Chemotherapy for Crohn's Disease

Chemotherapy for Crohn’s Disease

Learn how certain chemotherapy drugs, including 6-MP, Remicade, and Methotrexate, can benefit people with Crohn's disease.

Chemotherapy involves treating an illness using chemicals and has long been among the most successful treatments for patients with various forms of cancer. Certain forms of chemotherapy also have been effective for autoimmune disorders like Crohn’s disease.

6-MP

Administered orally, usually in tablet form, mercaptopurine, also known as 6-MP, is among the more popular chemotherapy treatments used for Crohn’s sufferers. 6-MP has been classified as an antimetabolite, a drug that interferes with metabolic action. Although antimetabolites have been found to be effective in the treatment of Crohn’s, they’ve been associated with side effects, too.

As with traditional forms of chemotherapy, the side effects of 6-MP can be difficult to handle. Extreme side effects include a temporary reduction in white and red blood cell count, which can increase your risk of infection and anemia. Liver problems and traditional chemotherapy side effects like nausea and vomiting may occur.

Methotrexate

Methotrexate is another popular Crohn’s prescription that has roots in chemotherapy treatments. Originally used for breast cancer patients, methotrexate is also used as chemotherapy for lymphoma and leukemia, among other illnesses. For treatment of autoimmune disorders, the dosage is lowered to a safer level.

Administered once a week, either orally or via injection, methotrexate blocks cell production, making it effective in controlling the inflammation caused by Crohn’s disease.  Methotrexate’s side effects include a reduction in blood cells produced by bone marrow, which can lead to complications. Methotrexate patients may be required to be tested occasionally to ensure adequate blood count. Patients taking methotrexate will often receive blood tests every two months to test liver function and creatinine levels in the urine to test for kidney function. Lung scarring is possible, so patients may be asked to watch for issues such as persistent coughing or trouble breathing.

Remicade (infliximab) (, a TNF blocker) often used in treating Crohn’s disease, has been reclassified as a chemotherapy drug because it requires special safety standards by the facilities that use it. It also falls into this category because it works by blocking proteins created by blood cells in your body.

Remicade is administered via IV, in a medical facility during an appointment that can take hours. Remicade is often used in more severe Crohn’s patients because it carries a lymphoma cancer risk, mostly among younger patients who take it. It also carries a risk of tuberculosis, which has sometimes been fatal among Crohn’s sufferers taking the drug.

Some people have experienced allergic reactions to Remicade, and a few have reported lupus-like symptoms, including chest or joint pains, shortness of breath, and rashes. If you begin to experience these side effects, your doctor may choose to either change your dosage or take you off the drug altogether.

Cyclosporine

Cyclosporine, also used in chemotherapy, has shown to be effective for Crohn’s sufferers. Like other medications used in the treatment of Crohn’s, cyclosporine decreases the body’s immune response.

Cyclosporine is traditionally used to prevent rejection during organ or bone marrow transplants.  Although it’s still unproven in the treatment of Crohn’s, the theory in using it is that weakening the body’s immune response will result in a lessening of inflammation in the gastrointestinal tract.

Some Crohn’s patients suffer from fistulas, abnormal connections in the intestines that can create discharge, fever, pain, and itching. Cyclosporine has had success in closing the resulting openings.  Some of the more severe side effects of cyclosporine include blood in the urine, high blood pressure, and kidney and liver problems. Because cyclosporine has such severe side effects, it’s rarely used to treat Crohn’s.

In 1997, researchers conducted a trial to determine if antituberculous chemotherapy worked in patients suffering from Crohn’s. The basis for this test was the theory that mycobacterium paratuberculosis is the cause of Crohn’s—a theory that has not been proven.

Mycobacterium paratuberculosis is a bacterial infection originates from the milk, feces, and meat of infected cattle. Some believe that the bacteria isn’t killed off during the cooking process and infects the humans who eat it, leading to Crohn’s.

Researchers hoped to eradicate Crohn’s disease in test subjects by using antituberculous chemotherapy, a tuberculosis treatment. However, the two-week trial found no change in Crohn’s patients participating in the study. At the end of the study, researchers concluded no detectable link between mycobacterium paratuberculosis and Crohn’s disease.

Copyright © 2005 - 2015 Healthline Networks, Inc. All rights reserved for Healthline. Healthline is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations. Terms of Use |Privacy Policy

Crohn's VS Ulcerative Colitis

The Difference Between Crohn’s, UC, and IBD

Part 1 of 5

Many people are confused when it comes to the differences between inflammatory bowel disease (IBD), Crohn's disease, and ulcerative colitis (UC). The short explanation is that IBD is the umbrella term for the condition under which both Crohn's disease and ulcerative colitis fall. But there is, of course, much more to the story.

Both Crohn’s and UC are marked by an abnormal response by the body’s immune system, and they may share some symptoms. However, there are important differences as well. These distinctions primarily include the location of the maladies in the gastrointestinal (GI) tract and the way each disease responds to treatment. Understanding these features is key to obtaining a proper diagnosis from a gastroenterologist.

Part 2 of 5

Inflammatory Bowel Disease

IBD was seldom seen before the rise of improved hygiene and urbanization at the beginning of the 20th century. Today, it’s still found mainly in developed countries such as the United States. Like other autoimmune and allergic disorders, it’s believed that a lack of germ resistance development has partly contributed to diseases such as IBD.

In people with IBD, the immune system mistakes food, bacteria, or other materials in the GI tract for foreign substances and responds by sending white blood cells into the lining of the bowels. The result of the immune system's attack is chronic inflammation. The word inflammation itself comes from the Greek word for flame. It literally means "to be set on fire."

Crohn’s and UC are the most common forms of IBD. Oftentimes, the terms are interchangeable. Less common IBDs include:

microscopic colitisdiverticulosis-associated colitiscollagenous colitislymphocytic colitisBehçet's disease.

IBD may strike at any age. According to theMayo Clinic, most people with IBD are diagnosed before the age of 30. It’s more common:

in urban areasamong people in higher socioeconomic bracketsindustrialized countriesnorthern climatesin Caucasians as opposed to darker-skinned people and those of Asian descentin people who eat high-fat diets

Aside from environmental factors, genetic factors are believed to play a strong role in the development of IBD. Therefore, it’s considered to be a "complex disorder.”

Unfortunately, there’s currently no cure for IBD. This is a lifelong disease, with alternating periods of remission and flare-up. Modern treatments, however, allow people to live relatively normal and productive lives.

IBD should not be confused with irritable bowel syndrome (IBS). IBS is a much less serious affliction than either Crohn’s disease or ulcerative colitis. It doesn’t involve inflammation or appear to have a physiological basis.

Part 3 of 5

Crohn’s Disease

Crohn’s disease may affect any part of the GI tract from the mouth to the anus, although it’s most often found at the end of the small intestine (small bowel) and the beginning of the colon (large bowel).

Symptoms of Crohn's disease include:

persistent diarrheacrampy abdominal painfeveroccasional rectal bleedingfatigue

Unlike with UC, Crohn's isn't limited to the GI tract. It may also affect the skin, eyes, joints, and liver. Since symptoms usually get worse after a meal, patients with Crohn's will often experience weight loss due to food avoidance.

Crohn's disease can cause blockages of the intestine due to scarring and swelling. Ulcers (sores) in the intestinal tract may develop into tracts of their own, known as fistulas. Crohn’s disease can also increase the risk for colon cancer, which is why patients must have regular colonoscopies.

Medication is the most common way to treat Crohn's disease. The five types of drugs are:

steroidsantibioticsimmune modifiers, such as azathioprine and 6-MPaminosalicylates, such as 5-ASAbiologic therapy

Some cases may also require surgery. Still, surgery will not cure Crohn’s disease.

Part 4 of 5

Unlike Crohn's, UC is confined to the colon (large bowel) and only affects the top layers in an even distribution. Symptoms of UC include:

crampy abdominal painloose stoolsbloody stoolurgent bowelfatigueloss of appetiteanemia due to blood loss (in severe cases only)

The symptoms of UC can also vary by type. According to the Mayo Clinic, there are five kinds of UC:

acute severe UC (a rare form that causes eating difficulties)left-sided colitis (affects descending colon and rectum)pancolitis (affects the whole colon and causes persistent bloody diarrhea)proctosigmoiditis (affects lower colon and rectum)ulcerative proctitis (mildest form that affects the rectum only)

With the exception of biologic therapy, treatments for the disease are the same as for Crohn's. Unlike with Crohn's, however, most patients with UC will almost never require surgery. 

Children with the disease may not develop or grow properly. Remission periods tend to be longer with UC than with Crohn's disease, and complications are far less frequent. Still, when complications do occur, they can be severe. Left untreated, UC may lead to:

holes in the coloncolon cancerliver diseaseosteoporosisblood clots

Part 5 of 5

Diagnosing IBD

There’s no doubt that IBD can significantly decrease quality of life, between uncomfortable symptoms and frequent bathroom visits. Even worse is the fact that IBD can lead to scar tissue, and even permanent damage. If you experience any unusual symptoms, it’s important to call a doctor. You may be referred to a gastroenterologist for IBD testing, such as a colonoscopy or a CT scan. Diagnosing the right form of IBD will lead to more effective therapies.

While there’s no cure for any form of IBD, early treatment and lifestyle changes can help minimize damage and complications. Treatment will also reduce the amount of symptoms.

Copyright © 2005 - 2015 Healthline Networks, Inc. All rights reserved for Healthline. Healthline is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations. Terms of Use |Privacy Policy

Update on my health

Im still having this flare up and it's getting worse. The nausea and urgency is getting bad.  The entocort hasnt started helping yet but I do feel like its going to.  And im not having the same side effects as with regular steroids. I like that.

Entocort for Crohn's Disease

Entocort (Entocort CR 3mg capsules) 

About Side effects

Overview

Information specific to: Entocort CR 3mg capsules when used in Crohn's disease.

Entocort (ent-o-kort) is a medicine which is used in Crohn's disease. Entocort contains budesonide. It is supplied by AstraZeneca UK Limited.

The information in this Medicine Guide for Entocort varies according to the condition being treated and the particular preparation used.

Your medicine

Entocort is a corticosteroid. Entocort works by preventing or reducing inflammation. It is used to treat Crohn's disease.

People who take corticosteroids for a long period of time are prone to infections as their immune system can become weak. These infections may be much more severe than they usually would be and the symptoms that would usually be used to identify such infections can be hidden. For this reason people who take Entocort must be careful to avoid exposure to infections such as chickenpox and measles whenever possible. If you have been exposed to chickenpox or measles, you must get immediate medical advice. You should continue to take your medicine unless your prescriber advises you to stop taking it.

Other information about Entocort:

if you have been given a steroid warning card, make sure you carry it with you at all times while you are taking corticosteroids. These cards are normally given to you by your prescriber or by your pharmacist. If you are currently taking corticosteroids, or have taken them in the last year, you must tell everyone involved in prescribing you medicines and giving you medical treatment. This includes your doctor, dentist, nurse and pharmacist. You must make sure that they all know about your corticosteroid treatment.

Do not share your medicine with other people. It may not be suitable for them and may harm them.

The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber.

If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

Whether this medicine is suitable for you

Entocort is not suitable for everyone and some people should never use it. Other people should only use it with special care. It is important that the person prescribing this medicine knows your full medical history.

Your prescriber may only prescribe this medicine with special care or may not prescribe it at all if you:

are about to have surgeryare allergic or sensitive to or have had a reaction to any of the ingredients in the medicineare elderlyhave a condition that becomes worse during steroid treatmenthave a peptic ulcerhave an infectionhave been exposed to chickenpox or measles while you are using Entocorthave cataractshave diabetes or have a family history of diabeteshave fructose intolerancehave glaucoma or have a family history of glaucomahave glucose-galactose malabsorption problemshave had psychoses caused by steroidshave high blood pressurehave liver problemshave or have had affective disorders or have a family history of affective disordershave or have had depressionhave osteoporosishave recently taken other steroidshave sucrase-isomaltase deficiency

Furthermore the prescriber may only prescribe this medicine with special care or may not prescribe it at all for a child.

As part of the process of assessing suitability to take this medicine a prescriber may also arrange tests:

to check that this medicine is not having any undesired effects

Over time it is possible that Entocort can become unsuitable for some people, or they may become unsuitable for it. If at any time it appears that Entocort has become unsuitable, it is important that the prescriber is contacted immediately.

Alcohol

Alcohol can interact with certain medicines.

In the case of Entocort:

there are no known interactions between alcohol and EntocortDiet

Medicines can interact with certain foods. In some cases, this may be harmful and your prescriber may advise you to avoid certain foods.

In the case of Entocort:

this medicine interacts with grapefruit or grapefruit juice. Grapefruit or grapefruit juice increases the level of Entocort in your blood

If your diet includes any of the above, speak to your prescriber or pharmacist for further advice.

Driving and operating machinery

When taking any medicine you should be aware that it might interfere with your ability to drive or operate machinery safely.

In the case of Entocort:

this medicine is unlikely to affect driving ability or the ability to operate machinery

You should see how this medicine affects you before you judge whether you are safe to drive or operate machinery. If you are in any doubt about whether you should drive or operate machinery, talk to your prescriber.

Family planning and pregnancy

Most medicines, in some way, can affect the development of a baby in the womb. The effect on the baby differs between medicines and also depends on the stage of pregnancy that you have reached when you take the medicine.

In the case of Entocort:

you should only take this medicine during pregnancy if your doctor thinks that you need ittaking this medicine during pregnancy may harm your baby. This can happen if it is taken repeatedly or for long periods of time

You need to discuss your specific circumstances with your doctor to weigh up the overall risks and benefits of taking this medicine. You and your doctor can make a decision about whether you are going to take this medicine during pregnancy.

If the decision is that you should not have Entocort, then you should discuss whether there is an alternative medicine that you could take during pregnancy.

Breast-feeding

Certain medicines can pass into breast milk and may reach your baby through breast-feeding.

In the case of Entocort:

this medicine passes into breast milk. Taking this medicine at high doses while breastfeeding may affect your baby

Before you have your baby you should discuss breast-feeding with your doctor or midwife. They will help you decide what is best for you and your baby based on the benefits and risks associated with this medicine. You should only breast-feed your baby while taking this medicine on the advice of your doctor or midwife.

Taking other medicines

If you are taking more than one medicine they may interact with each other. At times your prescriber may decide to use medicines that interact, in other cases this may not be appropriate.

The decision to use medicines that interact depends on your specific circumstances. Your prescriber may decide to use medicines that interact, if it is believed that the benefits of taking the medicines together outweigh the risks. In such cases, it may be necessary to alter your dose or monitor you more closely.

Tell your prescriber the names of all the medicines that you are taking so that they can consider all possible interactions. This includes all the medicines which have been prescribed by your GP, hospital doctor, dentist, nurse, health visitor, midwife or pharmacist. You must also tell your prescriber about medicines which you have bought over the counter without prescriptions.

The following medicines may interact with Entocort:

carbamazepinecimetidinecolestyramineitraconazoleketoconazole

The following types of medicine may interact with Entocort:

contraceptive steroidscytochrome P450 enzyme inducerscytochrome P450 enzyme inhibitorsoestrogensprotease inhibitors

If you are taking Entocort and one of the above medicines or types of medicines, make sure your prescriber knows about it.

Complementary preparations and vitamins

Medicines can interact with complementary preparations and vitamins. In general, there is not much information available about interactions between medicines and complementary preparations or vitamins.

If you are planning to take or are already taking any complementary preparations and vitamins you should ask your prescriber whether there are any known interactions with Entocort.

Your prescriber can advise whether it is appropriate for you to take combinations that are known to interact. They can also discuss with you the possible effect that the complementary preparations and vitamins may have on your condition.

If you experience any unusual effects while taking this medicine in combination with complementary preparations and vitamins, you should tell your prescriber.

Crohn's and Nausea

Nausea: Tips to Make it Better

By: SHARON DOERRE
WEDNESDAY, AUG. 27, 2014, 7:47 am
 

Nau­sea is never fun! Almost every­one with IBD will expe­ri­ence it at one time or another. Nau­sea can reduce appetite and lead to dehy­dra­tion and weight loss as well as make daily life mis­er­able. Don’t suf­fer needlessly.

Check your med­ica­tions. Metho­tex­trate, aza­thio­prine, and iron sup­ple­ments can cause nau­sea. Often tak­ing such a med­ica­tion right before bed­time can let you sleep through the effect. Steroids can also impact the stom­ach if pro­tec­tive med­ica­tions like omepra­zole (Prilosec) or ran­i­ti­dine (Zan­tac) are not taken. Ask your phar­ma­cist if a new pre­scrip­tion can cause nau­sea and ways to avoid it.

Ask your doc­tor for an anti-emetic med­ica­tion. Zofran (ondansetron) and Reglan (meto­clo­pramide) can often help reduce the nau­sea pro­duced by IBD medications.

Think about your trig­gers. Motion, dairy, greasy foods, stress, and sinus drainage can all cause nau­sea. Dehy­dra­tion can inten­sify the impact and IBD can lower your thresh­old to var­i­ous trig­gers, even ones that never both­ered you before.

Stay hydrated. Meclizine and dimenhydrinate(Dramamine)areavailable over the counter and can help with motion sick­ness. Lac­taid can ease the nau­sea from too much dairy; Tums can help soothe a stom­ach irri­tated by greasy foods. Gin­ger candy and even nib­bling on slices of raw gin­ger root can set­tle the stom­ach and com­bat nau­sea. Aller­gies and colds that cause sinus con­ges­tion can cre­ate nau­sea when drainage hits the stom­ach. Over the counter allergy med­ica­tions such as cet­i­rizine (Zry­tec) as well as decon­ges­tants and expec­to­rants like guaife­n­esin (Mucinex)can reduce and thin con­ges­tion and can keep it from caus­ing stom­ach problems.

Nib­ble. An empty stom­ach almost always makes nau­sea worse. Find a sim­ple food that is safe for you – IBD is such an indi­vid­ual dis­ease that it is impos­si­ble to make uni­ver­sal rec­om­men­da­tions — but­saltines or GF crack­ers, apple­sauce , or cooked rice are often safe,and nib­ble often.  If there is an imme­di­ate increase in nau­sea with nib­bling, add a Tums, gin­ger cap­sule, or water with lemon and keep eating.

Add cooked veg­eta­bles to your diet. This is a long-term strat­egy for those not flar­ing but expe­ri­enc­ing nau­sea, gur­gling, and burp­ing after eat­ing. Cooked veg­eta­bles, (and raw veg­eta­bles if tol­er­ated,) can reduce the over­all acid­ity of the diges­tive tract.

Con­sult your GI. Peo­ple with Crohn’s dis­ease in the upper GI tract can expe­ri­ence almost con­stant nau­sea as part of a flare. This type of nau­sea needs to be man­aged by a GI doc­tor. Ask about adding or increas­ing the dose of a proton-pump inhibitor (PPI).PPIs like Prilosec can help reduce stom­ach acid and can be taken sev­eral times a day under a doctor’s super­vi­sion. Other med­ica­tions like sucral­fate (Carafate) can coat the stom­ach and let the lin­ing heal. While these long-term med­ica­tions are tak­ing hold, anti-emetics med­ica­tions like Zofran can keep the nau­sea away.

Go to the ER. Stric­tures and obstruc­tions in the small bowel can also cause nau­sea if the stom­ach can’t empty. If your nau­sea is accom­pa­nied by vom­it­ing, a swollen hard belly, con­sti­pa­tion and the inabil­ity to pass gas along with abdom­i­nal pain seek med­ical atten­tion. Nau­sea is often the first symp­tom of an obstruc­tion to appear. So take per­sis­tent nau­sea that doesn’t respond to treat­ment and is accom­pa­nied by wors­en­ing symp­toms and pain seriously.

But don’t for­get non-IBD causes of nau­sea! Hav­ing CD or UC doesn’t pro­tect you from get­ting preg­nant, eat­ing spoiled food, or catch­ing a virus. Stom­ach viruses, the flu, food poi­son­ing, and preg­nancy can all cause nau­sea and vom­it­ing. So ask and see if a stom­ach virus is going around your school or office or if any­one else who ate the same dish is feel­ing ill. If preg­nancy is even a remote pos­si­bil­ity, take a preg­nancy test!

© 2012–2015 The Crohn's Journey Foundation*. All Rights Reserved.
  *designated by the IRS as a 501(c)(3) organization eligible to receive tax-deductible contributions.

Crohn's Flare

I'm getting worse. Now the nausea is terrible. My pharmacy still hasn't filled my entocort prescription and I dont even know if I can afford it yet. Calling my gi tomorrow.  I also want to become a foster parent but im terrified my disability will prevent it. Im not capable of working but caring for a child is different.  Especially being a foster parent.  It's rewarding and may make me feel better. Im going to discuss this with my dr 1st. Hopefully he will be with me on this. I know other crohnies get the difference, even when others dont.

Sick and no sleep

I havent been able to sleep in days...more like weeks. My restless legs are killing me and I think I have c diff again. .ugh!