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  • Q&A with Australian Health Practitioners

    What are the new or innovative treatments for severe Crohns disease?

    Related Topics
    Crohn's Disease & Ulcerative Colitis Digestive Health
    I have had Crohn's disease for 6 years and in that time I have been treated with all the available Crohns medications - including anti-TNF medications Infliximab and Humira - with no success.

    I have also had several surgeries, including sub-total colostomy, several small bowel surgeries for strictures and blockages and the last one for life-threatening bowel perforation that almost killed me and left me in intensive care for a couple of weeks and two months in a hospital ward.

    I am now on full-time IV total parenteral nutrition and also have short gut syndrome as a result of my last surgery making it very difficult to eat any food without having problems of excessive trips to the toilet.

    I am still at a great risk of the Crohns returning, as it has after every surgery and medication I have tried and the doctors I am under feels there are no options.

    Are there any new options or potential medications or procedures for treatment of severe and persistent Crohns disease?

    Liz Wood
    • 2 answers
    • A/Prof Greg Moore
    • Dr Simon Easterbrook-Smith
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    A/Prof Greg Moore

    Gastroenterologist

    Greg Moore is a Gastroenterologist specialising in Inflammatory Bowel Diseases (IBD), Crohn's Disease and Ulcerative Colitis. He is Head of IBD at Monash Medical Centre … View Profile

    There are several promising new therapies currently under development but access to them is limited to clinical trials.  Enrolement in clinical trials is according to strict criteria and usually means that you are ineligible if you have a stoma or are on total parenteral nutrition. The types of other medications you are on is also strictly limited and differs for the different agents being trialled.

    The types of new therapies being trialled include drugs that impair the ability of white blood cells that cause the inflammation in Crohn's disease (and ulcerative colitis) from getting to the bowel to cause damage.  There are IBD centres in most capital cities with access to these agents.

    There are also new immune suppressive drugs that inhibits the signals in the white blood cells that cause IBD.  One is a tablet which has been promising in rheumatoid arthritis and trials will start in Australia in the next few months. 

    Another injectible antibody drug will also be assessed in Australia and may particularly be an option for patients who have not responded to anti-TNF therapies (infliximab (Remicade)and adalimumab (Humira))

    Another possible option is an Australian based stem cell infusion trial.

    Crohn's and Colitis Australia (www.crohnsandcolitis.com.au) often have details on where trials are running or you doctor can contact one of the IBD specialists through AIBDA (Australian IBD Association) to try to find a local option (http://www.gesa.org.au/about.asp?cid=4&id=11).

    Another suggestion for symptomatic help with a short gut with diarrhoea is to look at using St. Mark's solution to avoid dehydration and to decrease diarrhoea. (http://www.nwlh.nhs.uk/services/Resources/73_Understanding_IF.pdf)

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    There is increasing evidence that differences in the kinds of bacteria which normally live in the gut (the “gut microbiome”) are causally associated with many diseases, including Crohn's Disease.
     
    This work is at the “basic science” stage now but fecal microbiota transplantation (using fecal material to restore the gut microbiome) has shown some promise, at least in clinical trials.
     
    You might like to contact the Centre for Digestive Diseases (http://www.cdd.com.au/index.html) about this. They are currently running some clinical trials, looking at the possible benefits of changing the gut microbiome as therapy for inflammatory bowel diseases.

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