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1.5 Chronic Bowel Disorders


NICE CG61 Irritable Bowel Syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care Feb 2008

Rifaxamin should be used for the treatment and prophylaxis of encephalopathy and may need to be continued long term in some individuals

1.5.1 Aminosalicylates

Stable patients may be switched to an equivalent ASA. New starters could be on Octasa instead of Asacol or Mesren. Despite the equivalency of drugs such as Octasa and Asacol some patients feel symptoms deteriorate when changed so any switch should be agreed with the patient and if there is any deterioration then they should be switched back to their previous ASA medication. Patients on other brands eg Pentasa or Mezavant should continue on the same branded prescriptions - Dr C Sheen

1st     MESALAZINE    Octasa® 400mg, 800mg MR    
2nd         Pentasa®   Pentasa granules should be used if the patient has problems swallowing tablets. Pentasa 1g suppositories are useful when treating proctitis 
2nd         Mezavant XL®



            Asacol® may be continued for existing patients

1.5.2 Corticosteroids

      BUDESONIDE (Yellow)   The use of these corticosteroids will depend on the extent and activity of the patient's disease   

1.5.3 Cytokine modulators - Cytokine modulators are to be prescribed by specialists only

      NICE TA187 Crohn's disease - infliximab (review) and adalimumab (review of TA40) May 10
      NICE TA163 Ulcerative colitis (acute exacerbations) - infliximab Dec 08
      NICE TA140 Ulcerative colitis (subacute manifestations) - infliximab April 08
    AZATHIOPRINE (Yellow) Azathioprine and mercaptopurine although unlicenced may be used in the treatment of Crohn's disease and acute ulcerative collitis under specialist supervision. Inflammatory Bowel Disease AZT monitoring for GPs LES agreement     
    6-MERCAPTOPURINE (Yellow)  
       NICE TA352 Vedolizumab for treating moderately to severely active Crohn's disease after prior therapy Aug 15


  General Blood Monitoring Guidance
  LES Shared Care
  Discharge for Shared Care
  Rapid Access Referral for Shared Care

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