you have disease in your small intestine?

Hi David,

Yes, I have crohn's disease in my small intestine - doctor said it was at the terminal ileum and a moderate long stricture in small intestine.

 

[David]

Hi Sarah,

The problem is, Asacol is coated with an acrylic based resin that is designed to BEGIN dissolving at pH 7 or higher. For most people that means in the terminal ileum though intestinal pH varies from person to person. What that means is that it is very likely waving to your stricture as it passes by in tact and is delivering medication to your colon like it was designed to. And even if it is getting some medication to your inflammation, mesalamine is topical in nature whereas Crohn's disease is transmural (affects every layer of the intestine). So the top layer of your intestine may be doing a little better but serious damage is being done deeper down.

Now, maybe Asacol is perfect for you. Everyone is different. But I'm extremely concerned that we're going to see you back here in one month or one year with complications from what was actually active inflammation (despite reduced symptoms) causing additional damage to your bowel.

Hopefully I'm wrong though.

 

[Sarah50]

Hi Sarah,

The problem is, Asacol is coated with an acrylic based resin that is designed to BEGIN dissolving at pH 7 or higher. For most people that means in the terminal ileum though intestinal pH varies from person to person. What that means is that it is very likely waving to your stricture as it passes by in tact and is delivering medication to your colon like it was designed to. And even if it is getting some medication to your inflammation, mesalamine is topical in nature whereas Crohn's disease is transmural (affects every layer of the intestine). So the top layer of your intestine may be doing a little better but serious damage is being done deeper down.

Now, maybe Asacol is perfect for you. Everyone is different. But I'm extremely concerned that we're going to see you back here in one month or one year with complications from what was actually active inflammation (despite reduced symptoms) causing additional damage to your bowel.

Hopefully I'm wrong though.

David, when I googled Asacol and Crohn's, this is what I found:

TARGETED RELEASE
One benefit of Asacol is that this formulation of mesalamine is designed to be released specifically in the ileum, the part of the small intestine most commonly affected in Crohn's disease, the Johns Hopkins University Department of Gastroenterology and Hepatology reports. Because Asacol and other mesalamine-containing drugs act at the specific location where they are released, it is crucial that the drugs are released in the correct part of the digestive tract.

Anti-Inflammatory Effect
The primary beneficial effect of Asacol is to reduce inflammation of the digestive tract, explains the Johns Hopkins University Department of Gastroenterology and Hepatology. Asacol also reduces the production of free radicals, highly reactive chemicals that can damage tissue in the digestive tract. Overactive cells of the immune response are also reduced by Asacol, including lymphocytes, plasma cells and monocytes. For patients whose Crohn's disease is primarily affecting the ileum region of the small intestine, Asacol is effective in reducing symptoms and inducing remission, reports an article published in the August 2003 issue of American Family Physician.


Read more: http://www.livestrong.com/article/22...#ixzz2MUzEMs2t

But please tell me, what medication is suppose to work with the crohn's that I have in the area that I have??? I know you have seen and heard a lot, having this forum, so please tell me what you know.

Thanks, I appreciate it!

 

[David]

Never use Livestrong as a source.

From the Asacol prescribing information:

Each Asacol ® delayed-release tablet for oral administration contains 400 mg of mesalamine, an anti-inflammatory drug. The Asacol delayed-release tablets are coated with acrylic based resin, Eudragit S (methacrylic acid copolymer B, NF), which dissolves at pH 7 or greater, releasing mesalamine in the terminal ileum and beyond for topical anti-inflammatory action in the colon.

As for your other question, I'll elaborate in the morning. I'm off to bed.

*hugs*

 

[PollyH]

Polly, I wasn't aware of sodium helping retain magnesium. That doesn't actually make sense to me actually considering salt is used to remove magnesium from water (hard water treatment systems). But I'm definitely open to it! Do you by chance have a source that showcases that?

Thank you

Here is an article about a lack of sodium in cattle. When the cattle are grazing on high nitrogen food, and if they are low in sodium, then they become deficient in magnesium and calcium, even though there is adequate magnesium and calcium in the food. From this, it looks like you need the sodium for the retention of both magnesium and calcium.

http://www.hinsleyracingstable.com/articles/Grass_Tetany_Syndrone.pdf

 

[JennyT]

That is really interesting Polly - my question is based on the fact that cow gut and human gut works really differently and we have hugely different diets. (Altho Ive heard some peeps eat grass LOL) Can cattle health findings relate to human health? Id be keen to see results in human studies as I find the subject quite interesting. Jen

 

[David]

As Jenny states, due to the enormous difference in the digestive system of humans and ungulates, I don't feel we can reliably conclude the same holds true for humans based upon that paper. I'm certainly open to the idea, but that doesn't sell me on it

 

[David]

But please tell me, what medication is suppose to work with the crohn's that I have in the area that I have??? I know you have seen and heard a lot, having this forum, so please tell me what you know.

I'm sorry I didn't get to this last night but I was exhausted and needed to get to bed.

If you wanted to stick with just mesalamine (the idea of that makes me cringe) then Pentasa would be a MUCH better formulation than Asacol. Now, I'm all for people with Crohn's disease taking a formulation of mesalamine IN CONJUNCTION with other treatments. But when I read that's all they're on, it concerns me a great deal. If you switched to Pentasa and that's it, I'd be worried, especially since you have stricturing disease. Conventional medications that are commonly used that have much better data supporting their efficacy in Crohn's disease than just mesalamine:

- Azathioprine
- 6-MP
- Remicade
- Humira
- Cimzia

Non conventional that I'm excited about via small studies and anecdotes on the forum:

- Low Dose Naltrexone

All heavy hitters, I realize. But Crohn's needs to be hit hard, especially since your disease is already stricturing. Heck, I'm a fan of throwing the kitchen sink. In my opinion, you want to hit it from every angle. For example:

- Western Medicine - Something more than just Asacol.
- Dietary changes - Improve your n3-n6 fatty acid ratio, Enteral/elemental nutrition, [wiki]paleo diet[/wiki], or [wiki]specific carbohydrate diet[/wiki]. Juicing is also growing on me a lot and we now have a juicing subforum located here.
- Hydration - Dehydration and loss of electrolytes is common. Proper hydration and adding electrolytes back in can help you a lot.
- Alternative treatments - I'm a big fan of Low Dose Naltrexone. Two studies in adults and one in children have had great results (see the stuck thread when following that link) and there are very few side effects. It's also not very expensive. Medical marijuana has been shown to help a lot as well if that's something you're comfortable with and is legally available in your area.
- Stress reduction. Do whatever it takes to reduce your stress levels. In addition, a weekly or even monthly massage if funds are tight is great. Studies have actually shown that massage can reduce inflammation. Give yourself self-massages as often as possible in between the professional ones.
- Exercise if you're able - a gentle yoga is a good one
- Vitamins and minerals - find out which you're deficient in and properly supplement. People with Crohn's disease are commonly deficient in vitamin B12, vitamin D, and magnesium as well as a host of others. But those three first ones should definitely be checked. Do not blindly supplement vitamin D and B12, treat these as medications and get your levels tested first. Although the blood test for magnesium is pretty useless and I strongly suggest you eat foods high in magnesium or discuss supplementation of it with your doctor.
- Supplements - there are a variety that help improve overall health. Check our our diet/fitness/supplements forum for ideas. I'm personally a big fan of tumeric (curcumin) and strongly suggest utilizing it if your doctor is ok with it.
- Alternative medicine - This could be stuff like acupuncture, including a naturopath in your treatment team, etc.

Bring your doctor in on the conversation for all of this. Get their input and let them help supervise your disease state. Some doctors might need a little push on some of this stuff, but we can provide studies that showcase the efficacy of all the above. I hope this helps a little. I know it's frustrating to be told that the medication that seems to be working for you probably isn't the best choice and I'm sorry for that

 

[Sarah50]

I'm sorry I didn't get to this last night but I was exhausted and needed to get to bed.

If you wanted to stick with just mesalamine (the idea of that makes me cringe) then Pentasa would be a MUCH better formulation than Asacol. Now, I'm all for people with Crohn's disease taking a formulation of mesalamine IN CONJUNCTION with other treatments. But when I read that's all they're on, it concerns me a great deal. If you switched to Pentasa and that's it, I'd be worried, especially since you have stricturing disease. Conventional medications that are commonly used that have much better data supporting their efficacy in Crohn's disease than just mesalamine:

- Azathioprine
- 6-MP
- Remicade
- Humira
- Cimzia

David, I really appreciate the time you took to answer my question!!! Thank you! The problem for me is I have HMO insurance. Switching meds *might* be a problem with my doctor. For example, when I saw him for my follow-up appointment, and all of my symptoms were gone after being on Asacol and a low res diet, I asked him how do we know I'm in remission and the inflammation is gone. He said, you have no symptoms. I asked if I could get a blood test to confirm the inflammation it gone. He said, no not without any clinical symptoms. I thought... oh, I have to be sick to get the damn blood test!! He's a bit arrogant too so I don't know how to approach him about changing the meds but I possibly could change gastro doctors.

I'll research those drugs but I will say I was told I have 'mild crohn's' ... don't know if that's true but I'm very leary of those heavy hitting drugs that could have drastic side effects... unless I really need it. But I'll look at the others you listed because I hear what you're saying - the Asacol dissolves at the terminal ileum so then how is the inflammation/stricture getting treatment? I don't know where the stricturing is exactly.

I love all of the other alternative therapies and will look into those as well. Thanks again, I really appreciate your info and knowledge.

 

[crohnicaly stinky]

anecdotal but none the less. Prior to my diagnosis I would get flare up every spring and fall when the pollen seasons were in full swing. The one year I didn't was the year I went on the glycemic load diet, strictly for losing weight. I basically cut carbs to a bare minimum. No rice, no chips, no potatoes, no refined sugars. I would have them in small portions with other food, i.e. you could have a bite sized chocolate at the end of a meal, according to the diet, since the contents of yoru stomach slowed the sugar absorption and so you didn't spike your blood sugar.

Well it was fabulous for weight loss and not only that, it was the only year I didn't have a flare up.

 

[JennyT]

Hi David - OH MY GOSH YOU MENTIONED PALEO DIET. With no help I found a diet by myself just using trial and error and a friend I was talking to said "Thats a Paleo Diet" and I looked it up and pretty much I was eating (when I could then) exactly that. Trouble is, and it has been soooo frustrating, no-one in my household agrees with me that this is either healthy or safe with Crohns and I have been called all kinds of stupid and when I flare "Its that food you are eating' <sob> SO is it true - other Crohnies find Paleo relieves the pain and allows you to eat a wider variety without doubling over? Jen

 

[David]

Jenny, click here to meet your new friends.

 

[PollyH]

I did some searching, and I couldn’t find any human studies showing that low sodium might induce low magnesium or low calcium. However, you might want to look at the problem this way. The predominant cations in the body are the positively charged electrolytes of sodium, potassium, calcium, and magnesium. (These also happen to be the same minerals people say will help alkalinize the saliva and urine.) If one of these minerals is deficient, the body may be able to use one of the others instead. That could cause a deficiency of the other mineral. That is essentially what the article on cattle and tetany is saying. If the body doesn’t have enough sodium to deal with the protein / nitrates, then it will substitute magnesium and calcium and cause a deficiency of those minerals. Those cations will be excreted with the nitrate anions. (Anions are negatively charged. Cations are positively charged.)

If they are right, then it seems reasonable that the general principle would apply to all animals, not just cattle. A high protein diet with not enough salt would deplete calcium and magnesium. (I found an article that said dogs on a high protein diet required more salt. However, the article didn’t mention calcium and magnesium.) I think the following paragraph from the cattle article is the best summary of their hypothesis.

“Since cations utilized to eliminate the excessive nitrate from the body have different solubilities and affinities for nitrate, the body will utilize the cations, if available in adequate concentrations, that have the highest affinity for nitrate. Magnesium, calcium and then sodium are the most soluble and potassium the least soluble [13], and likely the affinity of each cation for nitrate is similar to their solubility with nitrate. It is hypothesized that if there is a deficiency of sodium, and most forages and rations are deficient in sodium and excessive in potassium, and when there is a spike in nitrate, or excessive nitrate in the body, anionic nitrate is eliminated from the body as an ionic complex associated with magnesium and calcium. If nitrate is excessive, a hypomagnesia and/or hypocalcaemia may develop as the body is eliminating magnesium and calcium with the excessive anionic nitrate. However, if there is adequate sodium in the diet and organs and tissues, the excessive anionic nitrate is removed by the gut, kidneys, and mammary glands in lactating animals, as a ionic complex associated with sodium; and magnesium and calcium are maintained at physiologic levels and hypomagnesia and/or hypocalcaemia will not occur. For this reason adequate levels of sodium in the body and ration will lessen or prevent the drastic effects of nitrate toxicity. Also, it explains why adequate sodium in the diet will aid in the prevention of grass tetany, which is associated with high potassium and low magnesium levels. It also explains why the grass tetany syndrome cannot be readily induced experimentally unless cattle are exposed to high nitrogen or nitrate forages, and likely low sodium diets.”

 

[Sarah50]

I'm sorry I didn't get to this last night but I was exhausted and needed to get to bed.

If you wanted to stick with just mesalamine (the idea of that makes me cringe) then Pentasa would be a MUCH better formulation than Asacol. Now, I'm all for people with Crohn's disease taking a formulation of mesalamine IN CONJUNCTION with other treatments. But when I read that's all they're on, it concerns me a great deal. If you switched to Pentasa and that's it, I'd be worried, especially since you have stricturing disease. Conventional medications that are commonly used that have much better data supporting their efficacy in Crohn's disease than just mesalamine:

- Azathioprine
- 6-MP
- Remicade
- Humira
- Cimzia

David, I'm going to get a blood test at the end of this month from my regular doctor who said she'll also have my vitamin levels checked along with Iron since I was low in that.

Since my gastro doctor wouldn't check to see if the inflammation was gone - my regular doctor will check it. I have a couple of questions for you, David.

1. Are there any specific blood tests I should ask to have done for inflammation, to see if it's gone?

2. If the inflammation is gone - white blood cells and whatever is checked... is "normal" .... then would you still be telling me to change medication?

I guess what bugs me about what you said is the fact that ALL of my horrible Crohn's symptoms are gone after being on Asacol and a low res diet ... going on 3 months. I found a study from John Hopkins that says Asacol does stop inflammation cells.

I guess my question is, do people with Crohn's have all of their symptoms go away but their not really in remission? I know your concern is that the stricturing is not being treated but if I was still having problems with it, wouldn't I still be having abdominal pain and vomiting and night sweats, all which would indicate problems with stricturing/inflammation??? I just don't understand this point or how you know you're in remission when all of your symptoms are gone. :ybatty:

Thanks for any info ... I'm still learning about this disease.

 

[Sarah50]

David, this is what I found on WebMD about Crohn's, the goal of treatment and medications prescribed.

How is Crohn's disease treated?

There is no cure for Crohn's disease. The goals for treatment are:

to reduce inflammation
to relieve symptoms of pain, diarrhea, and bleeding
to eliminate nutritional deficiencies
Treatment might involve drugs, nutritional supplements, surgery, or a combination of these therapies. Treatment choices depend upon where the disease is located and how severe it is. They also depend on the complications associated with the disease and the way the person has responded in the past to treatment when symptoms reoccurred.

What kinds of drugs are used to treat Crohn's disease?

There are several types of drugs used to treat Crohn's disease. The first step usually involves reducing inflammation. Many people are first treated with sulfasalazine (Azulfidine). This drug is the most common of those that contain mesalamine. Mesalamine is also known as 5-aminosalicylic acid, or 5-ASA

If a person does not respond to sulfasalazine, the doctor may prescribe other types of drugs that contain 5-ASA. These other products include:

olsalazine (Dipentum)
balsalazide (Colazide, Colazal)
mesalamine (Asacol, Lialda, Pentasa, and others)

Crohn's disease may also be treated with drugs that stop the immune system from causing inflammation. Immunomodulators change the way the immune system behaves. Immunosuppressants decrease the activity of the immune system. Immunostimulators increase the activity. Immunosuppressants prescribed for Crohn's disease include:

azathioprine (Imuran, Azasan)
6-mercaptopurine (6MP, Purinethol)
tacrolimus (Prograf)
Methotrexate (MTX, Rheumatrex, Mexate)
Side effects of immunosuppressants may include:

diarrhea
higher susceptibility to infection
nausea
vomiting

A biologic drug, infliximab (Remicade), is often prescribed when a person with Crohn's disease does not respond to the standard treatments of mesalamine-containing drugs, corticosteroids, and immunosuppressants.


So.... I don't know what to think based on what you believe about Asacol and what I find on various crohn's websites. I'm confused why you think it doesn't work when all of my symptoms are gone??? It seems, according to WebMD, that the goal has been met and as long as my blood test shows inflammation gone in my body... why would you assume it's not working?

Again, thanks for any info you're aware of, preferably with links since we all need to see the research that you've seen to understand the science behind what you're saying. I'm sure I'm not the only person that's been prescribed Asacol for Crohn's disease (in the termial ileum). Thanks!


Edited to add, I remember my gastro doctor talking about one of these - sulfasalazine (Azulfidine) - asked if I was allergic to sulfa? and said that this medication often causes side effects in patients so I guess that as well as where my crohn's is, decided to prescribe Asacol, which has no side effects for me.

 

[David]

Please take a few minutes to read our wiki entry on remission. It may help you understand where I'm coming from a little.

Blood tests can be a signpost but are not an absolute indicator of inflammation. They are much more useful if you've been getting them regularly to determine trend. CRP, ESR, CBC can all help give us an idea of what's going on. They may be normal (biochemical remission) and yet you may not be in the remission you should be in.

Could you post the study you found from John Hopkins?

I suspect a lot of your symptoms are gone because of the low residue diet.

But hey, maybe Asacol is your miracle drug for some reason and your disease is responding incredibly well to it. I'm simply going by the numbers from studies and papers I read and innumerable stories I have read here where being just on mesalamine ended poorly. I pray that I'm not coming across as a jerk with all of this. I sincerely want you to have the best treatment and outcome as possible, thus my responses.

While WebMD is a step up from Livestrong, they still suck and the information they provide on Crohn's disease is terrible and misleads a lot of people. I could tear that article to shreds but for the sake of brevity, I'll just do the first line.

"To reduce inflammation"

No. The goal is to completely eliminate inflammation and promote full mucosal healing so the patient is in deep, stable remission.

Nothing less is acceptable. You may feel better in the short term with reduced inflammation, but Crohn's disease is a lifelong disease at present and even low levels of chronic inflammation will likely catch up with you sooner or later which is unacceptable.

 

[Sarah50]

Please take a few minutes to read our wiki entry on remission. It may help you understand where I'm coming from a little.

Blood tests can be a signpost but are not an absolute indicator of inflammation. They are much more useful if you've been getting them regularly to determine trend. CRP, ESR, CBC can all help give us an idea of what's going on. They may be normal (biochemical remission) and yet you may not be in the remission you should be in.

Could you post the study you found from John Hopkins?

I suspect a lot of your symptoms are gone because of the low residue diet.

But hey, maybe Asacol is your miracle drug for some reason and your disease is responding incredibly well to it. I'm simply going by the numbers from studies and papers I read and innumerable stories I have read here where being just on mesalamine ended poorly. I pray that I'm not coming across as a jerk with all of this. I sincerely want you to have the best treatment and outcome as possible, thus my responses.

While WebMD is a step up from Livestrong, they still suck and the information they provide on Crohn's disease is terrible and misleads a lot of people. I could tear that article to shreds but for the sake of brevity, I'll just do the first line.

"To reduce inflammation"

No. The goal is to completely eliminate inflammation and promote full mucosal healing so the patient is in deep, stable remission.

Nothing less is acceptable. You may feel better in the short term with reduced inflammation, but Crohn's disease is a lifelong disease at present and even low levels of chronic inflammation will likely catch up with you sooner or later which is unacceptable.

First I want to say that in no way do you sound like you're coming across as a jerk!!! I have seen enough of your posts to know your genuine concern and wanting to help. So I don't take it in any 'bad' way whatsoever!!! I truly appreciate the knowledge you've gleaned over this disease and sharing it with us. I'm the type that likes to get to the facts and appreciates studies/links too, to back up what you state. I am obviously new to Crohn's so I'm at the stage of weeding through fact vs fiction... and my posting links I find about Asacol doesn't mean I think it's the be all to end all.... but what else do I have to go on? And the fact that I *seem* to be in remission, or at least all of my horrible Crohn's symptoms are gone.

So here's what I found about Asacol and crohn's - from my notes from my gastro doctor, I have crohns "ileitis" and said my crohns was "mild". I found the following describing where Ileitis is located: Patients with ileitis, Crohn's disease at the bottom three fifths of the small intestine" - this is where the article below states that Asacol works specifically in this area. Maybe this is where my stricture is located... I'm not sure but it's definitely in the small intestines area.


The article below is from the American Academy of Family Physicians - 2003 ... I'd rather find something more recent about crohn's and Asacol but haven't come across anything yet.... what I want to know is if YOU know it doesn't work ... why don't gastro doctors not know, I'm obviously not the only person prescribed this. ??????????????


"Mild to Moderate Disease
Mild to moderate Crohn's disease can be treated with a salicylate preparation, and in patients who are unresponsive, an antibiotic may help. Response to therapy should be evaluated after several weeks; patients who do not respond should be treated for moderate to severe disease or with alternative therapy.

The salicylates include mesalamine (Rowasa) and sulfasalazine (Azulfidine). In its various preparations, mesalamine can be released in the stomach, duodenum, ileum, and colon (Pentasa), or primarily in the terminal ileum and colon (Asacol).7 Both mesalamine preparations are generally more effective than placebo in improving disease symptoms and inducing remission in patients with active Crohn's disease; however, greater benefit is seen in patients with ileitis versus colitis or ileocolitis.8 The dosage of oral mesalamine is 3.2 to 4 g per day.

http://www.aafp.org/afp/2003/0815/p707.html



If you don't mind David, do you have any article links that state your claim about Asacol? It's not that I don't trust what you've read... I would like to read it for myself. I'm sure others here that are on Asacol would like that too. How else can I go to my doctor and say I want to try something else besides Asacol with nothing to back it up?

Again, thank you... I appreciate your taking the time with my questions about Asacol, remission, etc.

 

[Sarah50]

Please take a few minutes to read our wiki entry on remission. It may help you understand where I'm coming from a little.

Blood tests can be a signpost but are not an absolute indicator of inflammation. They are much more useful if you've been getting them regularly to determine trend. CRP, ESR, CBC can all help give us an idea of what's going on. They may be normal (biochemical remission) and yet you may not be in the remission you should be in.


"To reduce inflammation"

No. The goal is to completely eliminate inflammation and promote full mucosal healing so the patient is in deep, stable remission.

Nothing less is acceptable. You may feel better in the short term with reduced inflammation, but Crohn's disease is a lifelong disease at present and even low levels of chronic inflammation will likely catch up with you sooner or later which is unacceptable.

I just found other notes from my doctor's office after my GI barium x-ray:

"Moderately long segment of abnormal narrowing and mucosal irregularity of the terminal ileum is consistent with manifestations of Crohn's disease."

Then from an "IBD Differential Panel" that stated the results were "consistent with Crohn's disease" - both tests were from last November when he diagnosed me with Crohn's:

Saccharomyces Cerevisiae AB (ASCA) (IGG) 109.0 U (Flagged High)
Reference range: <= 20 Negative
20.1 - 29.9 Equivocal
>= 30 Positive

Saccharomyces Cerevisiae AB (ASCA) (IGA) 62.4 U (Flagged High)
Reference range: <=20.0 Negative
20.1 - 24.9 Equivocal
>=25.0 Positive


So is the above blood test the same as any of those that you posted??
"CRP, ESR, CBC" ?? Do I just ask my regular doctor for those specifically?

Again, THANK YOU for your help, David!!

 

[Sarah50]

Ok, David, since you asked, I found the John Hopkins info:

"Anti-Inflammatory Drugs
Mild to moderate Crohn’s disease has a good response to 5-aminosalicylate-containing agents. 5-aminosalicylic acid (5-ASA) derivatives (mesalamine, mesalazine and sulfasalazine) provide anti-inflammatory actions for connective tissue. Aminosalicylates can be targeted to sites along the gastrointestinal tract. Asacol, coated with a pH-sensitive acrylic polymer, releases 5-ASA in the distal ileum and colon at pH of 7.0. Sulfasalazine acts as the transport mechanism to carry the 5-ASA component to the colon tract. Pentasa is comprised of coated granules that release 5-ASA in the upper gastrointestinal tract, as well as the ileum and colon.

Aminosalicylates have multiple anti-inflammatory effects that are primarily topical (mucosal), not systemic. They also inhibit oxygen radical production and are scavengers of free radicals. Sulfasalazine and 5-ASA preparations inhibit the function of lymphocytes, monocytes, and plasma cell production of immunoglobulins (Figure 19)."


"Continuous-release mesalamine (5-ASA products) has been shown to induce clinical improvement or remission. These drugs have also been evaluated for use in maintenance therapy with inconsistent results. Benefit has been demonstrated, however, with 3 g doses in reducing endoscopicendoscopic and clinical evidence of disease process in postoperative recurrence studies.."

http://www.hopkins-gi.org/GDL_Disea...sease_ID=291F2209-F8A9-4011-8094-11EC9BF3100E


Regarding the Ileum, here's what I found out:

The ileum is the final section of the small intestine. In humans, the ileum is about 2–4 m long, and the pH is usually between 7 and 8 (neutral or slightly alkaline).

So this would seem to support the use of Asacol.


It does state "evaluated for use in maintenance therapy with inconsistent results" so that backs up what you've read. There is no way I want to go on the heavy duty drugs - nor is it warranted, from what I've read so far, with mild crohn's. I'm just not sure of what to say to my doctor without proof one way or the other. I'll need to get at least some of these tests you've recommended to see if I have any inflammation going on or not.

 

[Sarah50]

David, I went to the "American Gastroenteroloy Association" website, put "Crohn's disease and Asacol" into the search and found this abstract that stated:


"Oral 5-aminosalicylic acid (Asacol) in the maintenance treatment of Crohn's disease. The Italian IBD Study Group"

"It is concluded that oral 5-ASA coated with Eudragit S (Rohn Pharma GmbH, Wieterstadt, Germany), 2.4 g daily, is safe and seems superior to placebo in preventing or delaying clinical relapse in Crohn's disease, especially in milder cases and in ileal disease. (Gastroenterology 1992 Aug;103(2):363-8)" I

http://www.gastrojournal.org/articl...efissn=0016-5085&refuid=S0016-5085(02)70129-7

I would still like to see something more recent or something that says it doesn't work. ?????????

 

[David]

Hi Sarah,

You've thrown a lot my way, kudos! I have to catch up on some other conversations but will reply when I get a chance. I just wanted you to know I'm not ignoring you and I really respect how much you're delving into all of this. All this knowledge and research is sure to result in you being able to better advocate for yourself which will no doubt result in a higher standard of care. Good for you!

 

[David]

Hi Sarah,

I've been super strapped for time lately, I'm sorry about that. I didn't want you to think I've been ignoring you though so let me toss a little your way.

1. Are you aware that no form of mesalamine is approved for use in Crohn's disease? It is only approved for use in Ulcerative Colitis. Anytime mesalamine is used for Crohn's disease it is off-label. There's a reason no form of mesalamine has made it through clinical trials for Crohn's disease. Point two showcases why.

2. This is a Cochrane review for mesalamine in Crohn's disease. http://onlinelibrary.wiley.com/doi/...ionid=C7E8160A5E5989EB38CDC05D30095591.d02t01 -- What the Cochrane group does is they pull every study they can find, every paper they can find, pretty much every piece of information they can get on a treatment and disease and do all kinds of analysis on it. The review the hell out of it. In the case of Crohn's disease and mesalamine, they reviewed 19 studies. 19. The took all the data from those studies and came up with the following conclusion:

Olsalazine and low dose mesalamine (1 to 2 g/day) are not superior to placebo. High dose mesalamine (3 to 4.5 g/day) is not more effective than placebo for inducing response or remission. High dose mesalamine was inferior to budesonide for inducing remission in a single trial. In conclusion, sulfasalazine shows modest efficacy for the treatment of active Crohn's disease. However, the existing data show little benefit for 5-aminosalicylates.

 

[David]

By the way, in addition to those blood tests, I strongly suggest utilizing fecal calprotectin to help monitor inflammation.

 

[shamrock15]

My personal experiences with 5-ASA type meds in the late '80s and early 90s was really not beneficial - I think I tried three different types with no benefit. In most cases, they passed through me without acting. They were visible in my stool. I was one of the budesonide trial patients in Canada, and it did not work for me due to my skip lesions.

 

[Sarah50]

Hi Sarah,

I've been super strapped for time lately, I'm sorry about that. I didn't want you to think I've been ignoring you though so let me toss a little your way.

1. Are you aware that no form of mesalamine is approved for use in Crohn's disease? It is only approved for use in Ulcerative Colitis. Anytime mesalamine is used for Crohn's disease it is off-label. There's a reason no form of mesalamine has made it through clinical trials for Crohn's disease. Point two showcases why.

2. This is a Cochrane review for mesalamine in Crohn's disease. http://onlinelibrary.wiley.com/doi/...ionid=C7E8160A5E5989EB38CDC05D30095591.d02t01 -- What the Cochrane group does is they pull every study they can find, every paper they can find, pretty much every piece of information they can get on a treatment and disease and do all kinds of analysis on it. The review the hell out of it. In the case of Crohn's disease and mesalamine, they reviewed 19 studies. 19. The took all the data from those studies and came up with the following conclusion:

Thanks for getting back with me... no problem when you do... I'm sure you're busy.

The info you posted is interesting .... but...how do you explain all of my crohn's symptoms gone after taking Asacol for 6 weeks (along with a low residue diet)? You had suggested that my low residue diet got rid of my symptoms in another post. I find it very hard to believe that that diet alone got rid of all of those symptoms - how would it get rid of nightly night sweats which has to be indicitive of inflammation? I can see the diet really helping the bad stomach aches as well as the nausea and vomiting. But what about the achey joints, backache and loss of appetite all diminishing after taking Asacol for 6 weeks? Again, I cannot believe that was all from the low residue diet. But tell me, is that what you think?

And why do you think, David, that doctors recommend Asacol for Crohn's disease? I'm in LA and in an area with a good health group system.... the doctor was highly recommended - not saying that he could be better.... but I don't get a doctor recommending the wrong medication for a serious disease - how would he recommend it if Asacol was ony recommended for UC??? It doesn't make sense and particularly since I have no more symptoms for 3 months. ???

And if Asacol works for UC and works - it obviously has the anti-inflammatory properties ... and according to the links I posted above, it works in the distal ileum, along with the colon.... and I was told my crohn's was in that area - the terminal ileum.

So I'm still confused about what you think and post about Asacol and crohn's.... again, especially since all of my symptoms are gone. ?????????

Thanks again....I appreciate any info!!

 

[David]

Hi Sarah,

Again, please read the wiki entry on [wiki]remission[/wiki] (click that) very carefully. I'm not saying Asacol isn't helping. While I think that the low residue diet is doing more than the Asacol, the Asacol may very well be helping. It may very well have you in clinical remission (a reduction of symptoms). However, Asacol is thought to be topical in its action. Crohn's disease is transmural (affects every layer of the bowel) and as you have stricturing, your disease is definitely not affecting just the mucosal layer. I do not believe you are in deep, stable remission in which case there is chronic inflammation slowly damaging your bowel. This is why some people do well with mesalamine formulations for awhile but then come back six months, a year, or two years later with symptoms of stricturing: it helped the top layer of inflammation but there was deeper damage going on.

Inflammation doesn't typically cause night sweats. My guess is you had some sort of infection going on.

I'd be curious what your diet was like prior to the low residue diet and what specific foods you're eating now?

Here is the Asacol prescribing information. Nowhere is Crohn's disease mentioned because it is not approved for Crohn's disease. Not one formulation of mesalamine has prescribing information that mentions Crohn's disease.

Why do I think that a doctor would prescribe just mesalamine for someone with stricturing Crohn's disease? Because they don't know how to properly manage the disease.

 

[Sarah50]

Ok, I understand what you're saying - Asacol is "topical" treatment, not systemic. It's just been hard to accept what you're saying when 1) many websites (Mayo Clinic, WebMD, etc, list Asacol for Crohn's treatment; 2) my doctor recommended it and/plus..... 3) ALL of my symptoms disappeared after 6 weeks on Asacol. So you can see why it's been hard for me to believe that it doesn't work. But you're saying, since it's not working systemically, there's a good chance the crohn's symptoms will come back within 6 months to a year or so and be worse. I already have stricturing.

So this makes me want to make an appointment with my regular doctor and discuss referring me to another gastro doctor!!! I will definitely do this when I see her at the end of this month for blood tests!!! So thank you for the information!

Before crohn's symptoms came on last fall, I pretty much followed Weight Watchers which is high fiber food (cereal, bread, pasta), lots of salads and veggies, mostly chicken and turkey for protein and a LOT less carbs/sugar type food than what I eat now!! Doesn't make sense. I used to smoke but quit 2 1/2 years ago.

 

[kiik]

My personal theory about food is that processed carbs (white bread, pasta, etc.) may not hurt going through your digestive tract as they are soft and not too hard to digest. However, over time they can contribute to an imbalance of bacteria.

How you start cutting those out when healthier foods hurt too much to eat, I don't know! I try to eat fruits/veggies but they often cause me pain and I'm already skinny enough as is without cutting out more food.

 

[crohnicaly stinky]

Kiik, you can try to mix them with other food. I used to eat a poached egg on dark rye toast. This helped slow the absorption down so I'm not sure how that impacts the feeding of the bad bacteria. But maybe limiting process carbs can still help. I think from a sustainability point of view you need some amount of enjoyment or you eventually fall off any diet. I used to treat myself with a scoop of carb smart vanilla topped with a broken up Hershey mini dark chocolate!

 

[David]

I totally understand your frustration Sarah. Hey, maybe I'm wrong. Let's get some insight from someone who knows more about IBD than me.

Aussie -- what's your opinion on someone with stricturing ileal Crohn's disease being only on mesalamine (Asacol specifically) and no other treatment other than a low residue diet?

 

[Spooky1]

Hi there,

diet plays a huge part in my crohns and bones issues. I'm liquid food and bland food, that's salmon and potatoes or boiled chicken and potatoes. But i'm certainly not as bad as I was. I know what i'm like if I eat normally, or get glutenous stuffs, along with dairy and fructose in the diet. omg. diet helps tremendously. Asacol made me sit on the floor by my loo for days, I was just so nauseous with vomiting. What suits one crohns sufferer may not suit another. we are very individual with our illness.

 

[JennyT]

Me too spooky, Im best on fibre free, gluten free, sugar fee, lactose free and its really worth it but some times I just think bugger it and I know Im in for a night on the loo, a burnt bum and a blimmin sore tum. Its hard getting people to beleive I shouldnt be on a "balanced diet" with peas n cabbage etc etc, I get flack from family who say Im making myself sick and why dont I just eat a sensible sandwich or loads of veg arghhhh! I find sweet potatoes are better than potatoes but we have a drought here at the mo and they are expensive to buy. Everyone is different as you say jusy addin my story so someone else can say "Oh thats just like me" and you dont feel so alone, theres another Crohnie like you

 

[Spooky1]

I agree, food is bad for us lol. shame, but that's the way it is. but better have less pain, sickness and diarrhoea than stuff my gob and pay a very hefty price.

 

[Aussie]

Hi David and Sarah. If you have a long segment of ileal involvement with stricturing, then you are in a poorer prognostic group, and your Crohns needs to be treated more aggressively, I'd agree with David, and suggest you talk to your Gastro about escalating to thiopurine therapy.

As to why you felt better, mesalamines do work well for extra intestinal manifestations of IBD, particular the joint symptoms (not as we'll as sulphasalazine though). Also, there is a poorly described subtype of Crohns, a superficial Crohns, that is usually colonic, and typically quite mild that does respond to mesalamine therapy. However, once you have stricturing, then you're not in that category, even though some of the surface inflammation may have reduced causing you to feel better, remaining on only mesalamine would be a poor clinical choice in my opinion.

As to why your doctor prescribed it. It wasn't that long ago that mesalamines were first line standard of care in Crohns, and perhaps old habits die hard. Also, mesalamines are relatively risk free (interstitial nephritis is very rare with them), so the doctor worries less about causing harm, whereas the thiopurines (Imuran and 6mp) do have a host of potential side effects. Perhaps your gastro is not an IBD specialist, if they were, I'd be quite surprised if they left someone with long segment ileal inflammation with stricturing not on something stronger.

Best wishes.

 

[Sarah50]

Hi Aussie,

Thank you for the information. I do intend to discuss this with my doctor, and yes, he is a gastroenterologist. I hear you about the stricturing, it does make sense but I don't think it goes away - from my understanding of research (so far), you can only get the inflammation down which helps. It's either that or surgery. Do you know something different? What would the medication you recommended do for stricturing that Asacol hasn't done?

If what you say is true, and that other gastroenterologists would recommend the stronger choice, then almost ALL websites I've looked at for Crohn's are giving out the wrong information... .. because they all list mesalamines that include Asacol as the first medication recommended for mild Crohn's. Apparently, it is still recommended ... which is disturbing if this isn't what is recommended for mild Crohn's because, obviously, I'm not the only one researching this disease. So again, it's confusing.

And yes, you're right, that the more 'heavy duty' medications come with some risks... and some of those, quite serious. I guess that's why different medications are recommended and different medications work for different people. As we know, this disease, how it affects each person, what gets one under control and does nothing for another is more of the norm than the exception. Which makes it frustrating for patients and doctors alike.

The good news for me is that I am and have been symptom-free for the past couple of months (since late December) with one bout of a 'flare' for a week when a situation stressed me out to the hilt. So although I'm not on a heavy duty drug (yet?), I seem to be doing very well with Asacol and a low residue diet. Thank God! I have looked at some posts here and other forums where there have been many people that have had success with Asacol - remission and no side effects. So... I will take into consideration what you and David believe, ask my doctor about it at my next appointment which isn't until July - unless, God forbid, I need to see him sooner. In the mean time, I am seeing my regular doctor/internist at the end of the month and will ask for those tests for Crohn's / inflammation.

Again, thank you for your opinion. It's appreciated.

 

[Sarah50]

For an example, when I go to the CCFA (Crohn's & Colitis Foundation of America), it first lists aminosalicylates:

Medical treatment for Crohn's disease and ulcerative colitis has two main goals: achieving remission (the absence of symptoms) and, once that is accomplished, maintaining remission (prevention of flare-ups). To accomplish these goals, treatment is aimed at controlling the ongoing inflammation in the intestine—the cause of IBD symptoms.
There is no standard regimen for managing all people with IBD. The symptoms, course of disease, and prognosis vary considerably. Proper disease treatment depends upon an accurate diagnosis.

Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA). These drugs, which can be given either orally or rectally, interfere with the body's ability to control inflammation. They are effective in treating mild-to-moderate episodes of ulcerative colitis and Crohn's disease, as well as preventing relapses and maintaining remission.

Oral Medications
Sulfasalazine (Azulfidine®), the first aminosalicylate to be widely used for IBD, is effective in achieving and maintaining remission in people with mild-to-moderate disease. The active portion of the drug, 5-ASA, is bonded to sulfapyridine, a compound that delivers 5-ASA to the intestine but comes with disagreeable side effects in some patients, such as headache, nausea, and rash. However, sulfasalazine is inexpensive and effective for the many patients who can tolerate it.

Researchers have also developed newer oral drugs that deliver 5-ASA without sulfapyridine. These include:

mesalamine (Asacol®, Pentasa®, Apriso™, Lialda® );
olsalazine (Dipentum®); and
balsalazide.

Up to 90 percent of people who cannot tolerate sulfasalazine are able to take other 5-ASAs.


http://www.ccfa.org/resources/types-of-medications.html


I will post what it says about the next level up... this is why it's confusing and we all need to find the right solution for each of us that have this disease.

 

[Clash]

My son has stricturing at his ICV and due to the stricturing the GI(pediatric GI that specializes in IBD) would not even consider 5ASAs. He stated that once CD is stricturing or fistulizing one could not be classified as having mild active CD and treating with 5ASA would be similar to aspirin for a brain tumor.

We do know adults treated with 5ASAs but none of them were dx'ed with stricturing or fistulizing C one although that progressed to stricturing CD and had to move to Remicade to get full mucosal healing.

That is just what we've encountered and most of what David has mentioned was reiterated by my son's Ped. GI but I do hope you are able to reach remission with whatever treatment you feel most comfortable with.

 

[Sarah50]

From the same website, CCFA:

As their name implies, immunomodulators weaken or modulate the activity of the immune system. That, in turn, decreases the inflammatory response. Immunomodulators are most often used in organ transplantation to prevent rejection of the new organ, and in autoimmune diseases such as rheumatoid arthritis. Since the late 1960s, they have also been used to treat people with IBD, which appears to be caused by an overactive immune system.

These drugs are appropriate for those who:

do not respond to aminosalicylates, antibiotics, or corticosteroids
have steroid-dependent disease or frequently require steroids
have experienced side effects with corticosteroid treatment
have perineal disease that does not respond to antibiotics
have fistulas (abnormal channels between two loops of intestine, or between the intestine and another structure—such as the skin)
need to maintain remission

An immunomodulator may be combined with a corticosteroid to speed up response during active flares of disease. Lower doses of the steroid are required in this case, producing fewer side effects. Corticosteroids also may be withdrawn more rapidly when combined with immunomodulators. For that reason, immunomodulators are sometimes referred to as "steroid-sparing" drugs.

Oral Medications
The first two immunomodulators to be used widely in IBD are azathioprine (Imuran®, Azasan®) and 6-mercaptopurine (6-MP, Purinethol®), drugs that are chemically quite similar. They are used to maintain remission in Crohn's disease and ulcerative colitis. Both have a slow onset of action (three to six months for full effect). Accordingly, they are usually given along with another faster-acting drug (such as corticosteroids).


This is just from one website - this is what I find all over the internet. Aminosalicylates that include Asacol for Crohn's, not just UC. It's hard to believe it hasn't worked when ALL of my symptoms went away....... bad stomach aches daily (this was the worst symptom - called into work sick often or worked poorly), extreme fatigue, night sweats (almost nightly), intermittent nausea and vomiting, definitely loss of appetite and fast weight loss, achy joints/back ache). I was really sick for several months... so when they all disappeared after 6 weeks on Asacol and a low residue diet... it's hard to believe the Asacol is not working. BUT - I am still open to it not being the right medication for me... of course I want to be in remission and stay in remission and hopefully avoid surgery .. for ever or for as long as possible!!!!!

 

[Sarah50]

I found the following article/clinical study that's interesting and confusing, again. (This is a 4 page in-depth study but I only took the info from the last page as it is a lot to include - so I wanted to 'cut to the chase':


Alimentary Pharmacology & Therapeutics
Systematic Review: The Potential Influence of Mesalazine Formulation on Maintenance of remission in Crohn's Disease
A. H. Steinhart, A. Forbes, E. C. Mills, B. S. Rodgers-Gray, S. P. L. Travis
Disclosures
Aliment Pharmacol Ther. 2007;25(12):1389-1399.

Discussion
The benefit of mesalazine treatment for maintaining surgically induced CD remission is reasonably well established; however, the effect of mesalazine for maintaining medically induced remission remains controversial because results vary between studies.[6,29,34] More compelling have been the meta-analyses[12,15] investigating mesalazine as a class for maintenance of medically induced remission, which have failed to detect any significant effect. This systematic review is the first to examine the efficacy of different mesalazine delivery systems for the maintenance of CD remission after both surgically or medically induced remission. It shows that the formulation appears to matter.

Care has to be taken when outcomes depend on the results of single trials (such as maintenance with pH 7-dependent mesalazine), but the results are consistent between medically and surgically induced remission. Furthermore, the number of patients approached or exceeded 100 for each study included in this review, and outcomes were extracted from carefully conducted RCTs. In both scenarios, pH 7-dependent mesalazine has a greater therapeutic benefit, with a lower NNT compared with pH 6-dependent and controlled-release mesalazine. In addition, the pH 7-dependent mesalazine has a statistically significant advantage over placebo, whereas neither the pH 6-dependent and controlled-release mesalazines do when each is analysed against placebo.


The three mesalazine formulations investigated in this study (pH 6-dependent, pH 7-dependent and controlled-release) are designed to release active drug (5-ASA) at different levels along the gastrointestinal tract. It has been suggested that differences in the various mesalazine formulations, with respect to 5-ASA release, may explain observed differences in therapeutic efficacy in CD.[17]

The Eudragit-S coating of pH 7-dependent mesalazine, however, is not broken down until the pH rises above 7 in the terminal ileum and colon.[38,40] It is known that CD most commonly affects the terminal ileum and colon;[1] thus, pH 7-dependent mesalazine may have greater clinical benefits because of a drug release profile that fits the most common disease location. Further, pH 7-dependent mesalazine may be particularly beneficial in the treatment of subpopulations of patients with ileocolonic or colonic disease.

Although our systematic review does not definitively answer whether formulation matters, we propose that the selection of mesalazine formulation potentially remains a key contributory factor in the clinical outcome of patients with quiescent CD maintained on mesalazine. Our study suggests that the apparent lack of impact of mesalazine in the maintenance of CD is open to different interpretation, and challenges the outcome of the Akobeng meta-analysis.[15] Large-scale, well-designed RCTs to investigate the efficacy of these different mesalazine formulations in CD patients are needed in order to confirm the findings of this analysis.

http://www.medscape.com/viewarticle/558396_4


Eudragit S-coated 5-ASA (Asacol)

 

[PVail]

Real interesting topic as i have been on Asacol for inflammation in the ileum for nearly two years. It works for me as the bleeding ,mucus and most of the pain has been stept down . I have from time to time stopped taking the Asacol in the hope that this has gone away but within a few days it all returns again . There is no question that it works for certain inflamation types , what they are specifically I cant say . But as someone who lives by this drugs I have to say it works. Do i have Crohns disease I dont know but I do have Inflammation which is controlled by taking Asacol.
Very interesting topic though.

 

[Sarah50]

PVail, glad to hear you are doing well with Asacol for the past 2 years. I have only been on it for almost 4 months and so far it seems to be working for me in that all of my Crohn's symptoms are gone.

If I find out that I need the stronger medication - Immunomodulators, of course I will take them. I want to do whatever it takes to keep this disease in remission.

I'm hoping, naturally, that I don't have to take Immunomodulators as they can have a *serious* side effect:

"These medicines may increase your risk of getting cancer, including lymphoma."

I can see why a doctor would try the milder drugs first, to see if they work!!!

 

[Aussie]

Hi Sarah, 5ASAs in Crohns is definitely a contentious topic. A lot of the data is quite heterogenous with regards to which 5ASA was used in the trials, and moreso, the location of the Crohns (upper GI, ileal, colonic). There was a recent analysis in the American Journal of Gastro. (AJG Apr 2011) which looked at this question and there was interesting letters following (AJG Oct 2011). Essentially, probably okay to try for mild Crohns given the good side effect profile, however, no significant benefit over placebo unless drilling down on particular subanalyses (I tend to think that if you have to look at particular subanalyses to see a benefit, then the likely benefit is going to be modest at best.)

At the end of the day however, it doesn't matter so much about what the trials say, it's more important looking at what the drug does to you - if you are lucky enough to be in remission with Asacol then keep going. Just be sure you're in remission though. Clinical remission is when you may have no symptoms, previously a target of treatment. However, that target has recently changed as ongoing inflammation could be asymptomatic and thus you could have ongoing bowel damage in the absence of symptoms. What you need is deep remission (clinical, biochemical and endoscopic). Unfortunately, CDAI and CRP and WCC etc are not reliable indicators of endoscopic activity of Crohns.

What I would suggest is consider a faecal calprotectin (+/- colonoscopy), if the calprotectin is normal, then continue as is, however, if that is significantly elevated, then there is ongoing subclinical inflammation that can, over time, further damage your bowel, and you should consider an escalation of therapy.

Best wishes.

 

[Sarah50]

Aussie,

Is the faecal calprotectin test something I can ask for with my internist? Is it a fecal test or a blood test or ??? Excuse my ignorance... but I want to know what I'm asking for. LOL Thanks!!

Edited to add:

I believe that it's a fecal test from what I could find by googling it. I will ask my doctor to do this test. Thanks again.

 

[David]

It is indeed a fecal test and your internist should be able to order it.

 

[Clash]

Sara50, the fecal calprotectin test has been a great test for my son since his blood work isn't a good barometer for his inflammation levels, hope it all goes well.

David or Aussie, I have a question regarding deep remission. My son's GI explained deep remission in much the same way as Aussie(clinical, endoscopic etc.) full mucosal healing. If you have reached remission by all these standards then could missing a couple of doses of your meds result in automatic symptoms? I am just trying to wrap my brain around, I guess, the idea of full mucosal healing and at that point how tenuous this level of remission is.

 

[mreyn]

I went from page one to page six.. I guess I'll have to read all the ones in between. I'm just trying to find what to give my son to help him heal so that he can get off of remicade. If there's any possible way to point me to something that says do this and take this.. etc.. that's what I need. ~Overwhelmed

 

[Hope345]

mreyn.

It is overwhelming. I am having that same feeling.
One thing my husband reminded me was to just try to keep her comfortable, that may be the best we can do right now.

WE have doubled the Remicade, but still having a flare. Hopefully the next treatment will show some improvements.

I am sorry that there is no right answer.
thinking of you and your son.

 

[Aussie]

Sarah, faecal calprotectin just a simple poo test, but probably the most sensitive non-invasive test looking for active inflammation, I imagine any doctor in US could write the path form.

Clash, deep remission is usually reasonably sturdy. In a cohort of patients who achieved deep remission, the majority could come off their Infliximab (continuing immunomodulator) without flaring (Stori trial).

When you say, could you miss a few doses, in regards to the Infliximab, I would try to avoid that because episodic therapy (have long gaps in between doses) increases your chance of developing antibodies to the Infliximab, which will likely lead to loss of response. Missing a few doses of methotrexate is probably not as serious, although best to be avoided if possible.

Best wishes.

 

[Clash]

Aussie, thanks for the information, and I wasn't considering him missing doses of any medication at any time just trying to grasp of deep remission. In relation to diet or meds, I have read many posts that mention if they miss a few days of their pills or alter their diet the symptoms immediately return, I was just hoping that "deep remission" was less tenuous than that since it won't be long until my son will be away at college and it will be up to him to remember to take his MTX.

 

[Deba]

So, If Crohn’s sufferers eat a low-carb diet will the inflammation/ulcers heal quickly?? ..
still waitn 4 ur nxt article .. and thnx

 

[Div]

Did Dave Watson ever post articles 2-5? I cannot find them, but I would really like to read them.

 

[JennyT]

. I ended up re-inventing the classic anti-candida diet. (I didn't have Crohn's or colitis. The only thing the doctor found was yeast in the lab tests, but but told me that yeast doesn't mean anything, because everyone has that.)

One heaped teaspoon of plain old baking soda in water a day is all you need. GOOGLE baking soda cure (especially cancer) and you will be amazed. No pharmacutical company wants to spend the millions to prove it cos its so cheap its not marketable. I watched my 52 year old male flatmate go from high blood pressure and using his angina spray sometimes a dozen times a day and being an invalid to normal BP and NO spray EVER and being well enough to become a gym bunny just by drinking baking soda daily.

Works for some, worth a try. Google it up first, the science of it is on Youtube.

 

[poing]

Your comment is complete rubbish

I've demonstrated a carb link to Crohn's. I've demonstrated that reducing carb comsumption improves Crohn's. That in itself suggests carbs are being used by bacteria.

Bacteria aren't the only things that eat carbs.... yeasts and other gut parasites do too.

Just thought that was worth pointing out.

 

[SugarberryGA]

I was diagnosed with Crohn's nearly 30 years ago and what has helped me the most, I do believe, is not drinking alcohol of any kind, not smoking, eating about as well as my tummy will allow, and taking my medicine regularly. Alcohol and smoking are huge no-nos with Crohn's. Crohn's patients that I have know who drink and/or smoke, have frequent flares and wind up in the hospital. I'm 52 and have only been hospitalized once for my Crohn's, and that was two years ago because I took Motrin for arthritis pain. Never again will I make that same mistake!

 

[pb]

Crohn's disease IS an autoimmune disease, our immune system doesn't properly recognized certain bacteria as being good and therefore attacks it thinking it's attacking bad bacteria....it's a malfunctioning immune system (not over active or under active) it simply has it's lines crossed and that's what causes the polyps and inflammation.

Same with Celiacs for example, difference being is once you take the wheat and gluten out of a Celiacs system, their immune system no longer attacks the GI tract because the wheat and gluten is no longer considered an invader by the immune system.

It's the immune system in IBD that needs to be fixed in order for the intestines to be healed (or cured).

 

[rollinstone]

Actually more and more evidence is showing that crohns could likely be caused from a microscopic infective agent, MAP in some people and Maybe AIEC in others, the problem is the immune systems in us crohnies don't clear the microbial agents out. Look at qu biologics SSI vaccine, I strongly Support their hypothesis, and it is about 180% from the autoimmune theory which has way too many facts against it.

 

[Ihurt]

I agree that a faulty immune system does play a role in this disease and many others, but there is more to it than that. Like for instance, what you said about celiacs disease, true, you take the Gluten out of the picture, the intestines heal. BUT, I read an article years ago about why the only reason people that have this reaction to the gluten is because of the way it is processed( it is crossbred with an actual weed that is not digestible to the human gut)! I believe there is only once place that has never crossbred their wheat fields and that is in Ireland. They say a person that has celiacs can actually eat wheat over there and have no problems. Now the big question is WHY then does everyone not have issues?? I guess that is where the faulty immune system comes in.

It is so very complex, that is for sure. It could be people get certain diseases due to a LOW immune system as well and also I think people have to already have a certain gene that allows this whole disease process to take hold. There are many factors involved I believe.

Now Polyps could be from ones diet as well and lifestyle factors. Millions of people get colon polyps and they do not have inflammation anywhere in the intestines.

Crohn's disease IS an autoimmune disease, our immune system doesn't properly recognized certain bacteria as being good and therefore attacks it thinking it's attacking bad bacteria....it's a malfunctioning immune system (not over active or under active) it simply has it's lines crossed and that's what causes the polyps and inflammation.

Same with Celiacs for example, difference being is once you take the wheat and gluten out of a Celiacs system, their immune system no longer attacks the GI tract because the wheat and gluten is no longer considered an invader by the immune system.

It's the immune system in IBD that needs to be fixed in order for the intestines to be healed (or cured).

 

[pb]

Actually more and more evidence is showing that crohns could likely be caused from a microscopic infective agent, MAP in some people and Maybe AIEC in others, the problem is the immune systems in us crohnies don't clear the microbial agents out. Look at qu biologics SSI vaccine, I strongly Support their hypothesis, and it is about 180% from the autoimmune theory which has way too many facts against it.

Except not all CD patients have MAP in them...years ago they did studies and test a large group of CDers and found not all of them had MAP.

I'm not 100% familiar with how having MAP works, if someone has it, is it in their blood? Where in the body is it? Does having MAP alter the immune system?

 

[SugarberryGA]

It's like my gastroenterologist told me once about Crohn's... if he knew how and and why people developed Crohn's disease, he'd be a wealthy man. I've learned to simply accept the fact that I have it, that I'm going to have it the rest of my life, and have quit researching it. The more I researched it, the more confused I got. Now I just say the Serenity Prayer. )

 

[Amy2]

What exactly is deep remission?

 

[PollyH]

I'm not 100% familiar with how having MAP works, if someone has it, is it in their blood? Where in the body is it? Does having MAP alter the immune system?

You can have the blood tested for the MAP DNA. However, even if a pathogen doesn't show up in the blood, it may still be present in the intestines.

MAP and invasive E Coli can be found inside macrophages. Therefore, they are able to interfere with your immune system.

 

[danieldresen]

While you do provide good points in reference to Crohn's research, albeit research into Crohn's is limited, your hypothesis loses flare when you become insistent. In any clinical setting when presenting a new take (unless you have letters such as PhD, MD, etc...) you should not suggest that it is, but that it could be. An example:

"In Crohn’s, the inflammation/ulcers are CAUSED by acid-producing bacteria along the gut lining."

When presenting a scholarly argument, utilize may be caused (and use lower case). This will limit criticism by many people. I am going to school for psychology but research writing is the same across the disciplines.

As for thoughts on prevalency, the VA has been conducting studies into Crohn's as well and there has been a surge in diagnosis between 1998 to 2008. Do you think MREs may be a source, or the environment? I have noticed that soldiers who have had a high risk of dysentery have a reduced risk of developing Crohn's Disease. Its odd to think that poor sanitation and altering the diet can reduce the risk... Check this study out and let me know your thoughts.

http://www.ncbi.nlm.nih.gov/pubmed/9732925

 

[PollyH]

I have noticed that soldiers who have had a high risk of dysentery have a reduced risk of developing Crohn's Disease. Its odd to think that poor sanitation and altering the diet can reduce the risk... Check this study out and let me know your thoughts.

http://www.ncbi.nlm.nih.gov/pubmed/9732925

It could be the unsanitary conditions that are helping. Here is an article about using worms to treat IBD.

http://www.altmedrev.com/publications/16/1/50.pdf

Of course, it could also be that those who survived the unsanitary conditions were less likely to get Crohn's in the first place.

As for the increased prevalence noticed between 1998 and 2008, I suspect the food or the vaccines. There has also been an upsurge in autism, which is associated with gut problems.

 

[Ihurt]

Actually it is not so odd at all. Think about it, when you are in an area where sanitation is poor, you are being exposed to many different types of bacterial strains that can likely help protect the gut. Also not to mention that in these areas where sanitation is poor( especially in certain countries) where exposure to antibiotics is also very low, it stands to reason why developing Crohn's would be low.

In Africa people who have Sickle cell anemia cannot get Malaria. They are immune to it due to the Sickle Cell anemia protecting the cell somehow from allowing the malaria to get through. So I can understand the theory of people who have been exposed to Dysentery may be immune to getting Crohn's. There also have been some articles on how people who Have H-pylori have a much less risk of having Gerd issues. One thing kind of staves off the other.

http://www.ncbi.nlm.nih.gov/pubmed/9732925[/url]

 

[rollinstone]

pb, you are right, that is whats so confusing, some people have crohns and don't have MAP. they are starting to classify crohns into subtypes (I don't have the link on me atm but hopefully some1 will post it), its very interesting though and it makes a lot of sense why some people respond to certain meds and why others don't, it suggests that crohns is a condition with various causes, each cause showing certain sub-type features when looked at extremely closely... ah I hope someone can post more on it. its very interesting though.

 

[hans]

Dave,

I've read your inputs regarding crohn's and also read the rest of the posts in the page. I think that there are more than one Valuable Key within your theory and article that can lead to the discovery of a solution to crohn's and many other illnesses.

I was diagnosed with crohn's last year ..
Few days ago, I had a feeling that my symptoms has much to do with smoking (Acid) and eating sugar (Acid residue). I've been a (sugar addict) almost all my life. Instead of eating normal food, i used to have loads of food and drinks full of sugar. I even ate raw white sugar alone with a spoon several times after waking up in the middle of the night craving for sugar.

I've also noticed that the symptoms are reduced when i don't eat bread or rice (High Carb).

My point is that my notes come from a personal experience, i'm not a doctor, but i believe that crohn's has much to do with sugar and yes acids - no matter what that means (we don't have to be doctors to feel that something is burning our guts..). Thanks Dave.

 

[hans]

Hi everyone.

I was diagnosed with Crohn's last year. I've been a (sugar addict) almost all my life. I used to eat loads of Cakes, Chocolate and drinks containing sugar. I used to wake up in the middle of the night craving for sugar and ate white sugar with a spoon!

During my illness I've noticed the pain and the flares are reduced immediately when eating (1) food containing refined sugar, and (2) High-Carb food such as rice and bread, and (3) Milk and Diary. But! after few days the flares becomes worst and persistent.

In the times that I didn't eat (1) Milk and Diary, (2) Bread and (3) Food containing refined sugar, I suffer for few days from sever pain attacks, but after few days the pain and symptoms almost disappear.

I'm not a doctor, and I'm not sure whether this works for someone else - this is only my personal experience.

What brought me to this page, is that few days ago I've (felt) that my problem is mainly related to relying on eating too much food containing sugar for most of my life.. that's why I types in Google: Sugar Intolerance and Crohn's!

 

[Spooky1]

Hans, I also confess that for many years, but not recently, I have been a spoonful of sugar person. I also felt I needed a lot of sweets. I read once, about 25 years ago, that Kabi pharmaceuticals produced a booklet on Crohns, and in it they said that research shows that Crohns sufferers all head towards the high sugar foods. But I also wonder whether this is a result of feeling nausic, fatigued and just giving the body what it needs, sugar for energy. I think we are much better off on a carb free diet, but i'm on liquid feeds, and can't get a balanced diet with all nutrients without it.

Must say, you did bring back memories of eating sugar.

 

[Axelfl3333]

My feeling on crohns is mostly caused,created over the years by the over processed food that is more and more the norm in westernised nations a prime example of that is peanut allergy which is almost unknown in the far,middle east nations and exacerbated by over prescription of needless and useless drugs that have helped to create super bacteria.

 

[PollyH]

My feeling on crohns is mostly caused,created over the years by the over processed food that is more and more the norm in westernised nations a prime example of that is peanut allergy which is almost unknown in the far,middle east nations and exacerbated by over prescription of needless and useless drugs that have helped to create super bacteria.

Peanut oil is a hidden ingredient in many vaccines. Some feel that repeatedly injecting this oil into the bloodstream could be the reason for the increase in peanut allergies.

http://www.thedoctorwithin.com/allergies/vaccines-and-the-peanut-allergy-epidemic/

 

[mjr]

Hi Dave,
Wow Thanks for the research with and keeping open mind when doing your research.

Could you send me a link to your next thread you have or will be writing. I would love to read your information you post. Your suggestions may help me.

allergies (food & enviro since birth requiring medical treatment at a week old)
asthma - began age 3 and tonsils removed at that time too
Crohn's - Not diagnosed till age 45. Had severe abdominal pain that calmed after a couple of days, but still could not eat and bowels still hadn't moved. At that time, I had constipation. Ten years before that I had severe diarrhea with nausea and vomiting. Nothing the dr.'s gave me seemed to work. I went to my allergist and my Ige levels were extremely high, my weight was barely 100 lbs. He did food allergy testing on me and most foods came back positive, all meats except chicken, coffee, chocolate, tea, etc. A lot of very commonly consumed foods. He gave me script for Sodium Cromoglycate capsules. I was to take the 20 min before meals. This helped enough to keep me working for about 6 years. Then one dr appointment (pap test), my dr found a lump in my lower right pelvic area and squeezed it. He asked if it hurt, I said no, but I was starting to feel much more sick. Before I got to my vehicle, I was vomiting uncontrollably. This seemed to trigger the constipation. Also, I never had another menstrual cycle after this. At age 44 I was in full menopause (no menstrual cycle after this and before it was still normal and was very predictable when it would start each month). I was also very sick like this when I was pregnant for my second child. I took lots of medicine to try to keep the symptoms down enough so I could work. I worked for another 20 months, till I could no longer work. The pain, migraines, vomiting, 24 hr sweating (would come and go every day, and every night I wake up several times totally soaked, then would need another blanket to try to go back to sleep. I found that the 100% polyester blankets and housecoats that are fluffy would help some to keep me feeling dry enough to sleep a bit) became intolerable for me to continue working. About 2 weeks after I stopped working, after Thanksgiving dinner. I had the 3 days of severe pain and no bowel movement and of course no eating. The severe cramping subsided but my bowels did not move. So after a total of 6 days, I went to the ER for help. I ended up have bowel resection and strictures expanded. The surgeon had no idea how my bowels got so damaged. Kept asking about other surgeries, but at that time, all I had had was tonsils removed, Fallopian tube removal for requested sterilization, and appendix removed 3 years earlier. His report about my surgery stated he thought I had some kind of adhesion disease, but he did not see any cause for all the scar tissue, distended bowel, and multiple strictures. The section of bowel that was removed was sent to the lab and from the lab tests, I was diagnosed with inflammation consistent with Crohn's disease. They tried me on all Crohn's medication, including remicade (cause of severe sinus infection) and none helped to relieve my symptoms. Now I've been told I have IBS, which to me means I do not know. The GI Dr. diagnosed me as Crohn's in remission based on blood tests showing normal CRP levels. But my symptoms had not improved. Then Dr. says he doesn't think I ever had Crohn's and only explanation is IBS and I would need to find out what the food triggers are and avoid those foods. To date, I still have not found even one food that agrees with me. Anything I eat, even soft foods would cause a lot of pain. My understanding of Crohn's is that it is always visible during surgery/colonoscopy.
The only time in those years my symptoms improved was when I was on antibiotics, which I may get once every couple of years. At the time of my surgery, I hadn't had any antibiotics for almost 5 years.
I am still praying for anything that will ease the symptoms I have to live with everyday. There is another thing about Crohn's that doesn't fit, I do not get flares, my symptoms are chronic daily if I do anything more than drinking water.

I thought sharing my story, you or someone else may be able to advise on some things I could try to do to relieve some of the symptoms. I have tried a lot of things, some of them crazy desperate.

Thank God for people sharing :ghug: on the site. I am sure many have been helped with the information here.

Happy 2015, I hope.
Maggie :mademyday:

 

[leezapeza]

Omg I thought my mum was bs ing me when she said that sugar can cause inflammation but after reading this I'm more than willing to cut my sugar out and see if it helps

 

[worriedboy]

mjr, it sounds strange whatbyour dr says... If they diagnosed Crohns in lab, it's most probable that it is what you have. CRP is really not enough to monitor your condition. You might want to push for some scopes if you hadn't had any lately.

Besides, if antibiotics helps you, maybe it's worth that you take a look at RHB104 trial, it's on phase III in the US and some other countries.

Feel well.

 

[Spooky1]

If perhaps it's IBS then maybe try the 50 billion probiotics available. I sincerely don't have anything else to suggest. However, strictures are part and parcel of Crohns. I can't believe your doctors leave you in limbo like this. Not sure anyone with IBS has strictures, but I do stand to be corrected.

Good luck.

 

[PollyH]

Strictures can cause IBS. MJR, I suggest that you do some reading about SIBO (Small Intestinal Bacterial Overgrowth). The stictures interfere with the removal of bacteria from the small intestine. The small intestine isn't supposed to have a lot of bacteria. When this happens, you get IBS.

The overgrowth of bacteria will produce hydrogen which can be measured in the breath. The test to determine this problem is called a hydrogen-lactulose breath test. You can get this test on-line without a doctor's prescription, if you want. If you or your doctor orders such a test, make sure they also check for methane in the breath. Methanogens in the gut will turn some of the hydrogen into methane. The methane will cause constipation.

To get rid of this problem, you can use certain antibiotics or certain "herbal antibiotics." You can learn more about this from Dr. Siebecker's website, or from some of the publications of Dr. Pimentel. Also, there are discussion groups on the internet, like yahoo's SIBOnation.

 

[Spooky1]

Thanks for the SIBOnation link, Polly.

 

[frank246]

Dave,

Looking forward to your follow-up.

BTW, I don't think most of the apparently negative, or "hostile," comments here are in fact that. I think it's just that the comments might not have been worded as carefully as they might have been in the responders' anxiousness to post their reactions. And, as we all know, that's a hazard of online communications since voice inflections, as well as facial expressions, are absent.

 

[Nym]

Catalyst - 'Gut Reaction' Part 1 (2014)

Published on 14 Aug 2014

Reported by Dr Graham Phillips
Produced by Dr Graham Phillips & Geraldine McKenna
Edited by Vaughan Smith

https://www.youtube.com/watch?v=w94D45txSxo

 

[crohnschef]

That's coming in a later article Dan where I explain how AIEC and MAP are indirectly responsible for the inflammation and ulcers.

Recent research has found 92% of CD sufferers infected with MAP, and up to 36% of sufferers infected with AIEC. If this research is fairly representative, it's quite possible all Crohn's sufferers are infected with either MAP, AIEC or both.

Well...
i was diagnosdd with moderate to-severe crohn's disease in may of 09', after over ten long years of bleedin and all the other symptoms.
I have never ever had a cavity in my life. But i def.have crohns. So much bleeding. I have chronic dry mouth which can cause teeth and mouth issues. Its because of my meds. This potentialooly could be the reason for it