Steatorrhea medical therapy: Difference between revisions
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* '''Celiac disease''' | * '''Celiac disease''' | ||
** Refractory disease | ** Refractory disease | ||
*** A minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain [[gluten]]. Pharmacotherapy is used if dietary modification is not effective.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | *** A minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain [[gluten]]. Pharmacotherapy is used if dietary modification is not effective.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | ||
****1. '''Steroids''' | ****1. '''Steroids''' | ||
*****Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | |||
*****Preferred regimen(2): [[Budesonide]] 9 mg q24h | |||
*****Preferred regimen(3): [[Prednisone]] 0.5–1 mg/kg q24h and [[azathioprine]] 2 mg/kg q24h combination | |||
****2. '''Immunosuppressive drugs''' (Used in steroid dependent or steroid refractory disease) | ****2. '''Immunosuppressive drugs''' (Used in steroid dependent or steroid refractory disease) | ||
*****2.1 '''Antiproliferative agents''' | *****2.1 '''Antiproliferative agents''' | ||
| Line 26: | Line 24: | ||
******Preferred regimen(1): [[Infliximab]] 5 mg/kg q24h | ******Preferred regimen(1): [[Infliximab]] 5 mg/kg q24h | ||
******Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week per 12 weeks | ******Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week per 12 weeks | ||
**Dermatitis herpetiformis | |||
*1. '''Life style modification'''<ref name="pmid12477369">{{cite journal |vauthors=Collin P, Reunala T |title=Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists |journal=Am J Clin Dermatol |volume=4 |issue=1 |pages=13–20 |year=2003 |pmid=12477369 |doi= |url=}}</ref> | ***1. '''Life style modification'''<ref name="pmid12477369">{{cite journal |vauthors=Collin P, Reunala T |title=Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists |journal=Am J Clin Dermatol |volume=4 |issue=1 |pages=13–20 |year=2003 |pmid=12477369 |doi= |url=}}</ref> | ||
**1.1 '''Gluten-free diet (GFD)''' | ****1.1 '''Gluten-free diet (GFD)''' | ||
*2. '''Pharmocatherapy'''<ref name="pmid18360613">{{cite journal |vauthors=Mutasim DF |title=Therapy of autoimmune bullous diseases |journal=Ther Clin Risk Manag |volume=3 |issue=1 |pages=29–40 |year=2007 |pmid=18360613 |pmc=1936286 |doi= |url=}}</ref><ref name="pmid20729961">{{cite journal |vauthors=Han A |title=A practical approach to treating autoimmune bullous disorders with systemic medications |journal=J Clin Aesthet Dermatol |volume=2 |issue=5 |pages=19–28 |year=2009 |pmid=20729961 |pmc=2924135 |doi= |url=}}</ref> | ***2. '''Pharmocatherapy'''<ref name="pmid18360613">{{cite journal |vauthors=Mutasim DF |title=Therapy of autoimmune bullous diseases |journal=Ther Clin Risk Manag |volume=3 |issue=1 |pages=29–40 |year=2007 |pmid=18360613 |pmc=1936286 |doi= |url=}}</ref><ref name="pmid20729961">{{cite journal |vauthors=Han A |title=A practical approach to treating autoimmune bullous disorders with systemic medications |journal=J Clin Aesthet Dermatol |volume=2 |issue=5 |pages=19–28 |year=2009 |pmid=20729961 |pmc=2924135 |doi= |url=}}</ref> | ||
**2.1 '''Sulfones''' | ****2.1 '''Sulfones''' | ||
***Preferred treatment(1): [[Dapsone]] 50 mg q24h increased every week until clearance or tolerance | *****Preferred treatment(1): [[Dapsone]] 50 mg q24h increased every week until clearance or tolerance | ||
**2.2 '''Suhphonamides''' | ****2.2 '''Suhphonamides''' | ||
***Alternative treatment (1): [[Sulfasalazine]] 500 mg q8h (maximum, 2g q8h) | *****Alternative treatment (1): [[Sulfasalazine]] 500 mg q8h (maximum, 2g q8h) | ||
**2.3 '''Combination treatment'''<ref name="pmid28133723">{{cite journal |vauthors=Bevans SL, Sami N |title=Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis |journal=Int. J. Dermatol. |volume=56 |issue=5 |pages=e90–e92 |year=2017 |pmid=28133723 |doi=10.1111/ijd.13542 |url=}}</ref> | ****2.3 '''Combination treatment'''<ref name="pmid28133723">{{cite journal |vauthors=Bevans SL, Sami N |title=Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis |journal=Int. J. Dermatol. |volume=56 |issue=5 |pages=e90–e92 |year=2017 |pmid=28133723 |doi=10.1111/ijd.13542 |url=}}</ref> | ||
***Alternative treatment (1): [[Dapsone]] plus [[sulfasalazine]] | *****Alternative treatment (1): [[Dapsone]] plus [[sulfasalazine]] | ||
**2.4 '''Other treatment''' (intolerance or allergies to dapsone and [[sulfasalazine]]) | ****2.4 '''Other treatment''' (intolerance or allergies to dapsone and [[sulfasalazine]]) | ||
***Alternative treatment (1): [[Colchicine]]<ref name="pmid7458365">{{cite journal |vauthors=Silvers DN, Juhlin EA, Berczeller PH, McSorley J |title=Treatment of dermatitis herpetiformis with colchicine |journal=Arch Dermatol |volume=116 |issue=12 |pages=1373–84 |year=1980 |pmid=7458365 |doi= |url=}}</ref> | *****Alternative treatment (1): [[Colchicine]]<ref name="pmid7458365">{{cite journal |vauthors=Silvers DN, Juhlin EA, Berczeller PH, McSorley J |title=Treatment of dermatitis herpetiformis with colchicine |journal=Arch Dermatol |volume=116 |issue=12 |pages=1373–84 |year=1980 |pmid=7458365 |doi= |url=}}</ref> | ||
***Alternative treatment (2): [[Cholestyramine]] | *****Alternative treatment (2): [[Cholestyramine]] | ||
***Alternative treatment (3): [[Tetracycline]]<ref name="pmid10844495">{{cite journal |vauthors=Shah SA, Ormerod AD |title=Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide |journal=Clin. Exp. Dermatol. |volume=25 |issue=3 |pages=204–5 |year=2000 |pmid=10844495 |doi= |url=}}</ref> | *****Alternative treatment (3): [[Tetracycline]]<ref name="pmid10844495">{{cite journal |vauthors=Shah SA, Ormerod AD |title=Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide |journal=Clin. Exp. Dermatol. |volume=25 |issue=3 |pages=204–5 |year=2000 |pmid=10844495 |doi= |url=}}</ref> | ||
***Alternative treatment (4): [[Nicotinamide|Niacinamide]]<ref name="pmid10844495" /> | *****Alternative treatment (4): [[Nicotinamide|Niacinamide]]<ref name="pmid10844495" /> | ||
***Alternative treatment (5): [[Heparin]]<ref name="pmid10844495" /> | *****Alternative treatment (5): [[Heparin]]<ref name="pmid10844495" /> | ||
***Alternative treatment (6): [[Cyclosporine|Cyclosporin]] | *****Alternative treatment (6): [[Cyclosporine|Cyclosporin]] | ||
**2.5 '''Monoclonal antibodies'''<ref name="pmid28030659">{{cite journal |vauthors=Albers LN, Zone JJ, Stoff BK, Feldman RJ |title=Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis |journal=JAMA Dermatol |volume=153 |issue=3 |pages=315–318 |year=2017 |pmid=28030659 |doi=10.1001/jamadermatol.2016.4676 |url=}}</ref> | ****2.5 '''Monoclonal antibodies'''<ref name="pmid28030659">{{cite journal |vauthors=Albers LN, Zone JJ, Stoff BK, Feldman RJ |title=Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis |journal=JAMA Dermatol |volume=153 |issue=3 |pages=315–318 |year=2017 |pmid=28030659 |doi=10.1001/jamadermatol.2016.4676 |url=}}</ref> | ||
***Preferred treatment(1): [[Rituximab]] | *****Preferred treatment(1): [[Rituximab]] | ||
** | *****'''Note:''' Used is severe cases not improved by other medications. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:20, 8 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Medical Therapy
Medical management of steatorrhea include treatment of underlying etiology.
- Celiac disease
- Refractory disease
- A minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain gluten. Pharmacotherapy is used if dietary modification is not effective.[1]
- 1. Steroids
- Preferred regimen(1): Prednisone 0.5–1 mg/kg q24h
- Preferred regimen(2): Budesonide 9 mg q24h
- Preferred regimen(3): Prednisone 0.5–1 mg/kg q24h and azathioprine 2 mg/kg q24h combination
- 2. Immunosuppressive drugs (Used in steroid dependent or steroid refractory disease)
- 2.1 Antiproliferative agents
- Preferred regimen(1): Azathioprine 2 mg/kg q24h
- 2.2 Calcineurin Inhibitors:
- Preferred regimen(1): Cyclosporine 5 mg/kg q24h PO
- 2.3 Monoclonal antibodies
- Preferred regimen(1): Infliximab 5 mg/kg q24h
- Preferred regimen(2): Alemtuzumab 30 mg twice a week per 12 weeks
- 2.1 Antiproliferative agents
- 1. Steroids
- A minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain gluten. Pharmacotherapy is used if dietary modification is not effective.[1]
- Dermatitis herpetiformis
- 1. Life style modification[2]
- 1.1 Gluten-free diet (GFD)
- 2. Pharmocatherapy[3][4]
- 2.1 Sulfones
- Preferred treatment(1): Dapsone 50 mg q24h increased every week until clearance or tolerance
- 2.2 Suhphonamides
- Alternative treatment (1): Sulfasalazine 500 mg q8h (maximum, 2g q8h)
- 2.3 Combination treatment[5]
- Alternative treatment (1): Dapsone plus sulfasalazine
- 2.4 Other treatment (intolerance or allergies to dapsone and sulfasalazine)
- Alternative treatment (1): Colchicine[6]
- Alternative treatment (2): Cholestyramine
- Alternative treatment (3): Tetracycline[7]
- Alternative treatment (4): Niacinamide[7]
- Alternative treatment (5): Heparin[7]
- Alternative treatment (6): Cyclosporin
- 2.5 Monoclonal antibodies[8]
- Preferred treatment(1): Rituximab
- Note: Used is severe cases not improved by other medications.
- 2.1 Sulfones
- 1. Life style modification[2]
- Refractory disease
References
- ↑ Rubio-Tapia A, Murray JA (2010). "Classification and management of refractory coeliac disease". Gut. 59 (4): 547–57. doi:10.1136/gut.2009.195131. PMC 2861306. PMID 20332526.
- ↑ Collin P, Reunala T (2003). "Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists". Am J Clin Dermatol. 4 (1): 13–20. PMID 12477369.
- ↑ Mutasim DF (2007). "Therapy of autoimmune bullous diseases". Ther Clin Risk Manag. 3 (1): 29–40. PMC 1936286. PMID 18360613.
- ↑ Han A (2009). "A practical approach to treating autoimmune bullous disorders with systemic medications". J Clin Aesthet Dermatol. 2 (5): 19–28. PMC 2924135. PMID 20729961.
- ↑ Bevans SL, Sami N (2017). "Dapsone and sulfasalazine combination therapy in dermatitis herpetiformis". Int. J. Dermatol. 56 (5): e90–e92. doi:10.1111/ijd.13542. PMID 28133723.
- ↑ Silvers DN, Juhlin EA, Berczeller PH, McSorley J (1980). "Treatment of dermatitis herpetiformis with colchicine". Arch Dermatol. 116 (12): 1373–84. PMID 7458365.
- ↑ 7.0 7.1 7.2 Shah SA, Ormerod AD (2000). "Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide". Clin. Exp. Dermatol. 25 (3): 204–5. PMID 10844495.
- ↑ Albers LN, Zone JJ, Stoff BK, Feldman RJ (2017). "Rituximab Treatment for Recalcitrant Dermatitis Herpetiformis". JAMA Dermatol. 153 (3): 315–318. doi:10.1001/jamadermatol.2016.4676. PMID 28030659.