Tag: digestion

Crohn’s Disease in Children: Symptoms, Diagnosis & Causes

Crohn's disease in children
Crohn’s disease can develop in children younger than 15 years old. Here are the symptoms of the disease to look out for in your child.

Crohn’s disease is a type of inflammatory bowel disease (IBD) that commonly affects people between 15 and 30 years of age. However, it can also affect children younger than 15 years old. About 20 to 30 percent of all people with Crohn’s disease develop symptoms before they reach 20 years old.

The most common symptoms of Crohn’s disease in children are abdominal pain and diarrhea. Other common symptoms include:

Less common symptoms include:

Moreover, Crohn’s disease may cause delays in the growth of affected children, including sexual development.

What are the complications of Crohn’s disease in children?

Children with Crohn’s disease may not be able to gain weight and instead experience weight loss. This is because the condition usually causes them to:

  • Eat less or avoid eating.
  • Skip some (or maybe many) of their favorite foods.
  • Become nutritionally deficient due to the inflamed digestive system causing malabsorption.

Crohn’s disease may also cause other complications in children such as:

What causes Crohn’s disease?

What exactly causes Crohn’s disease is not clear yet. Doctors and researchers believe the condition is most likely caused by a combination of genetics, the immune system and environmental factors that initiate and further trigger inflammation in the digestive tract.

Risk factors:

The risk of Crohn’s disease is overall low. However, children with a family history of the disease are at risk more than other children with no family history.

Children of Jewish ancestry have a higher risk of the condition than those of other ethnicities.

Moreover, smoking makes teens more likely to develop Crohn’s disease.

How is Crohn’s disease diagnosed in children?

Your doctor will ask you questions regarding your child’s signs and symptoms and perform a physical examination, including a rectal examination. They will ask questions such as if anyone in your family has Crohn’s disease.

To find out whether your child has Crohn’s or another condition causing their symptoms, the doctor will order tests that include:

What can I do to help my child live with Crohn’s disease?

Since Crohn’s disease is a long-term condition, it will come and go at various times during your child’s life. Due to their illness, your child may suffer emotional, physical and social problems. Because of this, you must work alongside your child’s healthcare provider to treat and manage their disease.

Have your child’s provider check their health regularly, which includes checking their:

Does Crohn’s disease weaken your immune system?

Crohn's disease immune system
Studies show that Crohn’s disease is the result of a weakened immune system; however, the extent of that weakness varies by patient.

Crohn’s disease is an autoimmune disorder that primarily affects the gastrointestinal (GI) tract. In Crohn’s patients, their immune system attacks healthy body cells due to abnormal regulation of the white blood cells in their body. 

The term weakened immune system or immune suppression often describes the lack of an appropriate response by the body to fight harmful germs. Numerous studies conducted on people with Crohn’s disease have presented the following findings:

  • Individuals with Crohn’s often exhibit granulomas throughout the gut wall, which reflect a defect in the clearance of foreign material from their intestines. This may be due to poor phagocyte (a type of white blood cell) function. 
  • The serum obtained from patients with Crohn’s disease has shown that their neutrophils (white blood cells) have reduced chemotactic response (slower to move toward and attack a foreign body). 
  • Failure of phagocytes to respond optimally to an attack by a foreign body.

These studies consistently prove that individuals with Crohn’s disease have an inadequate response to any kind of foreign (bacterial, viral and fungal) invasion. Thus, Crohn’s itself is a result of a weakened or inadequately trained immune system.

Additionally, the corticosteroid medications, surgeries to treat the disease complications and the immunosuppressant mediators all further weaken the immune system in a person with Crohn’s disease.

However, each patient is different, and their immune status may ultimately depend upon the extent of disease severity, flares, type of medications as well as genetic predisposition.

How do you know if you have a weakened immune system?

A weakened immune system or immune suppression refers to the lack of the body’s response to fight diseases and infections. Some of the reasons for a weakened immune system include:

The most common sign of a weakened immune system is increased susceptibility to infections. Such a person may fall sick often and have repeated cases of flu and colds. Others may have repeated skin infections, especially fungal infestations.

How does Crohn’s disease affect the intestines?

In the early phase of Crohn’s disease, small erosions develop on the inner surface of the bowel. As the disease advances, these erosions turn into large ulcers that cause scarring and stiffness of the bowel leading to scarring and narrowed lumen.

When food content cannot pass through a narrow lumen, the person experiences intestinal obstruction. Sometimes, heavily fibrous food such as vegetables and fruits can worsen this obstruction. When the intestine is obstructed, food, fluid and gas from the stomach and small intestine cannot pass further, which results in symptoms such as:

Obstruction of the small intestine is more common as it is narrower than the colon.




QUESTION

What is Crohn's disease?
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What are the complications of untreated Crohn’s disease?

If untreated, deep ulcers tend to create perforations in the walls of the small intestine and the colon. Also, a person with untreated Crohn’s disease may have the following complications:

  • Fistula (an ulcer creating a tunnel between the intestine and adjacent organs)
  • Abdominal abscess (a collection of infected pus formed when the ulcer tunnel reaches an adjacent space inside the abdominal cavity)
  • Urinary tract infections when a fistula develops between the intestine and the bladder
  • Passage of gas and feces during urination
  • Pus and mucous emerging from the skin of the abdomen when a fistula develops between the intestine and the skin
  • Gas and feces coming from the vagina when a fistula develops between the colon and the vagina
  • Discharge of mucous and pus from the anus when a fistula develops between the intestine and anus

Other complications include:

Is there a permanent cure for Crohn’s disease?

There isn’t a permanent cure for Crohn’s disease; however, scientists are seeking better ways to diagnose, treat and perhaps even cure this debilitating and painful disease.

While there is no permanent cure, doctors can administer treatment that aims to:

  1. Induce remissions
  2. Maintain remissions
  3. Minimize any side effects from treatment
  4. Improve your quality of life

Treatment options may include anti-inflammatory agents, medications and surgery (when necessary). Additionally, doctors could advise counsel from a dietician to help implement dietary changes that avoid foods that trigger inflammation.

Warning Signs of Crohn’s Disease: Symptoms & Diagnosis

Crohn's disease symptoms
Crohn’s disease can cause these signs and symptoms; however, only a doctor can properly diagnose you with the condition.

Crohn’s disease is an inflammatory bowel disease (IBD) that affects each person differently. The condition is characterized by periods of flare-ups and remissions. Flare-ups are active periods of the illness when you experience the symptoms, whereas remissions are periods when you remain symptom-free.

Crohn’s disease most commonly affects the small or large intestine, although it can affect any part of your body, from your mouth to the anus.

Symptoms of Crohn’s disease can range from mild to severe and can appear suddenly or start gradually.

Common warning signs (or symptoms) of Crohn’s disease include:

Other less common symptoms include:

In children, Crohn’s disease can manifest as delayed sexual growth or development.

If you or your child develop these signs and symptoms, only a doctor can fully diagnose you with Crohn’s disease. You may have another condition (and not Crohn’s) that is causing the symptoms. Schedule an appointment with your doctor for early diagnosis and treatment.

What are the complications of Crohn’s disease?

In severe cases, Crohn’s disease may cause complications that necessitate emergency surgery, including:

  • Fissures: These are tears in your anus resulting in symptoms such as abdominal pain and blood in your stool during bowel movements.
  • Anal fistula: Fistula is an abnormal connection that forms in the same organ or between two organs. It can also form between one part of the intestine and another or between the intestine and bladder, vagina or skin. It is most common in the anal area.
  • Ulcers: Ulcers are open sores that can develop anywhere in your colon, including your anus.
  • Strictures: Stricture is a narrowing of the intestine due to long-term inflammation.
  • Bowel obstruction: Strictures in many parts of the bowel can block the flow of digestive contents through the organ in a condition known as bowel obstruction.

As Crohn’s disease progresses, you may develop other complications that affect your overall health and quality of life, which include:

Since Crohn’s disease elevates your risk of colon cancer, ask your doctor whether you need to undergo screening tests for cancer and, if yes, how frequently.

How is Crohn’s disease diagnosed?

Your doctor will inquire regarding your signs and symptoms and perform a physical examination. They will also take your family history and medical history into account.

To find out whether you have Crohn’s disease or another condition that is causing your symptoms, they will order tests that include:

  • A rectal examination
  • A stool test
  • Blood tests
  • A computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan of the abdominal area
  • X-rays of the intestine
  • Colonoscopy (inserting a thin, flexible tube fitted with a lighted camera into the colon through the anus)

Best Crohn’s Disease Diet: Food Triggers for IBD

Crohn's disease diet
Your diet for Crohn’s disease will vary depending on the food triggers that result in your symptoms.

Crohn’s disease is one of the two inflammatory bowel diseases (IBD), apart from ulcerative colitis. It is a chronic condition that has no cure. However, medications, surgery (when necessary) and dietary modifications can help you lead a better quality of life.

Living with Crohn’s means paying special attention to your diet, which includes being able to consume different foods during flares and remissions. Flares are periods when you experience the symptoms of the disease, while remissions are the times in between the flares when you are symptom-free.

What are the best foods to eat during flares of Crohn’s disease?

Flares of Crohn’s disease can be triggered by certain foods. Your dietician will put you on an elimination diet after identifying those triggers. Identify your triggers by maintaining a food diary in which you write down items that trigger your inflammatory bowel disease (IBD) symptoms.

These triggers are most likely insoluble fiber foods (that are hard to digest), sugary foods, high-fat foods and spicy foods. Some people may also find that alcoholic drinks and non-absorbable sugars (such as sorbitol) also cause their IBD flares. Remember, triggers may differ from person to person.

Potential food triggers of Crohn’s disease include:

  • Fruits with skin and seeds (something as innocent as strawberries and tomatoes)
  • Raw green vegetables (especially with peels)
  • Whole nuts
  • Whole grains
  • Beans
  • Lentils
  • Red meat
  • Butter
  • Margarine
  • Cream
  • Cheese
  • Fried foods
  • Pastries
  • Candies
  • Pear
  • Peach
  • Prune
  • Carbonated beverages
  • Coffee
  • Tea
  • Chocolate

During a flare, you will need to avoid a high-fiber diet (especially food that contains soluble fiber) or reduce your overall fiber intake, which means foods low in fiber are your best bet. But, you should also consume food items that are dense in nutrients. 

Some of the best foods for a flare of Crohn’s disease include:

  • Bananas
  • Cantaloupe
  • Honeydew melon
  • Cooked fruits
  • Soy
  • Eggs
  • Fish
  • Lean cuts of pork
  • White meat
  • Gluten-free bread
  • White pasta
  • White rice
  • Oatmeal
  • Fully cooked, seedless, skinless vegetables, such as: 
    • Asparagus tips
    • Cucumbers
    • Potatoes
    • Squash

Oral nutritional supplements or homemade protein shakes are also one of the best food options for Crohn’s disease. Ask your doctor or your dietitian about what supplements will work best for you.

What are the best foods to eat during the remission of Crohn’s disease?

You should not ignore your nutritional needs even after your symptoms of Crohn’s disease have disappeared. Remissions of Crohn’s also require a rich supply of nutrients, such as proteins and calorie-dense foods.

This is also the time when you should avoid ingesting refined grains and instead opt for whole wheat food (unless you have a gluten intolerance). You should also seek high-fiber foods, as compared to the low-fiber diet recommended during flares. 

Best diet during remission of Crohn’s disease include:

  • Oat bran
  • Beans
  • Barley
  • Nuts
  • Whole grains 
  • Lean meats
  • Fish
  • Eggs
  • Tofu
  • Fruits and vegetables (remove the peel and seeds if they do not suit you)
  • Collard greens
  • Milk
  • Yogurt
  • Food with probiotics, such as:
    • Kefir
    • Kimchi
    • Miso
    • Sauerkraut
    • Tempeh

Choose lactose-free dairy products if you are lactose intolerant. If gluten causes gastric discomfort, it is better to avoid wheat-containing foods.

Your doctor will also make changes in your diet and ask you to eat low-fiber foods if you had an ostomy, had been diagnosed with strictures or had recent surgery. Listen to your doctor’s advice.

The diet mentioned above is general for all patients with Crohn’s disease and is meant only for educational purposes. Consult with a registered dietician or nutritionist to decide the best diet plan as per your specific trigger foods and nutritional requirements. A wrong diet can lead to the worsening of Crohn’s, nutritional deficiencies and weight loss.

Rheumatoid Arthritis vs. Crohn’s Disease. Are They Related?

Rheumatoid Arthritis vs. Crohn's Disease
Since Crohn’s disease causes inflammation of the body, including the joints, sufferers are at a greater risk of developing rheumatoid arthritis.

Crohn’s disease is a condition of the digestive system characterized by inflammation that occurs most commonly in the colon. However, it can affect any gastrointestinal site from the mouth to the anus. Crohn’s falls under the umbrella term “inflammatory bowel disease” (IBD).

The inflammation caused by Crohn’s disease can also extend to other parts of the body, including the joints. Rheumatoid is one such inflammatory joint disease that has been recently linked with IBD. A review article published in BMC Gastroenterology concluded that patients with IBD, such as Crohn’s, are at a greater risk of developing rheumatoid arthritis (RA).

Researchers speculate three reasons why patients with IBD may also develop RA, which include:

  • The shared disease processes related to a dysregulated immune system
  • The common inflammatory pathways triggered in autoimmunity
  • Some common genetic factors

Additionally, studies have linked both RA as well as IBD to the altered intestinal flora (dysbiosis); however, this mechanism requires further analysis.

Apart from RA, Crohn’s disease makes you more likely to develop other kinds of arthritis too. Studies show that arthritis can occur in 6 to 46 percent of patients with IBD, with spondylitis affecting 1 to 26 percent.

How do doctors treat rheumatoid arthritis caused by Crohn’s disease?

Doctors can treat rheumatoid arthritis caused by Crohn’s disease in several ways, such as:

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help relieve joint pain and swelling in rheumatoid arthritis, but they are harmful to patients with Crohn’s disease. They can worsen the symptoms of Crohn’s by irritating the digestive system, especially the intestines. The only safe drug that doctors recommend for minor pain is acetaminophen.

Common drugs that can benefit both Crohn’s disease and rheumatoid arthritis include:

Home remedies

In addition, patients with rheumatoid arthritis due to Crohn’ disease can also use simple measures to alleviate their joint pain and swelling, such as:

  • Resting the affected joint
  • Icing and elevating the joint
  • Physiotherapy exercises that strengthen the muscles around the joints and help relieve the stiffness

Lifestyle changes

Because both Crohn’s disease and rheumatoid arthritis are caused by inflammation, the affected patients should avoid ingesting foods that trigger any inflammation, which include:

  • Foods high in saturated fats
  • Sugary foods
  • Processed and packaged foods
  • Fried foods
  • Dairy products

Patients should find replacement options for these foods. For example, try switching to whole wheat substitutes of bread instead of bread made from refined white flour, and replacing red meat with foods rich in omega-3 fatty acids such as fatty fish (salmon, sardines and tuna).

Probiotics are also proven anti-inflammatory substances that are present in foods such as yogurt and kefir (a type of fermented drink). These foods can fight off gut inflammation caused by Crohn’s disease and thus alleviate the symptoms related to rheumatoid arthritis.

Patients with Crohn’s disease should let their doctor know if they experience joint pain, joint swelling or joint stiffness. Some medications used for Crohn’s are also known to cause osteoporosis, which can result in joint pain.

Cortenema (hydrocortisone enema) Side Effects (Weight Gain)

What are the uses for hydrocortisone enema?

Hydrocortisone enema is used rectally for the treatment of ulcerative proctitis, inflamed hemorrhoids, and anal itching, burning, and inflammation caused by several conditions that affect the anal area.

What brand names are available for hydrocortisone enema?

Cortenema

Is hydrocortisone enema available as a generic drug?

Yes

Do I need a prescription for hydrocortisone enema?

Yes

What are the side effects of hydrocortisone enema?

Side effects of hydrocortisone enema include:

Other side effects include:

Possible serious side effects include:

What is the dosage for hydrocortisone enema?

For proctitis the usual dosage is one enema applied at bedtime for 21
days or until symptoms resolve.

Which drugs or supplements interact with hydrocortisone enema?

The risk of drug interactions from hydrocortisone enema is
low because it is administered rectally.

Is hydrocortisone enema safe to take if I’m pregnant or breastfeeding?

  • Hydrocortisone enema has not been adequately evaluated during pregnancy.
    Hydrocortisone enema taken orally can appear in breast milk, and can have
    adverse effects on the baby.
  • It is not known whether hydrocortisone administered rectally is absorbed in
    sufficient amounts to appear in
    breast milk.

What else should I know about hydrocortisone enema?

What preparations of hydrocortisone enema are available?

Enema: 100 mg/60 ml

How should I keep hydrocortisone enema stored?

Hydrocortisone enema should be stored at room temperature, 20 C to
25 C (68 F to 77 F).

rifaximin (Xifaxan) Uses, Side Effects & Dosage

What is rifaximin, and how does it work (mechanism of action)?

Rifaximin is a semi-synthetic antibiotic used for
treating traveler’s diarrhea and
hepatic encephalopathy. It is derived from
rifamycin, a naturally occurring chemical produced by a bacterium called
Streptomyces mediterranei. Rifaximin is active against
Escherichia coli
bacterial strains that cause traveler’s diarrhea, preventing growth of the
bacteria by preventing them from manufacturing proteins needed for their
replication and survival. By suppressing growth of the bacteria, rifaximin
reduces symptoms of traveler’s diarrhea. Hepatic encephalopathy is a serious
neurologic complication of advanced liver disease that affects the brain. It is
believed to be caused by the absorption of ammonia and other chemicals produced
by bacteria in the intestine. It is believed that rifaximin prevents and treats
hepatic encephalopathy by reducing the intestinal bacteria that produce ammonia.
The FDA approved rifaximin in May 2004.

What brand names are available for rifaximin?

Xifaxan

Is rifaximin available as a generic drug?

No

Do I need a prescription for rifaximin?

Yes

What are the side effects of rifaximin?

Common side effects associated with rifaximin include:

Many of these side effects are also symptoms of traveler’s diarrhea which rifaximin is used
for treating. Rifaximin also causes allergic reactions, rash, and itching. Like
other antibiotics rifaximin can alter the normal bacteria in the colon and
encourage overgrowth of some bacteria such as
Clostridium difficile which causes
inflammation of the colon (pseudomembranous colitis). Patients who develop signs
of pseudomembranous colitis after starting rifaximin (diarrhea, fever, abdominal
pain, and possibly shock,) should contact their physician immediately.

What is the dosage for rifaximin?

The recommended dose for traveler’s diarrhea is 200 mg 3 times daily
for 3 days and the recommended dose for hepatic encephalopathy is 550 mg twice
daily. Rifaximin may be administered with or without meals.

Which drugs or supplements interact with rifaximin?

Rifaximin does not interact with
oral contraceptives and
does not significantly interact with midazolam. Rifaximin has a low risk of drug
interactions because it is poorly absorbed into the blood stream, and it does
not significantly affect liver enzymes that break down most drugs.

Is rifaximin safe to take if I’m pregnant or breastfeeding?

The safety of rifaximin in
pregnant women has not been adequately
evaluated.

It is not known whether rifaximin is excreted in
breast
milk.

What else should I know about rifaximin?

What preparations of rifaximin are available?

Tablets: 200 and 550 mg

How should I keep rifaximin stored?

Rifaximin should be stored at room temperature at 15 C – 30 C (59 F – 86 F).

Opium Tincture Uses, Side Effects & Dosage

What is tincture of opium liquid, and how does it work (mechanism of action)?

Opium tincture is an oral liquid medication used to
control diarrhea. Opium tincture contains morphine which is an opioid pain
reliever. Opioids can reduce gastrointestinal motility, propulsion, secretions,
and increase gastrointestinal muscle tone. These effects help in controlling
diarrhea. Opium tincture is a controlled substance.

What brand names are available for tincture of opium liquid?

N/A

Is tincture of opium liquid available as a generic drug?

Yes

Do I need a prescription for tincture of opium liquid?

Yes

What are the side effects of tincture of opium liquid?

Side effects of opium tincture are:

Respiratory depression and physical and psychological dependence also occur.

What is the dosage for tincture of opium liquid?

  • Adults: Take 0.6 ml by mouth 4 times a day not to exceed 6 ml per day.
  • Children: Safe and effective use of opium tincture is not established in
    children.

Which drugs or supplements interact with tincture of opium liquid?

Opium tincture should not be used with medications like
naltrexone and buprenorphine because they increase sedation and lower beneficial
effect of opium tincture.

Opium tincture contains morphine. Morphine should be avoided in patients
treated with monoamine oxidase inhibitors (MAOI) due to enhance toxicity of
morphine including confusion, high blood pressure, tremor, hyperactivity, coma,
and death. Drugs in this class include isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), selegiline (Eldepryl), and procarbazine (Matulane),
and linezolid (Zyvox). Morphine should not be administered within 14 days of
stopping an MAOI.

Is tincture of opium liquid safe to take if I’m pregnant or breastfeeding?

There are no adequate studies done on opium tincture to determine
safe and effective use in
pregnant women.

Opium tincture contains morphine. Morphine is excreted in
breast milk; however, the American Academy of Pediatrics committee states that
it is safe to use while
breastfeeding.

What else should I know about tincture of opium liquid?

What preparations of tincture of opium liquid are available?

Opium tincture is odorless oral liquid containing 10 mg of
anhydrous morphine per one ml.

How should I keep tincture of opium liquid stored?

Store tincture of opium at room temperature between 68 F to 77 F (20 C to 25 C).

mesalamine (Lialda) for UC, Side Effects, and Dosage

What is mesalamine (Lialda), and how does it work (mechanism of action)?

  • Mesalamine is an oral drug used for treating ulcerative colitis.
  • Lialda is mesalamine in a form that is slowly released in the intestine so that it can be given just once-a-day.
  • Other oral drugs containing mesalamine that are similar to Lialda include Asacol, Pentasa, and Apriso. 
  • Asacol and Pentasa, however, are given as multiple daily doses.
  • The exact mechanism of mesalamine is not known but is believed to be by reducing inflammation in the colon.
  • Ulcerative colitis and other inflammatory diseases cause excessive production of chemicals (i.e., prostaglandins) that produce inflammation in the colon.
  • Prostaglandins are produced by cyclooxygenase and lipoxygenase enzymes.
  • These enzymes are over-active in individuals with ulcerative colitis.
  • Mesalamine may work by blocking the activity of cyclooxygenase and lipoxygenase, therefore, reducing the production of prostaglandins.
  • Reduced prostaglandin production reduces inflammation in the colon and other symptoms associated with ulcerative colitis.
  • Lialda is the brand name available for mesalamine. 
  • Mesalamine is not available is available in generic form.
  • You need a prescription to obtain mesalamine.
  • The FDA approved Lialda in January 2007.

What is mesalamine used for?

Lialda is used for inducing remission in patients with active, mild to moderate ulcerative colitis. In clinical studies which compared mesalamine against placebo for 8 weeks, more patients in the mesalamine group achieved remission.

What are the side effects of mesalamine?

The most common side effects are:

Other less common side effects include:

Possible serious side effects include an acute intolerance syndrome that resembles a flare of inflammatory bowel disease. Symptoms include:

These symptoms usually subside once mesalamine is discontinued. Since mesalamine is related chemically to aspirin, individuals who are allergic to aspirin should not take mesalamine.

What is the dosage for mesalamine?

The recommended dose is 2.4 g or 4.8 g once daily with a meal. Tablets should be swallowed whole without breaking the coating.

Which drugs or supplements interact with mesalamine?

Specific drug interaction studies have not been conducted with Lialda. Other mesalamine medications have been associated with several drug interactions. Combining mesalamine with drugs that affect kidney function, for example, nonsteroidal antiinflammatory drugs (for example, ibuprofen), may increase the likelihood of kidney dysfunction. Concurrent use of mesalamine and 6-mercaptopurine or azathioprine (Imuran) may increase the likelihood of blood disorders. Mesalamine may increase the blood thinning effect of warfarin (Warfarin).

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Is mesalamine safe to take if you pregnant or breastfeeding?

  • There are no adequate human studies of mesalamine use during pregnancy. Mesalamine is known to cross the placenta into the fetus, but animal studies revealed no evidence of harm to the fetus. Mesalamine should only be used during pregnancy if it is felt that the benefit of its use justifies the unknown risks.
  • Mesalamine is excreted in breast milk. Mesalamine should only be used by nursing mothers if it is felt that the benefit of its use justifies the risk.

What else should you know about mesalamine?

What preparations of mesalamine (Lialda) are available?

Tablets: 1.2 g

How should I keep mesalamine (Lialda) stored?

Store at room temperature, 15 C – 25 C (59 F – 77 F)

Prednisone vs. Budesonide: Steroids for Crohn’s Treatment

What Is the Difference Between Prednisone and Budesonide?

What Are Prednisone vs. Budesonide?

Prednisone is a man-made corticosteroid used for suppressing the immune system and inflammation. It has effects similar to other corticosteroids such as methylprednisolone (Medrol), prednisolone (Prelone), triamcinolone (Kenacort), and dexamethasone (Decadron). These synthetic corticosteroids mimic the action of cortisol (hydrocortisone), a naturally-occurring hormone produced in the body. Corticosteroids are used for their anti-inflammatory effects to treat arthritis, ulcerative colitis, Crohn’s disease, asthma, bronchitis, skin problems, allergies, systemic lupus, and severe psoriasis.

Budesonide is a man-made steroid of the glucocorticoid family that is used to treat mild-to-moderately-active Crohn's disease. It is also used for the induction of remission in patients with active, mild to moderate ulcerative colitis. Budesonide mimics cortisol (hydrocortisone) and has anti-inflammatory actions.

What Are the Side Effects of Prednisone and Budesonide?

Prednisone

Side effects of prednisone and other corticosteroids range from mild annoyances to serious, irreversible organ damage, and they occur more frequently with higher doses and more prolonged treatment.

Common side effects include:

  • Retention of sodium (salt) and fluid
  • Weight gain
  • High blood pressure
  • Loss of potassium
  • Headache
  • Muscle weakness
  • Nausea
  • Vomiting
  • Acne
  • Thinning skin
  • Restlessness
  • Problems sleeping

Serious side effects include:

This drug also causes psychiatric disturbances, which include:

Other possible serious side effects of this drug include:

Prednisone and diabetes: Prednisone is associated with new onset or manifestations of latent diabetes, and worsening of diabetes. Diabetics may require higher doses of diabetes medications while taking prednisone,

Allergic reaction: Some people may develop a severe allergic reaction (anaphylaxis) to prednisone that includes swelling of the airways (angioedema) that may result in shortness of breath or airway blockage.

Immune suppression: Prednisone suppresses the immune system and, therefore, increases the frequency or severity of infections and decreases the effectiveness of vaccines and antibiotics.

Osteoporosis: Prednisone may cause osteoporosis that results in fractures of bones. Patients taking long-term prednisone often receive supplements of calcium and vitamin D to counteract the effects on bones. Calcium and vitamin D probably are not enough, however, and treatment with bisphosphonates such as alendronate (Fosamax) and risedronate (Actonel) may be necessary. Calcitonin (Miacalcin) also is effective. The development of osteoporosis and the need for treatment can be monitored using bone density scans.

Adrenal insufficiency and weaning off prednisone: Prolonged use of prednisone and other corticosteroids causes the adrenal glands to atrophy (shrink) and stop producing the body's natural corticosteroid, cortisol.

Necrosis of hips and joints: A serious complication of long-term use of corticosteroids is aseptic necrosis of the hip joints. Aseptic necrosis is a condition in which there is death and degeneration of the hip bone. It is a painful condition that ultimately can lead to the need for surgical replacement of the hip. Aseptic necrosis also has been reported in the knee joints. The estimated incidence of aseptic necrosis among long-term users of corticosteroids is 3%-4%. Patients taking corticosteroids who develop pain in the hips or knees should report the pain to their doctors promptly.

How should prednisone be tapered, and what are the withdrawal symptoms and signs?

Patients should be slowly weaned off prednisone. Abrupt withdrawal of prednisone after prolonged use causes side effects because the adrenal glands are unable to produce enough cortisol to compensate for the withdrawal, and symptoms of corticosteroid insufficiency (adrenal crisis) may occur. These symptoms include:

Therefore, weaning off prednisone should occur gradually so that the adrenal glands have time to recover and resume production of cortisol. Until the glands fully recover, it may be necessary to treat patients who have recently discontinued corticosteroids with a short course of corticosteroids during times of stress (infection, surgery, etc.), times when corticosteroids are particularly important to the body.

Budesonide

The most common side effects of budesonide are:

Excessive corticosteroid use causes:

Serious side effects of budesonide include:

What Is the Dosage of Prednisone vs. Budesonide?

Prednisone

The initial dosage of prednisone varies depending on the condition being treated and the age of the patient.

  • It's recommended that you take this medication with food.
  • The starting dose may be from 5 mg to 60 mg per day, and often is adjusted based on the response of the disease or condition being treated.
  • Corticosteroids typically do not produce immediate effects and must be used for several days before maximal effects are seen. It may take much longer before conditions respond to treatment.
  • When prednisone is discontinued after a period of prolonged therapy, the dose of prednisone must be tapered (lowered gradually) to allow the adrenal glands time to recover.

Budesonide

  • The recommended dose for active Crohn's disease is 9 mg once daily in the morning for up to 8 weeks.
  • The 8 week course may be repeated for recurring episodes.
  • The dose for maintenance of remission is 6 mg once daily for 3 months.
  • The recommended dosage for the induction of remission in adult patients with active, mild to moderate ulcerative colitis is one 9 mg extended release tablet to be taken once daily in the morning for up to 8 weeks.
  • The recommended dose for the spray is 1 spray administered twice daily for 2 weeks followed by 1 spray once daily for 4 weeks.




QUESTION

What is Crohn's disease?
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What Drugs Interact with Prednisone and Budesonide?

Prednisone

Prednisone interacts with many drugs, examples include:

  • Prednisone may interact with estrogens and phenytoin (Dilantin). Estrogens may reduce the action of enzymes in the liver that break down (eliminate) the active form of prednisone, prednisolone. As a result, the levels of prednisolone in the body may increase and lead to more frequent side effects.
  • Phenytoin increases the activity of enzymes in the liver that break down (eliminate) prednisone and thereby may reduce the effectiveness of prednisone. Thus, if phenytoin is being taken, an increased dose of prednisone may be required.
  • The risk of hypokalemia (high potassium levels in the blood) increases when corticosteroids are combined with drugs that reduce potassium levels (for example, amphotericin B, diuretics), leading to serious side effects such as heart enlargement, heart arrhythmias and congestive heart failure.
  • Corticosteroids may increase or decrease the response warfarin (Coumadin, Jantoven). Therefore, warfarin therapy should be monitored closely.
  • The response to diabetes drugs may be reduced because prednisone increases blood glucose.
  • Prednisone may increase the risk of tendon rupture in patients treated with fluoroquinolone type antibiotics. Examples of fluoroquinolones include ciprofloxacin (Cipro) and levofloxacin (Levaquin).
  • The elderly are especially at risk and tendon rupture may occur during or after treatment with fluoroquinolones.
  • Combining aspirin, ibuprofen (Motrin) or other nonsteroidal anti-inflammatory agents (NSAIDS) with corticosteroids increases the risk of stomach related side effects like ulcers.
  • Barbiturates, carbamazepine, rifampin and other drugs that increase the activity of liver enzymes that breakdown prednisone may reduce blood levels of prednisone. Conversely, ketoconazole, itraconazole (Sporanox), ritonavir (Norvir), indinavir (Crixivan), macrolide antibiotics such as erythromycin, and other drugs that reduce the activity of liver enzymes that breakdown prednisone may increase blood levels of prednisone.

Budesonide

Medicines which block the liver enzymes that break down budesonide may lead to higher blood concentrations and more side effects of budesonide. Such medications include:

Are Prednisone and Budesonide Safe to Take While Pregnant or Breastfeeding?

Prednisone

Corticosteroids cross the placenta into the fetus. Compared to other corticosteroids, however, prednisone is less likely to cross the placenta. Chronic use of corticosteroids during the first trimester of pregnancy may cause cleft palate.

Corticosteroids are secreted in breast milk and can cause side effects in the nursing infant. Prednisone is less likely than other corticosteroids to be secreted in breast milk, but it may still pose a risk to the infant.

Budesonide

There are no adequate studies in pregnant women. Budesonide should only be used in pregnant women if the benefits outweigh the unknown risk. Use of budesonide during pregnancy may suppress the adrenal glands of the infant.

Budesonide is secreted in human breast milk. Because of the potential for adverse reactions in nursing infants from any corticosteroid, a decision should be made whether to discontinue nursing or discontinue the budesonide.