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From the month of August, Italian pharmacies no longer find the Questran, an inexpensive, old but effective and irreplaceable medicine for people with Crohn's disease. Patients, especially those who have undergone surgery, phoned pharmacies from all regions, sought help from ASLs and hospitals, desperately tried to contact the Ministry of Health. However, as confirmed by the website of the Italian Medicines Agency (AIFA), this deficiency is due to production problems related to the supply of the active substance and should end on 28 February.
"And how are we doing?" An alternative medicine does not exist, the same doctors say, especially for us who have been operated on Crohn's disease, this sachet of medicine is essential.Without this drug, we are disabled, we have to stay indoors because we need permanent toilets, "says Margherita Guasparini, a patient from Lucca who searches the Questran throughout Italy, as many others who suffer from the same pathology. And he continues: "The advice on the site of the AIFA is to have the doctor sign an alternative medicine or ask a health facility to buy it abroad, but the badog drug is not there and the request abroad did not take place.responses because even outside of Italy we find it ". After all, take a look at the social networks to find out how many people are trying to get information on Questran. And now, they are waiting for at least one signal from the Ministry of Health. Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, causing a wide range of equally important symptoms.
Crohn's disease is a chronic inflammation that affects the digestive tract. it may involve the entire pathway from the mouth to the anus, but it is mainly localized in the last part of the small intestine (ileum), in the colon or in both. The inflammation, swelling and ulceration affect the entire intestinal wall of the affected areas. By neglecting the differences from one case to the other, in Crohn's disease, the predominant symptoms are abdominal pain (which sometimes resembles an appendicitis crisis), badociated with diarrhea and in some cases have a fever. The pain, which often occurs after meals, is localized at the navel or right side of the abdomen. More rarely, other symptoms may appear, such as joint pain, loss of appetite or weight loss. It is a chronic pathology characterized by the alternation of periods of well-being in phases of relapse, without it being possible to predict a stage of exacerbation of the disease, after pharmacological treatment. or surgery.
The outlook is variable and depends on many factors, as well as of course the extent of the spread of the disease. Some sufferers may have intermittent symptoms of abdominal pain and must pay attention to the diet. Others require constant care when administering high doses of cortisone and other drugs. Others still need a surgical procedure to treat frequent bowel obstruction (one of the complications of the disease). "However, most patients are in an intermediate situation and lead healthy lives, without having to follow a diet and take medication when needed." In Crohn's disease, intestinal and extra-intestinal complications can occur, affecting 10 to 20% of patients: among the most common, there are episodes of intestinal stenosis, perforations (in case of very active pathology), abscesses abdominals and fistulas (considered as an extension of the same pathological process, sometimes requiring surgery). Extra-intestinal complications can affect the skin and joints, as well as some diseases of the liver and bile ducts
CAUSES: AN INHERITANCE OF THE GENETIC CODE?
This is not a hereditary disease in the strict sense of the term; it is true that there is a greater likelihood of contracting Crohn's disease in a family where a member is already affected, but if a person is sick, there is a low probability that a child may to contract the pathology. To date, the causes are unknown, which limits pharmacological treatment primarily to the use of anti-inflammatory drugs. The most recent discoveries indicate a disproportionate and prolonged activation of the immune system over time: as a result of an antigenic stimulus (food bacterium) or internal to the body, a violent and continuous immune response is triggered . Stress does its part. In fact, Crohn's is increasing in all countries with advanced technology, so we recognize the cases in which the beginning is due to pediatric age. Once the diagnosis is received, patients begin to face the problems and limitations that this pathology imposes on daily life; first of all, the fear and the worry of not being able to foresee the beginning of a new phase of activity; Another reason for apprehension, no less important, is represented by the idea of having a bathroom available to customers in case of a crisis. The difficulties also concern the personal life: in some cases, the Crohn influences the point which determines the interruption of the affective relations of those who are affected. "The picture of the patients' work situation is no less worrying: 11% of patients are unemployed or underemployed because of the disease; 9% can not work full time. In addition, 24% say they have been recognized as disabled or waiting to receive it. These are data from the DIOGENE survey, a research that allowed us to obtain an image of patients with IBD (inflammatory inflammatory diseases) in Sicily and the rest of the country, by means of a questionnaire. "The results of a national survey will fill the data gap in our country and allow the implementation of programs to improve the overall management of IBD and the quality of life of these patients," explained Mario Cottone. . , Professor of Internal Medicine at the hospital "Ospedali Riuniti Villa Sofia – Cervello" of Palermo. AMICI, the badociation that for years has been a reference for people with Crohn's disease and ulcerative colitis. This project is part of a larger international project promoted by the European Federation of Crohn's and Colitis Associations (EFCCA), which brings together 27 national badociations of IBD patients in 26 countries. different and whose objective is: to ensure equitable access to treatment, as well as early detection and to limit the social impact of IBD.
THE NEWS OF THE THERAPEUTIC FRONT
Current therapies involve the use of cortisone, used in the acute phase (abdominal pain and significant diarrhea), at fairly high doses and for periods of several weeks. In mild to moderate forms, topical cortisone such as budesonide or beclometasone dipropionate may be used. Antibiotics such as metronidazole, ciprofloxacin and rifaximin may be particularly useful at different stages of the disease, especially in cases of colitis. If seizures are repeated and it is necessary to use cortisone very often (or if the response to cortisone is insufficient), immunosuppressants such as azathioprine or 6-mercaptopurine or the methotrexate can be used. A monoclonal antibody (infliximab) has been available in Italy for several years and is directed against the cytokine TNFa, one of the causes of the inflammatory process. The use of this drug is currently approved in Italy for: • Severe active Crohn's disease, in patients who have not responded to treatment, who have intolerance or who have contraindications to cortisone or immunosuppressants such as azathioprine / 6-mercaptopurine. • Fistulising Crohn's in the active phase, which has not responded to an appropriate cycle of conventional treatment (including, in this case, also antibiotics and drainage.) • Moderate-to-severe active ulcerative retettitis, with the same limitations. It has recently been approved by the EMA (European Agency for the Evaluation of Medicinal Products) and a new anti-TNFa monoclonal antibody called adalimumab is being validated by AIFA (the Agency). Italian medicine). the treatment of severe active Crohn's disease in patients who have not responded, who are intolerant or who have contraindications to treatment with corticosteroids and / or immunosuppressants. Adalimumab is a totally human anti-TNT (like infliximab). Its lower immunogenicity is aimed at reducing allergic-type adverse reactions and antibody formation. Finally, in addition to these 2 drugs, many other biological drugs are tested against both TNFa and other cytokines (or are anti-inflammatory cytokines per se).
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