Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD)
Disease (IBD)
Kelompok Studi Infl ammatory Bowel Disease Indonesia. Konsensus nasional penatalaksanaan
infl ammatory bowel disease (IBD) di Indonesia. Jakarta: Perkumpulan Gastroenterologi
Indonesia 2011.
ALGORITMA TERAPETIK CD
Kelompok Studi Infl ammatory Bowel Disease Indonesia. Konsensus nasional penatalaksanaan
infl ammatory bowel disease (IBD) di Indonesia. Jakarta: Perkumpulan Gastroenterologi
Indonesia 2011.
TERAPI UC
TERAPI CD
Sulfasalazine
• Sulfasalazine is used to treat a certain type of
bowel disease called ulcerative colitis. This
medication does not cure this condition, but it
helps decrease symptoms such as fever,
stomach pain, diarrhea, and rectal bleeding.
Side Effects
• Stomach upset, nausea, vomiting, loss of
appetite, headache, dizziness, or unusual
tiredness.
• This medication may cause your skin and urine
to turn orange-yellow. This effect is harmless
and will disappear when the medication is
stopped.
Dose
• Usual Adult Dose for Ulcerative Colitis
Active
3 to 4 g/day orally in evenly divided doses
Maintenance
2 g/day orally in evenly divided doses
Comments:
-To reduce possible GI intolerance, a lower starting
dose (e.g., 1 to 2 g/day) may be considered.
Corticosteroids
• MOA: enter cells and bind to and activate specific
cytoplasmic receptors
• Steroid-receptor dimers enter cell nucleus
• Activate steroid-responsive elements in DNA
• Gene repression or induction anti-inflammatory
effects
• Anti-inflammatory effects take several hours
Corticosteroids
• Prednisolone oral/ enema
• Hydrocortisone iv
• Budesonide (poorly absorbed – used for
iliocaecal CD/ UC)
Indications
• Moderate to severe relapse UC & CD
• No role in maintenance therapy
• Combination oral and rectal
• No added benefit over 40mg /day
• <15mg ineffective
• Rapid reduction a/w relapse
Effect
• inflammation
• healing
• Na retention/ K loss / Ca loss
• gluconeogenesis – diabetogenic
• catabolism
• Redistribution of fat – Cushingoid appearance
• Reduced endogenous steroids – withdrawal a/w
acute adrenal insufficiency
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Methotrexate
• Inducing remission/preventing relapse in CD
(Unlicensed indication)
• Refractory to or intolerant of Azathioprine
• MOA: inhibitor of dihyrofolate reductase; anti-
inflammatory
• S/E: myelosupression*;mucositis;GI; hepatotoxicity;
pneumonitis
• Co-administration of folinic acid reduces
myelosupression;mucositis
PUSTAKA
1. Kuhbacher T, Folsch UR. Practical guidelines for the treatment of infl ammatory
bowel disease. World J Gastroenterol 2007; 13(8): 1149 – 55.
2. Sands BE. New therapies for the treatment of infl ammatory bowel disease. Surg
Clin N Am 2006; 86: 1045–64.
3. Bernstein CN, Fried M, KraRENCbshuis JH, Cohen H, Eliakim R, Fedail S, et al. World
gastroenterology organization practice guidelines for the diagnosis and
management of IBD in 2010. Infl amm Bowel Dis 2010; 16(1): 112-24.
4. Kelompok Studi Infl ammatory Bowel Disease Indonesia. Konsensus nasional
penatalaksanaan infl ammatory bowel disease (IBD) di Indonesia. Jakarta:
Perkumpulan Gastroenterologi Indonesia 2011.
5. Tamboli CP. Current medical therapy for chronic infl ammatory bowel disease. Surg
Clin N Am 2007; 87: 697 – 725.
6. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister
AR. Ulcerative colitis in Olmsted County, Minnesota, 1940-1993: incidence,
prevalence, and survival. Gut 2000; 46(3): 336-43.
7. Bossuyt X. Serologic markers in infl ammatory bowel disease. Clinical Chem
2006;52(2):171-81.
THANK YOU