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Inflammatory bowel disease (IBD) often significantly affects the daily lives and quality of life of those affected. At an information event at the Brothers Hospital in Trier, it appeared that most of the patients were dependent on long-term treatment and intensive medical care. But for many, there is new hope, says professor med. Christian Kölbel, Chief Medical Officer of the Department of Internal Medicine I, explains what new drugs promise relief and why it is important to get treatment from an expert.
Professor Kölbel, the drugs have high priority in the treatment of patients with chronic inflammatory bowel disease, but the preparations do not always bring the desired effect. Why can affected people now gain new hope?
Professor med. Christian Kölbel: Because the range of possibilities in this area has greatly expanded in recent years. More and more drugs have different points of attack and thus allow individualized treatment for each patient. And since there is no promising treatment for everyone in CED, these new opportunities help us much further.
They talk about antibodies. What other mechanism of action distinguishes this from the usual arsenal of preparations?
Teacher. Kölbel: The antibodies go directly against inflammatory mediators, that is, against inflammatory messengers. They also have the great advantage of intervening much more deeply in the inflammatory and non-cortisone process. Moreover, their effect usually lasted a few weeks.
Although these drugs do not work for everyone …
Teacher. Kölbel: This is true, and unfortunately, we have so far no medicine to permanently cure these diseases. But with tofacitinib in ulcerative colitis and ustekinumab in Crohn's disease, to name just two examples, there are now drugs that can continuously improve their health status in many patients.
Which patients are treated with such drugs?
Teacher. Kölbel: In general, as with all previously available treatment options, it should be emphasized that even new drugs will not produce the desired effect on all patients. Highly expensive drugs are also used only when cortisone-based drugs have failed or the disease is initially characterized by highly inflammatory activity.
How to know in advance which drug promises the most success in which patient?
Teacher. Kölbel: The use of this broad spectrum of drugs requires a lot of knowledge and experience. This can only be done by an expert. In addition: As a physician, you should also know and recognize side effects, such as increased vulnerability to infections.
The surgeon also plays a key role in the treatment of IBD. What contribution does it make?
Teacher. Kölbel: In ulcerative colitis, surgery is necessary if the drugs fail in life-threatening situations or if the chronic inflammation of the colon in the long term becomes malignant. In the case of Crohn's disease, the importance is mainly, but not exclusively, in the treatment of scar narrowing of the intestine or complications of these complex chronic diseases.
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