Does Asacol Help Crohn's? Review of Literature

So for a while now I have been off Asacol HD 800 mg. My usual routine was to take 2 pills in the morning when I woke up and 1 pill before bed (the logic I hear is that if you have side effects you would get them in the night-which is why you take the lower dosage before bed). Speaking of side effects my primary doctor told me that since Asacol is aspirin based it is possible to get ringing in the ears (which I did have from time to time). Asacol always for some reason gave me cramps (which is odd since Asacol is designed for inflammatory bowel disease!). This would be like taking an anti-depressant and then becoming more depressed.

The very first study I could find was this one from 1983 in the Journal of Gastroenterology which showed that improved the symptoms of 72% of patients with Crohn's disease (only 18 patients were in the study though). It seems as if in the 1990's there were studies that showed that Asacol was effective in treating Crohn's. In 1992 this study showed that Asacol helped patients who didn't have ileal involvement. In 1993 this trial showed that 78% of patients maintained remission when Asacol was used alone.  This study from 1994 showed that oral mesalamine (Asacol) was effective in helping achieve a partial or complete remission in 60% of patients as opposed to 22% of patients in the placebo group. In 1995, this double blind study showed that Asacol had a "moderate but significant benefit to preventing relapse in Crohn's in remission; this occurred only in patients with small bowel involvement or those older than 30 years". This 1998 study showed that 5-ASA treatments were helpful after surgery (in resection) for maintenance of Crohn's disease

Then this study from 2007 showed that oral mesalazine right after surgery prevented endoscopic recurrence in Crohn's over a 2 year period and it was estimated that it prevented 39% of all recurrences.

Recently however, the data doesn't support the notion that Asacol helps people with Crohn's. This study found that Humira after an intestinal resective surgery was effective in preventing endoscopic and clinical recurrence of Crohn's. This study showed a small subgroup of Crohn's patients may be helped from 5-ASAs (Asacol). This study shows a benefit for Asacol for patients with ulcerative colitis but the evidence for Crohn's is not clear. Perhaps Asacol has become less effective over time, Crohn's has possibly changed, or some other reason.

From what I understand Asacol is very effective for people with ulcerative coltis (I don't have a medical background to explain why this is), however for me at least I did get cramps from taking Asacol at night usually. I now feel better after getting of it. Also the fewer drugs you are taking the fewer risks for not only short term but potential long term side effects substantially decreases. I would be pretty happy if I didn't have to take Asacol for a while. Time will tell though.

Getting Off Asacol, Feeling Tired, and A Little Bit Anemic

So over the past week my GI called me (from what I have heard very few doctors call back patients with lab results and results. My blood test looked good although he told me I was just a tad bit anemic. So last night (Saturday night) I had a pretty big bowel movement (I could see some blood inside it-not explicitly). When I was at Mayo I was told that sometimes blood can at a small level be in the bowel is hard to see with the naked eye. Anemic seems to be common for Crohn's. Lately I have been feeling a little tired (I felt tired even before getting off the Asacol). First I thought it I wasn't getting enough sleep but a few weeks ago on a Sunday night I felt tired at 9:00 P.M. (which is usual unusual). Tonight I feel like going to bed around 9:30 P.M. On April 20, 2014 I took my last Asacol pill (hopefully I won't have to retake it). I have been taking Asacol since December 2011. Really I haven't noticed too much of a difference. My doctor said "it may take time to notice a difference".

It feels as if the Asacol really didn't help in the time I took it. Really the major game changer was Humira which I started in June 2012 and still going strong on that. I can still remember in May when I was really tired, really sick, and had to throw up at night (actually the morning around 2 or 3). When I was initially diagnosed with Crohn's I actually didn't feel really bad. Yes, I felt pretty tired, was down to 125 pounds but I didn't feel as if I were going to die.

Hopefully, my doctor can give me something to help to help the anemia and feel a tad better. All in all I can't complain too much though. I actually think I may have less cramping after getting off Asacol. Time will tell though of course.

Update: Car Accident, Sleep, Cramping, and Easter

So this week has been a crazy week. On tax day (April 15th, 2014) I got into a car accident. Luckily I wasn't serious hurt. My back felt a little bit sore afterwards, however that seems to be going away. Dealing with the stress of getting the car towed, talking to the insurance company, working, and studying, does get stressful. I also moved in to a new apartment so I have been pretty busy trying to knock things out and take care of things.

I have been cramping a little bit. I honestly think it is due to lack of sleep. My apartment has a window that lets a lot of light into it. In my old bedroom I had plantation shutters that could block that out (which I like). Usually my alarm on my iPhone wakes me up. Anyways, some cramping and feeling tired from this. I have been okay otherwise. Last weekend I had some fast food since I was moving in and didn't have very much in my apartment. I can honestly say I felt pretty good even after eating it. At night I still sometimes use ice packs. This weekend I will try to get more sleep and not feel as tired. This morning (Sunday) I woke up and was a little tired (even after 9 hours of sleep) however sometimes your body has to get going in the day to wake up.

On Monday I see my GI. I have some questions for him in terms of how useful Asacol is. There is a rebate program that allows you to save $200 on Asacol, however it is a pain to deal with and I had to get multiple cards from my GI and resubmit them to Asacol in order to get the drug. I hear Asacol is going generic so I will have to ask him about that. When I see my GI I usually type out my list of questions because sometimes I forget what to ask and I only am allowed probably 10 minutes with him.

All and all things are pretty good. I would like to improve the cramping some. Not sure what my weight is these days since I don't have a scale (update I have a scale and now am 168 pounds by Saturday this was down to 164 as I worked out for the week).  I have been working out in the apartment gym which is pretty nice. Today is Easter and I will be having dinner with my parents at their home. Most likely we will just be having Mexican food takeout.

I can't complain too much. Crohn's is a lifelong disease and chronic. Feeling 90% is a great feeling. I often am grateful there are medications like Humira and Asacol now and glad I didn't get this disease in the 1980's or early 1990's. Hopefully the future will bring even a better understanding of Crohn's and how to treat it to improve the quality of life of so many people.

Weekend Health Update: Less Cramping, Dry Nose (Still), and Sleep

So this week my stomach was a tad better. The beginning of the week brought some cramping but cleared out toward the end of the week. The ice pack at ice seems to help out. I tend to have cramping after I take Asacol. My nose continues to be crusty and dried out. However, I am thinking in the next few weeks we should get more humidity and help out. The thing that bothers me is sleeping. My whole life I have been a late night person and usually on weekends I fall asleep around 2 a.m. but my mind keeps going for a while. I sometimes wish I could start work at 11 a.m. (I could probably work more hours and be more productive). Today I felt like I got a pretty good rest however my body is trying to make up from the lost sleep from the beginning of the week so. I was worried I wouldn't be feeling well since some of the Humira injection came out 2 Friday nights ago when I injected it.

Next week I move into an apartment (I have been living at home a while-saving money) and working). I get a little nervous that I might get a flare up, however I am pretty sure I have a flare up it won't be as long as when I was initially diagnosed. I just saw a study that showed that about 21% of Crohn's patients missed >25% of work in the previous week.

I am just glad I am feeling good these days and a far cry from last year when I went many months with c difficile!

Friday Night Stomach Hurricane, Humira Leaked (A Little), and Dry Nose

So Friday night (March 28), I had a large bowel movement. It really was multiple bowel movements at once. In order to help myself recover I put some ice (as I normally do over my stomach to recover). Saturday I felt pretty good. My body woke up at 9 a.m. (usually I get up around 8 for work on weekdays). However, I went back to sleep and when I woke up around 11 was a little tired but the rest of the day I felt pretty amazing. I didn't have a bowel movement the whole day and my stomach felt fine. Personally I wonder about the connection between sleep and how Crohn's or IBD patients feel. When I did my injection Friday night I also did notice a small amount of liquid that leaked out of the injection pen. It seems to be harder to inject the stomach than the legs. Just have to remember to hold it in as long as possible!

Saturday morning when I woke up my nose was stuffy (it has been pretty dry for about a month or so). There was stuff in my throat that made it feel sore but it was just nasal dripping. It really sometimes gets annoying sometimes having a mildly bloody nose. Taking a shower is the best thing for it and I often do Sinusrinse to get everything out of my nose.

Other than what I mentioned above I feel pretty good. Some days I really don't know I even have Crohn's which is a miracle. Today (Sunday) I was even able to work out for 50 minutes on the elliptical burning roughly 500 calories which is great! I plan to move out of the house very soon and get my own place. The apartment has a work out center so I will be hopefully able to burn some calories and get somewhat in shape. My weight these days is around 167. My whole life I was around 150 or so. However, I feel better being more filled but wouldn't mind shedding some pounds to fit into my pants a little better.

Dr. Thomas Borody on Fecal Transplant and Cure for Crohn's?

Recently an article came out about Dr. Thomas Borody claiming that a fecal transplant might be used for a whole host of things from multiple sclerosis, to Crohn's, to Parkinson's disease. In the article nurse Suzanne Heskett had Crohn's and seems like she had a bad flare up in 2001. She was going to the bathroom 18 times a day and thought she would have to get part of her colon removed. In trying to help her dire health situation she went to Dr. Thomas Borody (who even I will admit is a gastro star doctor in Australia and has done tremendous research in gastroenterology in general).

Suzanne had a nasal tube and three different donors donate their "stuff" which took about 5 hours and she felt better right after and several months later her condition improved. What is interesting is that 11 months after having a colonoscopy and Dr. Borody didn't even recognize she had Crohn's. Borody first did a fecal transplant for Crohn's in 1988 according to this journal article.

Borody goes on to say that he has done a fecal transplant for someone with a young person with rheumatoid arthritis and it went away after the transplant. He also claims that he has "cured" dozens of people with colitis and Crohn's. Dr. Borody also claims that three Parkinson's patients was helped by fecal transplants. Fecal transplant even has the potential to help patients with Alzheimer's, autism, obesity, rheumatoid arthritis, acne, insomnia, major depression, autism, and even diabetes. 

I am a little skeptical of the claims that fecal transplants will "cure" Crohn's, however I don't think a fecal transplant would hurt Crohn's patients. Speaking as someone who actually had a fecal transplant in 2013 I did feel a little better after the transplant, however still had a flare up (which could have been caused by the c diff I had). However, I feel pretty great now and some days don't even realize I have Crohn's. All the research I have seen tends to show fecal transplant work better for ulcerative colitis. 

If you don't live in Australia Dr. Thomas Borody will charge $10,000-$15,000 and you can be expected to stay between 2 and 10 weeks and have to have a doctor that will resume care after the procedure. The first step however is to have an initial interview which would cost $150. However, Borody has been doing fecal transplants since the 1980's and as I wrote here does 5-6 per week and I estimate by now has done close to 2,000 fecal transplants.

The application of fecal transplant for multiple illnesses sounds exciting. Perhaps the reality will be it won't be apply to as many things as possible but could have an impact on people with Crohns, ulcerative colitis, and other major diseases. Hopefully, with time we will learn even more about fecal transplants and how they can help hundreds of thousands if not millions of people suffer less and enjoy life more. 

Weekday Links Part II: Anti-inflammatory herb for IBD, Stem Cell Crohn's, Detecting Crohn's With Laser, Sweden Highest Crohn's Rate in Europe

Endoscopic Balloon Dilation and Crohn's
So I wasn't familiar with what even a endoscopic balloon dilation (EBD) does. The procedure seems like it is mainly used for strictures and can be used as an alternative to surgery. In the study 43% of patients achieved long-term benefit from EBD.

Vitamin D and Crohn's: Sunlight Decreased of Crohn's Disease 
In a study that looked at over 90,000 women in France higher levels of sun exposure was associated with an decrease in Crohn's but not ulcerative colitis.

Anti-inflammatory herb for IBD?
So it seems as if a Chinese herbal drug may have some benefits in people. The trial looked at just mice however showed that FAHF-2 may be a novel treatment for Crohn's.

Hematopoietic stem cell transplantation in refractory Crohn's. 
Stem cells has been used for Crohn's (however it can be quite dangerous and even deadly). In this trial 26 patients were included. Many patients in this study (which just looked at toxicity) experienced infections and the study recommends to use the stem cells only in extraordinary situations.

Early Detection of Crohn's With Laser
Recently it was announced that a pill camera was approved by the FDA to be used as a colonoscopy. Now it seems as if researchers are taking colonoscopy to the next step by using blue laser which can magnify the intestinal wall and magnify it 1,000 times and see the earliest abnormal cells. The laser is being used by Ohio State Medical Center. Dr. Razvan Arsenescu has been using the laser and the hope is the laser will be used not only to treat IBD but also lung, bladder, and other diseases.

Sweden Highest Rates (In Europe) of Crohn's Disease 
Canada has the highest rates of Crohn's disease in the world and it looks like Sweden has the highest rate in Europe. The study showed that patients who had Crohn's for 40 years had an increased risk for surgery. The mean annual rate for Crohn's was 9.9 people/100,000/year (which is still a very small percentage of the population).