Talk:Ulcerative colitis/Archive 3

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• Moved from top

Help: It has been too long since I have edited here. My formating skills have lapsed. Can somone fix up the references I've just added for Vitamin U and the studies on the impact it has been shown to have on reducing, avoiding or healing lesions/ulcers? Knoma_Tsujmai

I've removed them. Not UC references, sorry, not related to pathogenesis of the disease -- Samir धर्म 23:17, 17 October 2006 (UTC)

I disagree Samir. Can you look a bit into these links? MMSC (vitamin U) has been shown to be effective in the treatment of UC:

Studies show that Vitamin U helps to prevents and can revert ulcer damage in gastric tissues.

The cause of UC may be debated (is it autoimmune, etc); but the symptoms can be significantly lessened by MMSC.

Take another look at these links if you would:

Quoted: "Role of sulphydryl-containing agents in the management of recurrent attacks of ulcerative colitis. A new approach."

Quote: "This double-blind randomised study investigated the role of sulphydryl-containing agents in the management of recurrent attacks of ulcerative colitis. ... These results demonstrate that sulphydryl-containing agents play a key role in the treatment of and protection against ulcerative colitis."

Role of sulphydryl-containing agents in the management of recurrent attacks of ulcerative colitis. A new approach: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1362613&query_hl=10&itool=pubmed_docsum

Knoma_Tsujmai

• Hi Knoma, I agree that there is basic science evidence on the cytoprotective effects of sulphydryl derivatives in ulcerating disease. However, the one clinical trial (PMID 1362613) evaluating MMSC in UC has certain limitations (primarily because it was done in 1992, and we've learned much on UC since then). First, it was a trial on left sided UC, that we know from the literature is best managed with rectal 5-ASA (PMID 10925961, PMID 7654892, PMID 15951542) or combination therapy. Secondly, there are questions about the endpoints in the trial cited. I just don't think there's enough evidence for it to be included in the article. Thanks -- Samir धर्म 17:13, 18 October 2006 (UTC)

• I again have to disagree. MMSC is a substance that is obtainable over the counter, does not require enemas and either alone or in combination has been show to help people recover from gastric ulcers. It has to be at least as effective (if not more effective) than the Kampo herbal medicine that is already in the article (and people have let stand). Why remove this? If even one person is able to help speed or augment their recovery then this information is worth leaving in. I'll admit I'd love to see more US studies on it, but as MMSC is something that cannot be 'patented' or packaged up at hundreds of dollars a dose I do not expect to see that happen. I think that is sad, but it is the reality. Please reconsider letting this stand as is. User:Knoma_Tsujmai
  • Okay, how is this as a compromise [1]? The important thing to note is that MMSC is not commonly used in management of ulcerative colitis and is an adjunctive therapy at best -- Samir धर्म 04:27, 19 October 2006 (UTC)
    • Can we let people know it is generally called "vitamin U". No local health store will likely know what MMSC is. I still believe that there is much more research to the benifit of this than this one line compromise shows. Can you add this reference as well: "Methionine derivatives diminish sulphide damage to colonocytes--implications for ulcerative colitis." http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=8881814&query_hl=9&itool=pubmed_docsum
    • This one is is Russian, so may not be as useful: "[Therapeutic effect of MMSC1 (vitamin U) on gastric and intestinal function in the treatment of patients with chronic gastritis]" http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=4428258&query_hl=9&itool=pubmed_docsum
    • This one is old and German: [Contribution to the knowledge of the ulcer-preventive factor (so-called vitamin U) intestinal activity of vitamin U-containing dry extracts of cabbage. II.] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=13610295&query_hl=9&itool=pubmed_docsum
    • Yes, you are right in that rectal steroids or ASA are the recomended treatment, but I believe that this 'vitamin' actually helps to prevent the irrative conditions that lead to the ulceration to begin with. The side effects of long term constant steroid use for people with UC are not without issue. Common side effects of ASA include stomach cramps and pain. Do you have any UC patients? Would you be able to coordinate any type of study? I think you would be honestly very surprised at the effectiveness of this approach. Knoma Tsujmai 13:13, 19 October 2006 (UTC)

Clearly the eastern hemisphere of this small planet also is coping with this disease using herbal medicines.

I once added such information to the article with Pubmed references. References were deleted since they showed only clinical trials on mice and not men. Let me remind you that Inflixmab/Remicade was "developed from a mouse:human chimerized antibody". One cannot categorically say that clinical trials of specific medicines on mice are without correlation to the effect on humans. If nothing else the clinical effect on mice tells us the effect of these medicines are not placebo effects. Thus 2000 years use of such herbal medicines on humans in China and Japan with empirical results are partly confirmed.

But now the TCM/Kampo references have been completely deleted.

Why?

I wish doctors in general were an ounce more open minded, humble and willing to absorb knowledge outside their "western medicine box" - at least when the true cause of UC is NOT known.

I for one disagree with labeling removal of colon as a "cure". Especially since I have found information that UC was re-established in a transplanted colon - hinting at a more complex cause-and-effect. BUT whatever I think, I still think it is better to have a multitude of viewpoints, since it will stimulate research and breakthrough ideas.

Keeping the "Alternatives" section overly sanitized does not promote creative solution thinking or completeness of the subject.

Cheers, Rune

Cite evidence and it will be included. Don't cite evidence and it won't. -- Samir धर्म 00:31, 2 November 2006 (UTC)

→ Well, the evidence references were originally included but deleted. (Catch 22) Anyway goto PMID 10528991 Perhaps also of interest - one of the identified flavonoids of this traditional medicine - baicalein - PMID 11914968. 11:45 UTC, 2 November 2006, Tellus, Sol system, MW galaxy, The outskirts. /Rune

→ Add also to the evidence PMID 10945829 - Berberine chloride is another known compound of the Kampo/TCM medicines used for UC. See also some photos on this external page of clinical trials on rat colons. /Rune

I moved this section from "alternative treatments" for discussion:

A total of 10 000 patients have been treated with selective cleaning of the blood in Japan and Europe. This method may offer an option to patients that do not respond to the tradidional medicines or have medicine intolerances. It is a proven method that shows a 50-70 percent remission rate. For more information see: http://www.otsukapharma.info/medical_professionals/patients.htm

Since this is approved in the EU and Japan but not the US, I have no way of knowing its efficacy or much else about it. Should Adacolumn be included in the section on alternative treatments? KrakatoaKatie 06:53, 29 May 2007 (UTC)

Why not include it? It is a fact that patients will sometimes cross borders to try specific medical treatments. There is information relating to the USA and Canada on http://www.adacolumn.com/index.htm and http://clinicaltrials.gov/ct/show/NCT00162942 => currently in the "recruiting patients" phase.

At the very least it should be included in the "Ongoing research" section.

Also be aware that not only readers from the US is using the us/english version of Wikipedia for reference - so don't be so arrogant. As long as the geographic area where the treatment is available, I see no problem with this.

You "have no way of knowing its efficacy" ?? - so please explain to me how europeans and japanese differ signifcantly from the US population ? Or is it just that you don't trust the corresponding authorities in the EU that matches the FDA in the US? The clinical trials and documentation demands are every bit as strict if not more.

I know there is currently a significant segregation of European and US drug testing and approval. But keep in mind that this division has been made primarily for economic and political reasons. Not for medical reasons.

Please include it again.

83.109.128.30 21:34, 29 May 2007 (UTC)NN

Please refrain from personal attacks – calling me "arrogant" does not help your credibility. I simply asked for discussion on the process and how effective it is in treating UC, because I'm not familiar with it. - KrakatoaKatie 02:03, 3 June 2007 (UTC)

Well, sorry if that came across too harsh. Although I think some latitude should be allowed. The information was verifiable by doing a 2 minute Google search - that was the basis of my irritation. It may be quick for you to delete something, but it costs me time and effort to put it back. Anyway I see Samir has now removed the information I added for Adacolumn under "Ongoging research" under the pretext of it being "written like an advertisment" ??

I must confess I have found some of Samir's editings (read: removals) "interesting" - to the point where I wonder if he receives funding in some form or shape from a "big-pharma" company? It is well known that these are interested in (if the EU is anything to judge that by) limiting any competing new medicines or treatments that could otherwise erode their established economic foundation.

83.109.151.173 22:25, 7 June 2007 (UTC)NN

Well now, some of us have found your "edits" quite interesting: All of your edits are about Adacolumn and you accuse me of receiving funding from a big-pharma company? You added: "Adacolumn blood cleansing. A total of 10 000 patients have been treated with selective cleaning of the blood in Japan and Europe. This method may offer an option to patients that do not respond to the tradidional medicines or have medicine intolerances. It is a proven method that shows a 50-70 percent remission rate. For more information see: http://www.otsukapharma.info/medical_professionals/patients.htm" with a link to a commercial site. This is akin to advertising, hate to break it to you. There is literature on Adacolumn and UC, cite it in your edits and it constitutes a reliable source. Cite a commercial source and it gets removed as advertising. Throw on personal attacks and no one here will take you seriously -- Samir 22:34, 7 June 2007 (UTC)

For example, here's a Sandborn review from 2005: PMID 16378006. Other relevant articles: PMID 17532273, 17531555. There's literature, and it's a novel idea. We should add it to the article. But not in a spammy way that cites the Otsuka page. -- Samir 22:56, 8 June 2007 (UTC)

Hmm, this is where logic fails. You say it should be added but you remove it ?! This does not add up... My intention was to add this information so that patients are aware it exists - I personally did not know it existed until a couple of weeks ago - and it may indeed be of interest to my son who has UC where the docs are now talking about surgery after Remicade gave him serious pneumonia. In what shape, form or linguistically customized way it is added to pass your camel-through-a-needle-eye phrasing is not really of interest in the big picture here. The information on Adacolumns pages seem factually correct and your own findings in Pubmed confirm this - indeed there would be legal penalties if it was false information - so why in the world do you choose to remove rather than edit the information according to your preferences ??? I can assure you that my interest for "advertising" (aka make something known to the public) is fueled by something much stronger than "big pharma" - namely the well-being of my young son and not wishing anyone have to remove their large intestine by surgery unnecessarily. Surgery in my opinion (also based on what I read in discussion forums on the topic) is not such a final solution as the doctors promote it as. Complications and repeat surgery and a (especially for kids) lower quality of life are factors that are hard to avoid.

217.204.142.41 23:39, 10 June 2007 (UTC)NN

I just did a search on the [2] there is no research there showing any type of clinical research being done for colitis. I did find [3] which shows it is being clinically trialed for Crohn's disease. ----CrohnieGal^Talk/_Contribs 12:42, 11 June 2007 (UTC)

Well, here is some actual usage at the National Hospital, Rikshospitalet, Norway. http://www.rikshospitalet.no/view/readavdi.asp?nPubID=3075 Section:

Hvem får behandlingen?

Adacolumn kan anvendes til pasienter med revmatoid artritt og ulcerøs colitt, eventuelt også ved andre lignende sykdommer, hvor annen behandling ikke har gitt tilfredsstillende effekt.

Translation :

Who can get this treatment?

Adacolumn can be used for patients with rheumatoid arthritis and ulcerative colitis, potentially also for other similar diseases, where other treatment has not given satisfactory effect.

Personally I find it interesting that several diseases with unknown root cause respond to the same medication or treatment. This hints at one or more common causes which the current simulations and knowledge is not yet able to grasp. Particularly Crohns and UC have a significant overlap in terms of the same medicines being used.

83.109.151.173 16:03, 15 June 2007 (UTC)NN

Some information from another Scandinavian country, Sweden: http://crohns.se/fragor/20847_Skillnader_mellan_Remicade_och_Adacolumn

Briefly a patient asks for the difference between Remicade (Inflixmab) and Adacolumn.

Gastro Enterologist Dag Risberg answers (translated to the best of my abilities):

Remicade and Adacolumn are two completely different treatments: Remicade is a medicinal drug with potent anti-inflammatory effects, which is administered directly into the bloodstream. Indications so far has been Rheumatoid Arthritis and severe Crohns disease that do not respond satisfactory on usual medicines as e.g. cortisone.

Adacolumn first of all is not a medicine, but rather a "medical-technical aid", comparable to kidney dialysis. The treatment consists of inserting one cannula in one elbow and pump the blood through a filter, back via another cannula in the other elbow. In this filter a number of white bloodcells and other harmful elements which are considered to contribute to inflammation in for example Crohns will be trapped. According to my own experience 30-60% of patients responds to Adacolumn, depending on the type of disease etc. An advantage is of course that one generally sees no side effects, of disadvantages can be mentioned the high price and extremely limited access to this treatment in Sweden, and further that a lack of objective studies that confirm the treatment effectiveness of Adacolumn.

Dag Risberg 27 dec 2005

83.109.151.173 17:43, 15 June 2007 (UTC)NN

See this page http://www.otsuka.com/oapi/OAPIPipeline.asp According to this the Phase I, II, and III testing as well as Filing for Ulcerative Colitis and Crohns are finished and it is now at the approval phase.

Further if you look at the press release archives http://www.otsuka.com/oapi/OAPIArchives.asp you see Ulcerative Colitis mentioned in April 2004.

• So, are we in agreement of adding this info to the main page?

• Any protests?
  • Reasons for protesting?
• Under what section should it be posted?
  • Ongoing Research or Alternative?
    • Note that adacolumn is approved in EU and Japen. So I guess it depends if Wikipedia's english version should be reserved for the US point of view (Ongoing Research) or a world point of view (Alternative Treatment)

NN

The one [4] title just mentions Crohn's disease but if you check the link you will see it is a resourse for inflammatory bowel diseases. --CrohnieGal^Talk 18:12, 19 June 2007 (UTC)

The treatment section has main pages. IMO these subsection should be linked to in an outline and the Treatment section should be shorted to a summary table with embedded links. Maybe only be one linkout for treatment (KISS - common sense directive) and further subpages should be linked to from the treatment page.

Taking treatment out of view, as I understand Samir put a lot of work into renovating the page, know how difficult that is, having renovated some of my own disasters. But structurally the page is too complex and actually, backwards.

1. Symptoms

2. Diagnosis and pathology (or simply pathology) If a whole section on clinical presentation is needed then -> subpage. Clinial presentation of ulcerative colitis.

3. Epidemiology

4. Genetics

5. Treatment

After reading the page I asked myself the question, what is ulcerative colitis? I read articles on pubmed and they give different descriptions. The literature makes heavy mention of anti-nuclear antibodies, which is mentioned with several other genetically (HLA) linked diseases that are mentioned on the page. Anti-nuclear antibodies are for other organ disease correlate with severe disease. There is no particular evidence of anti-food antibodies with the disease. Viruses, are, however implicated in the increase of anti-nuclear antibodies in other diseaeses. Multiple autoimmune conditions may involve ulcerative colitis, and multiple HLA are invovled in these conditions, DR3-DQ2.5 is suppressive. Less genetics does not need more mention, what it needs is less of a genetics section. Epidemiology, unless it pertains to ethnic or geographic differences, is superfluous. Diseases associated with UC can be placed on its own page. I have created one such page for celiac disease. The problem with autoimmune disease, as one gets away from the core pathology, elevated but low frequency associations can be found with many other diseases. Ergo it is not possible to cover all associated disease in a concise main page.

Example: Ulcerative colitis is associated with other diseases main page: ulcerative colitis associated conditions

Also, there are many factual tidbits that lack references on this page. Maybe if one looked for peer-reviewed material for these references one might be able to clean a few out that were without reference?

This page is not that far away from being a really good page, short of a clean up.Pdeitiker 02:30, 7 September 2007 (UTC)