Leading Edge Developments in ... Video Transcript

Participants

, Bettina Gregory , Edward V. Loftus Jr, MD, Scott Eric Plevy MD, Mark Reiner MD, Barry Salky MD, Ellen Scherl MD

Summary

Research is constantly pointing toward new and better ways to treat inflammatory bowel disease. In this webcast leading scientists and doctors bring you the latest on new medicines and surgical techniques.

Webcast Transcript

BETTINA GREGORY, MD: Hello, I'm Bettina Gregory. Welcome to this webcast on leading edge developments in the diagnosis and treatment of inflammatory bowel disease.

This program is being sponsored by the Crohn's and Colitis Foundation of America. In this part of the webcast, we're looking at what's new in the treatment of IBD.

Joining me are three GI specialists: Dr. Edward Loftus is from the Mayo Clinic in Rochester, Minnesota; Dr. Scott Plevy is from the University of Pittsburgh School of Medicine; Dr. Ellen Scherl is from the Weill Medical College of Cornell University. Also joining us is a leading laparoscopic surgeon, Dr. Mark Reiner from Mount Sinai School of Medicine.

Coming up in a few minutes we're going to tell you about one of Dr. Reiner's patients, an 18-year-old woman here in New York with ulcerative colitis and her recent experience with surgery.

But first, we'd like to review the current state-of-the-art in medical therapy for IBD. Dr. Loftus, let's start with you.

BETTINA GREGORY, MD: But first we'd like to review the current state-of-the-art in medical therapy for IBD. Dr. Loftus, let's start with you.

EDWARD V. LOFTUS, MD: The first class of medications are the aminosalicylates. This includes sulfasalazine, which has been around for 50 years and three of its sulfa-free cousins. And the differences between these medications relate to not only whether or not they have a sulfa molecule, the sulfa can sometimes cause side effects such as headache or indigestion, but also where in the intestine they're released.

For example, olsalazine is basically two 5-ASA molecules joined together. That's released in the colon.

The second molecule would be mesalamine and that's just the active 5-ASA by itself. There are two formulations of that. One is called Pentasa which is released in the small intestine and in the colon. The other one is Asacol which is a delayed release and that's released in the bottom part of the small intestine and in the colon.

The third molecule is balsalazide and this has a similar structure to sulfasalazine but without the sulfa component and that's also released in the colon.

The second category of medications is the corticosteroids. And we like to consider these the fire extinguisher of the gut. So people that have active flares of inflammatory bowel disease are frequently put on medications like prednisone to control the symptoms.

These are very effective drugs but over time, they can lead to side effects. Some of the short-term side effects include facial swelling, acne, insomnia, mood swings and over the longer term we're concerned about side effects such as potential hypertension or diabetes or osteoporosis.

Interestingly about a year ago a new form of a steroid was approved for the treatment of Crohn's disease and this is called budesonide. Budesonide is structured in such a way that it has activity against inflammation in the gut but then it is rapidly metabolized and inactivated by the liver so that only 10% of the drug gets into the systemic blood stream. So it has activity against inflammation but fewer steroid-related side effects.

And again, this drug is approved for mildly to moderately active Crohn's disease. And some studies suggest that it is more effective than some of the 5-ASA preparations for the treatment of Crohn's disease.

The third category of medications are antibiotics. And the most common antibiotics we use in inflammatory bowel disease are metronidazole and ciprofloxacin. We only use these in certain indications.