Patients suffering from Crohn’s disease or ulcerative colitis currently have a lot to worry about, in addition to constantly dealing with the symptoms of their disease, they must often be well-versed in the therapeutic options available to them. The Solmed Polyclinic team led by Dr. For 4 years, Dominik Kralje has been trying to offer patients new therapeutic options and strategies for the treatment of inflammatory bowel diseases. We also know that new medicines can only be a good addition to natural medicines such as optimal diet (gluten-free, LCHF, paleo diet), certain food supplements, and lifestyle changes.
We recognize several problems that patients face in their daily lives: too little discussion about optimal nutrition and nutritional supplements, too long a wait for biological therapy, confusion in choosing the optimal biological therapy, and too few therapeutic options for patients with localized forms of ulcerative colitis in which local therapy would be very was probably optimal. We found the answer to all these problems, so let’s go in order.
1. Diet
The Mediterranean version of the LCHF diet is the optimal diet for patients with inflammatory bowel diseases. It is a diet based on a lot of olive oil, nuts, and seeds, a lot of fish and poultry, and a little red meat, a significant reduction of carbohydrates in the diet, almost complete elimination of gluten from the diet, and the introduction of excellent desserts based on sugar-free almond or coconut flour and a glass of red wine a day. This type of diet has been shown to be effective in positive changes in the intestinal microbiome in people with irritable bowel syndrome (IBS), and intestinal bacterial overgrowth (SIBO), and there is more and more evidence in patients suffering from inflammatory bowel diseases. With this kind of diet, it is good to add a little vitamin D and B complex, and the addition of curcumin will not hurt either. We have detailed instructions and meal plans and weekly menus ready, we are sure that you will enjoy this diet and that your gut will be happy.
2. Systemic biological therapy
If you have difficulty finding biological therapy, we can help you. Namely, Polyclinic Solmed is a collaborating institution on several international research projects, within the framework of which we can provide patients with biological therapy and all necessary diagnostic tests, including colonoscopy under anesthesia, free of charge. A biological therapy is currently available that blocks the effect of one molecule that promotes the development of inflammation, interleukin 23 (IL-23). What is it really about? IL-23 receptors on T lymphocytes bind the IL-23 molecule twice as strongly, which means that a normal concentration of IL-23 in the blood can over-activate T lymphocytes, which then activate the further cascade that causes Crohn’s disease. Blocking this receptor can potentially prevent the further cascade that causes Crohn’s disease to flare up. The realization that the oversensitive receptor for IL-23 is actually the main culprit of Crohn’s disease led to the discovery of drugs that block IL-23 receptors in a targeted manner. And indeed, this group of drugs has been shown to be more effective than “joint” IL-12 and IL-23 inhibitors in the treatment of Crohn’s disease, psoriasis, psoriatic arthritis, and atopic dermatitis. In earlier tests, this drug proved to be very effective, namely 55% of patients went into clinical remission of the disease after 3 months of treatment.
3. Ineffectiveness of previous biological or conventional therapy
Most patients have unfortunately experienced failure of conventional and/or biological therapy. At the Solmed Polyclinic, we have an option that does not belong to either of these two groups of drugs. It is a special separate group of drugs that block the S1P receptor in lymphocytes. What kind of medicine is it actually? Namely, the inflammation of the intestinal mucosa in some patients with Crohn’s disease is caused mainly by lymphocytes, and in others mainly by neutrophils. A drug that blocks the S1P receptor in lymphocytes is designed precisely with the goal of keeping lymphocytes in the lymph nodes and preventing their excessive accumulation in the intestinal mucosa. Despite the fact that the drug “numbs” lymphocytes, important cells in the body’s defense against infections, it is not associated with a higher risk of developing infections or any other side effects. Although the drug has no major side effects, we will not use it “by heart”. Namely, the patients will first undergo a colonoscopy under sedation, when samples of the inflamed intestinal mucosa will be taken. The pathohistological analysis will assess whether the patient has inflammation caused by lymphocytes or neutrophils. If lymphocytes are the main cause, only then do we start treatment. In earlier trials, as many as 94% of patients had clinical improvement, and 65% of patients had disease remission after one year of therapy. The medicine is taken in the form of tablets, so the therapy is maximally simple, safe, and effective.
4. Localized (left-sided) ulcerative colitis
In patients who have Crohn’s disease or ulcerative colitis that affects a large area of the small colon, systemic treatment (taking the medicine in the form of a tablet or injection) is the only logical treatment option, because this is the only way the medicine can reach every diseased place in the intestine. But if the patient has ulcerative colitis, which for example affects only the left half of the colon, why expose the whole organism to the potential side effects of the drug, when the drug, in that case, can be delivered to the inflamed area in a simpler way? Enemas have been used for a long time in the treatment of patients with left-sided ulcerative colitis, but for now, they mostly contain conventional drugs that are not overly effective. For the first time, we have the option of enema treatment that contains biological therapy. The patient self-administers this medicine in the form of an enema every three weeks, and the results of the tests so far are excellent: as many as 75% of patients have already had a significant clinical improvement after two applications of the medicine. Patients who have left-sided ulcerative colitis, in which the inflammation has affected more than 15 cm of the colon, and who have not responded well to at least one line of treatment, are candidates for this innovative therapy.
At the Solmed Polyclinic, patient treatment always implies a holistic and individualized approach. Contact us with confidence.
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