 |
|
 |
||
Ask
The Doctor
Dear Doctor is a regular feature of The Journal, our member publication. Questions are answered by Dr. Remo Panaccione. The following questions are excerpts from The Journal.
Could canker sores be related to colitis? DEAR DOCTOR: I was diagnosed with colitis about a year and a half ago. In the last three months I have not been able to rid myself of canker sores in my mouth – could they be related to the colitis? I have read that people with my condition can be deficient in iron and the B vitamins, and this could cause cankers. I take a multi-vitamin everyday to try and avoid these deficiencies. I also have a job that is intermittently very stressful, but even when my stress levels subside, I have the cankers. Do you have any suggestions? DEAR CCFC MEMBER: Canker sores or apthous ulcers are common in people who suffer from inflammatory bowel disease and may occur in approximately 20% of patients with a known diagnosis of Crohn’s or ulcerative colitis. In the absence of other causes (see below) recurrent apthous ulcers may be a sign that the inflammatory bowel disease is not under optimal control. Other causes of recurrent apthous stomatitis include stress, foods (citrus fruits,acidic foods, chocolate), oral trauma and the vitamin deficiencies (Vit. B complex and iron) that you have described.The vitamin deficiencies necessary to cause these problems are rare but can occur in patients with inflammatory bowel disease and should be ruled out. In general, apthous ulcers which occur as part of the spectrum of inflammatory bowel disease come up in crops as opposed to those due to other causes which occur only a few at a time. If you suffer from IBD, the other causes of cankers have been ruled out and vitamin deficiencies have been treated, the next step should be the use of local therapy to the lesions themselves.Topical steroids applied directly to the lesions are very effective and have minimal side effects. Proper oral hygiene with routine dental care, which includes an anti-septic mouthwash, can also help. If this does not help, then I usually recommend re-evaluation and more aggressive treatment of the
Stem Cell Research DEAR DOCTOR: We hear so much about stem cell research in the media; can you tell me what it is and whether it has any application or benefit for people with IBD? Are there any investigations using this approach? DEAR CCFC MEMBER: In order to answer this question one
needs to understand the technology Do acne medicines
increase IBD risk? DEAR CCFC MEMBER: The question is very interesting and
very topical. Isotretinoin (Accutane) is What are biological
therapies? DEAR CCFC MEMBER: Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. Even for diseases of unknown cause, such as Crohn’s disease and ulcerative colitis, molecules that are involved in the disease process have been identified, and can be targeted for biological therapy. Biological therapy refers to therapy that is produced using techniques of bioengineering.These drugs are usually directed against known targets or pathways
which are believed to be important in either causing inflammation or enhancing the ability of the body to dampen the inflammatory response or improve healing. Examples of drugs which are considered biological therapy in Crohn’s
disease include infliximab (Remicade®), adalimumab (Humira®) and certolizumab (Cimzia®) all of which are targeted against tumour necrosis factor alpha (TNF alpha), a molecule in the body which is believed to be important in the development and Colitis or Crohn’s? DEAR CCFC MEMBER: I always try to educate patients on the difference between ulcerative colitis and Crohn’s disease. Ulcerative colitis only affects the colon; Crohn’s disease can affect any portion of the gastrointestinal tract including just the colon – which it does in 25 per cent of cases. Therefore “colitis” can be ulcerative colitis or Crohn’s disease (Crohn’s colitis) and the symptoms are An experienced physician can usually tell the difference between the two. But in 5-10% of IBD cases, there is no clear distinction (so called indeterminate colitis). The true nature of the disease is apparent only at surgery, when the larger specimen is available to the pathologist (the doctor who examines the surgical specimen). Once again, an experienced pathologist can tell the difference, especially in surgical specimens. From your description, it sounds like the pathologist is seeing transmural inflammation, raising the question of Crohn’s disease. About Molo-cure Molo-cure or Aloe mucilaginous polysaccharide (A.M.P) is probably a safe and non-toxic compound which in theory, may aid in the digestive process. But it HAS NEVER BEEN EVALUATED SCIENTIFICALLY in patients with IBD. It may not be harmful, but I would caution patients about believing claims on their website. Just as you would be skeptical about infomercials that claim the 200 pound individual turns into a sculpted god or goddess overnight, you should be equally skeptical when reading the claims of Molo-cure. Again, when counseling patients, I stress that if it was that easy, we’d all be using it! Certainly, as a physician, I would prefer to prescribe an all natural product that is proven instead of a drug that has potential side effects. If the proponents of this and similar products truly had the best interest of patients in mind, it would make sense that they would perform a proper investigation.
|
||
