Talk:Management of Crohn's disease

Complimentary Medicine section removed pending discussion/references

The segment below was removed pending further discussion and referencing. If referencing is found, I think that the tone should be worked on to make it more NPOV.

The somewhat recent revelation that a scientiest had discovered a bacterial or parasitic link to Crohns Bacteria linked to Crohns suggests that the theories proposed by herbalism or many herboligists was correct.

Limited but positive research confirms that a treatment consisting of wide spectrum anti-parasitic herbs, such as garlic, ginger, grapefruit seed extract, green black walnut hulls, cloves, together with an intestinal cleanser, ie fiber including psyllium, and probiotics known as acidophilus, intestinal flora, friendly bacteria for the intestinal system are showing very good results. ATTENTION: It should be noted that grapefruit seed extract is claimed to be a natural remedy, however, studies have concluded that the universal antimicrobial effect is merely due to synthetic preservatives. [1]

It should be noted that research into historic and simple herbal treatments is not what is currently being promoted in the mainstream system of disease treatment which focuses on patentable drugs.

Where are mention of studies of Fecal Transplants? http://www.ncbi.nlm.nih.gov/pubmed/25168749 http://www.ncbi.nlm.nih.gov/pubmed/25647155 — Preceding unsigned comment added by 96.253.43.28 (talk) 20:49, 5 September 2016 (UTC)

InvictaHOG 16:56, 18 August 2006 (UTC)

We have owned a retail speciality shop for decades, and we have sold herbal products for some 25 years, the background on this I can provide is various reference material from a variety of herbal sites, and companies.

However the best most reliable information has been my own research, personal and otherwise with these diseases, and noted that patients have improved with this 'treatment'.

I hope you find it on the internet, key words, "herbal treatments for Crohns or IBS...

This is very, very important information for those suffering from Crohns, I know of people who suffered with IBS and the system the mainstream system did nothing to help them...

--Son of Maryann Rosso and Arthur Natale Squitti 20:35, 18 August 2006 (UTC)

It would be nice to have the references before readding the material - make sure that the source material is consistent with the policy on no original research. To start, I will look to add the peer-reviewed data on probiotics to the article tonight InvictaHOG 21:51, 18 August 2006 (UTC)

Question: What do you do if you are the first to discover something, and other medias do not want to publish ?

I would like to believe that my research was original on Crohns or IBS but it was not, it was merely an experiment to confirm what some books stated. Thanks

--Son of Maryann Rosso and Arthur Natale Squitti 01:12, 19 August 2006 (UTC)

If there are published books which have information which can be referenced here on Wikipedia, then we should take the chance to review the data that's presented. I can't comment on any difficulties you are having with your discoveries! InvictaHOG 03:52, 19 August 2006 (UTC)

Well, no

We should just be adding sourced material to this article. -- Samir धर्म 02:05, 19 August 2006 (UTC)

Helminthic therapy

Hi, with the results Summers and Weinstock got at Iowa, and the recent proof of concept out of Nottingham, any chance we can fit in a link to the Helminthic therapy Wikipedia entry somewhere on this page? FQ1513 00:03, 11 October 2007 (UTC)

I really think that Helminthic therapy does not deserve it's own section, as its effectiveness is unproven, and it is not in use medically, except in experimental mode. It really should be part of the Alternative or In-Research categories....io-io (talk) 20:44, 9 March 2008 (UTC)

I agree with Io io on this. --CrohnieGal^Talk 20:54, 9 March 2008 (UTC)

After rereading the article

The drugs used to try to help Crohn’s are all over the place and need to be put under the Medication title. The whole article is almost about medications and some of them are out dated or have serious side effects not mentioned.

I also put a title in called "Pregnancy with Crohn's disease" This is very important to put information in because if a woman has CD then decision when to stop them are important and also some woman go into remission during their pregnany. Also, if the male has CD and is on certain medications it needs to be told because some of the meds are dangerous for the child. I don't have time right now to do this but I didn't want to forget this important information to be added.

Another thing, when all the meds get put in one locations, how does everyone feel about adding other subjects like strictures, blockages and so forth. I really want this article to tell people what Crohn's is and the way it is written it doesn't do that. The reason I know is I have asked a few editors who do not know CD to read the article and they came away with questions to me and didn't understand what a monster IBD can be. Does anyone have a problem with the plan I am trying to set up? If so, please speak up now. My feelings don't get hurt with honesty so be honest, but also please be polite! :) I am just trying to make an article here great, and right now I see it all over the place. Thanks so much for any input, --CrohnieGal^Talk 21:58, 9 February 2008 (UTC)

I think this article is a mess, for all the reasons you gave and more. It needs a complete rewrite, both for overall organization, by paragraph and sentence, and an addition of simple terms where there is now only jargon. It will be a big job. Brooks' law probably applies, so it might be even more difficult if people "help" you.

For example, take the introduction: "Treatment of Crohn's disease is sequential: to treat acute disease, and then to maintain remission."

I do a lot of medical writing and I regularly talk to patients to get a sense of what kind of language they understand. I will bet money that you can stop 5 people on the street and they won't be able to define "sequential", "acute", or "remission" in this sentence.

The best medical writing for the ordinary reader that I know of is the Merck Manual and I spent a lot of time reading it to understand how they do it. I recommend that everybody do the same. For example, they talked to readers and found out that readers wanted to learn the technical terms that their doctors and the literature used, so they deliberately used the technical terms -- but first they explained the concept in simple English and then defined the technical terms. (And they don't use words like "sequential" when a simpler word will do.)

The best, most reliable source of information that you can get free on the Internet (or anywhere, at any price) is the Cochrane Collaboration, and they even have plain-language summaries, which I have also studied very carefully to see how they do it. The best way to have written this entry would have been to start with the Cochrane Collaboration, since they simply summarize all the major treatments, and tell you how good the scientific evidence is for each treatment.

As I said, this article is a mess. Here's a writer's trick: The best way to organize it would be to start from the beginning and write a good summary in simple language. Then expand the summary. Move everything below up to the summary. If you have anything left over that doesn't fit into a well-organized summary, consider throwing it out. Then put subheads into the summary and make that the article.

I don't know if you've read any review articles, but medical librarians told me that the best way to start researching a subject is to read review articles in the big 4 medical journals: New England Journal of Medicine, JAMA, BMJ and Lancet. Any one of them would probably do; they repeat the same important points. In addition, or alternately, you can read a good introductory medical textbook like Harrison's Principles of Internal Medicine. You probably know everything they have in there, but each of their articles is very well organized. It's often very difficult to organize all this information, and the people who write medical journals and textbooks do it very well.

After you've collected a huge amount of information, the most difficult thing, in my experience, is to figure out (1) how to organize it, and (2) what's important and unimportant. (To put it another way, the most difficult thing is throwing stuff out.) I use a lot of hilighters, although some people love MS Word outlines. Since I assume you're seeing doctors, you might want to print it out or email it to one of your doctors, and ask him or her for feedback and advice. You could even go to one of the top experts in your area, and ask him or her for feedback. Lots of doctors love getting requests like that, and I'm sure most doctors would be intrigued at the thought of contributing to Wikipedia. They might even get a good presentation about it at a gastroenterology meeting.

We actually had a discussion at the NYC Wikipedia meetup by a teacher who assigned his students to work on Wikipedia pages, and he was very happy to be able to help his students write good entries on WP. WP:Meetup/NYC/January_13,_2008#Wikipedia in the Classroom I think most academic doctors would agree that it would be good for them to help people write Wikipedia entries (rather than undoing Internet misinformation afterwards).

The most important thing is something that you've already done, which is to ask people who don't know much about the subject to read it and see if they understand it. This leads me to believe that you really know what you're doing, and I'm sure you can do a good job. But it's not easy. Nbauman (talk) 00:16, 16 February 2008 (UTC)

Not just Infliximab - other MABs / biologic therapies too

Because there are now 2 other MABs (Adalimumab and Natalizumab) approved and in-use for Crohns, I propose to either 1) shorten Infliximab and add complimentary short sections (no more than 3 lines) for the otehr MABs; - or - 2) change the name of the sections to Biologic Therapies (MABs)...anyone care to comment/render opinion?.........io-io (talk) 03:52, 9 March 2008 (UTC)

I like your second choice of changing the section and adding the other treatments in as you say here. It's a great addition. I don't know enough about them to actually make the move so please be bold and add them in like you are suggesting. I don't think it should cause any problems on this article. So far, knock on wood, everyone who comes to edit here has been very polite and will talk to you here if there should be a problem with your edits. Thanks a lot, I personally just started to catch up on the new information going on with the new treatments so I look forward to seeing what you put in. --CrohnieGal^Talk 14:14, 9 March 2008 (UTC)

I have to apologise, I remember now that in early February you popped up on my Talk Page, but it was at the start of a 3-week period in which I had no time for Wiki. I have to say that I know less about Crohns than MS, although I was told by an MS-er (blinded in one eye) that he considers Crohns usually worse, as it is unrelenting......Here's what I think - I would be concerned about patients coming here and concluding that Helminthic Therapy or Alternative Therapies are on an equal playing-field to the proven biolgical drugs....especially as they all come with safety stigmas that are over-blown....perhaps the answer is that Helminthic Therapy be removed as a section, and mentioned (only) under the Alternative Therapies....for many years there have been Alternative Therapies for every serious disease it seems, and they seem to make no difference to the medical need....in any case, I think the Treatment options deserve "scale" in proportion to what they have proven...io-io (talk) 17:57, 9 March 2008 (UTC)

No apology is at all necessary. As for the degree of illmess between MS and CD well it really depends on the people involved. My CD is unrelenting and always attacking in some way or another, others with it can gain remission and keep it. The same can be said for MS as I had a nice neighbor who had to deal with the seriousness of it.

As for the Helminths I have mixed feelings on the subject. I used to watch it constantly as a big great hope. They are still getting decent results with patients though not as much as I hope and it is considered from my propective as an alternative treatment since a few I know of tried this therapy and had good results to no results. I too think that main stream meds should be more dominate in the article including all of the different pharmaceuticals available. A section for alternative treatments I think might be a good idea to separate tested and proven vs the not tested. I like to say with things like MAP and the worms that there still might be a hopefully angle they haven't found yet. But of course you can tell this is my POV and I am not in remission. --CrohnieGal^Talk 20:26, 9 March 2008 (UTC)

I wrote above a suggestion that Helminthic Therapy be down-graded. I know a lot about Natalizumab as I have been updating and discussing it. I know less about Adalimumab, except that it is similar to Infliximab (targets TNF-alpha) and has been used in RA for years, but I will do some research and come back to this in a few days. That will give time for others to chime in....io-io (talk) 20:52, 9 March 2008 (UTC)

Risk of PML and also new medication

There is only one drug used for Crohn's Disease that carries a risk of PML, and that is Tysabri (Natalizumab). Remicade (Infliximab) does not carry that risk, so the risk of PML should be removed from that section. Also it has been found that Tysabri can still carry a risk of PML even when used by itself.

Under new medications, I recommend the addition of a new stem cell drug known as Prochymal. It is being tested in Phase III clinical trials by Osiris Therapeutics. The stem cells are derived from adult bone marrow, and are infused into patients. This drug has shown impressive remission rates with no side effects attributed to the drug. Prochymal has the potential to be the greatest drug for the sufferers of Crohn's Disease ever. Although Prochymal does not "cure" the disease itself, it does have the potential to heal the current diseased areas and return the affected part of the digestive tract to normal. For more on Prochymal visit www.osiristx.com —Preceding unsigned comment added by Jmiller056 (talk • contribs) 19:40, 12 March 2009 (UTC)

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Aminosalicylates for Crohn's Disease

The missing citation needed in this paragraph is the updated AGA guidelines for management of moderate to severe luminal and perinatal Crohn's disease. These guidelines do not mention the role of 5-ASA in pharmacological management of patients with moderate to severe disease HasselbladWhisperer (talk) 01:04, 23 June 2023 (UTC)

Targeted small molecules Section

Hello fellow editors.

I would like to highlight that this page continues to be in dire needs for updating the available treatment modalities and drug classes. Specifically, I would like to add a section for targeted small molecules after biologics that sets the stage for JAK inhibitors.

Additionally, I wanted to solicit inputs on adding a section for generic biologics. HasselbladWhisperer (talk) 17:09, 5 November 2023 (UTC)