News

The options for the more severe spectrum of ulcerative colitis has increased significantly. There is the real prospect of preventing surgery (colectomy) for many patients. The new drugs include vedolizumab, ustekinumab (recently funded) and tofacitinib or upadacitinib. There is an application for upadacitinib under consideration.

Amgevita is the new bio similar for adalimumab - replacing Humira. This is an excellent option - definitely equal efficacy with Humira. The biosimilar Amgevita is cheaper and these savings have allowed some more options for treatment. Amgevita is available for ulcerative colitis. There is also the option for weekly dosing if there is some loss of effect over time.

From Feb 1st this year two new drugs are available. Ustekinumab requires an intravenous loading dose then a subcutaneous injection every 8 weeks Vedolizumab requires an intravenous infusion every 8 weeks - this will need to given in a hospital outpatient setting. Both drugs can only be given after adalimumab (Amgevita) has been given and shown to be ineffective - either no initial response are gradual loss of response.

The NZ government has announced a plan to eliminate Hepatitis C by 2030. Excellent treatment is available but uptake is below expectations Some of the problem is that 40% of people infected with Hepatitis C are unaware of the diagnosis

I have had information on dietary exclusions on my website for almost 20 years - even a time when this advice was not popular. Now the low FODMAP diet is widely known and encouraged by gastroenterologists and dietitians. The advice is similar to the exclusion diet that I have advocated for many years but does have a lot more resource and scientific backing. I have revised this section to take on board these changes

There is a lot a discussion now about the safety of PPIs - omeprazole and other similar drugs. This class of drugs has been used for 40 years and used to be considered very safe. Have a look at the heartburn section / tab for "medication" to read an in-depth analysis of the safety concerns with long term treatment

With more time as part of COVID-19 lockdown I have completely revised all of the pages on the website. I am confident that you will find relevant and up-to-date information on any topic covered in the index.

The comments section has been an interesting part of the website for many years. At times I have not been able to add my own feedback because of time constraints. This should now improve - so please add your stories. This may help your problem but also your story may be relevant to many people with similar problems all over the world.

Vedolizumab is used for Crohn's disease and ulcerative colitis. Ustekinumab is used for Crohn's disease at present but also looks good for ulcerative colitis. Go to section on Crohn's disease / monoclonals for more details

Teas containing senna have been removed from sale after consumer NZ article revealed that Medsafe approval was required for these products. This is an excellent move. Always look at the ingredients for any natural product promoted for constipation, bowel cleanse or detox. See sections on constipation and alternative treatments

Molaxole (a product identical to Movicol and Lax-sachets) is now available on prescription without a special authority. This is an excellent long term treatment for constipation with less side-effects than lactulose

A recent article has sparked some debate about a possible link between drugs like Losec (omeprazole) and osteoporosis. The rationale for thinking that this may be possible is because there may be reduced calcium absorption if there is reduced stomach acid - the main effect of omeprazole treatment. A community based study suggested a weak association of these acid reducing drugs and osteoporosis. The study was complicated by the fact the many people were taking mutilple drugs - in fact patients taking Losec were more likely to be also taking multiple other drugs - some of which are known to affect calcium metabolism. More studies are needed but at this stage the association is unproven. There are theoretical reasons to believe that calcium losses are reduced by taking these drugs - therefore there should be a benefit. There is no reason to stop taking these drugs that are a highly effective treatment for indigestion and heartburn.

There is now a fully funded treatment for all types of Hepatitis C. This is very effective - 97% success rate. The treatment is for 8 weeks and there are few side-effects. There is now a national campaign to identify everyone infected with Hepatitis C - perhaps 50,000 people - maybe only 10,000 treated to date

Adalimumab is now available for Crohn's disease with fistula formation. This is a severe and disabling complication of Crohn's disease. Often patients with this problem could be funded based on other criteria. However having a complicated or significant fistula is now enough to justify funding for adalimumab. Treatment will need to be for several years as fistulas can be slow to respond

Rectogesic is effective treatment and should be used if fibre and local ointment fails. the ointment should be applied sparingly to avoid headache. The ointment works by relaxing the anal sphincter and improving blood supply. Excess absorption (using too much) causes dilatation of blood vessels to the head - leading to headache

There is new treatment for constipation that is now funded by Special Authority. This is called Movicol. This is a sachet contains a small amount of powder that dissolves in a glass of water. This is a "gentle" osmotic laxative that works by retaining water in the colon. It is safe for long-term use and has been a major advance in the treatment of constipation. It is available direct from the Pharamcy - therefore you can try this first to see if it will suit you. The usual dose is one sachet daily but can vary from one sachet every 2-3 days to 2 sachets daily

Probiotics are a new and evolving form of treatment for bowel disorders. Probiotics have been proven to work to prevent to some degree for diarrhoea associated with antibiotics. There is some good work now suggesting a role in irritable bowel syndrome. Some of the problem in evaluating this treatment is the wide variety of products with different bacteria, different doses and differing viability of the bacteria. It seems likely that these details - particularly the strain type - may be very important and different strains may be required for different indications I have been very pleased with Inner Health Plus which is a capsule containing equal amounts of Lactobacillus acidophilus and Bifidobacterium - 25 billion bacteria per capsule. This is the sort of amount of bacteria that is likely to work. Check out the website for more details (www.innerhealh.co.au). There is also a probiotic that has been extensively studied for IBS - "IBS Support - Lactobacillus plantarum"

Losec is a widely respected brand name for Omeprazole - an effective treatment for reflux. This was previously only available on prescription but has now become available directly from the Pharamcist. Packs of 7 or 14 tablets can be bought "over the counter" after discussion with your pharmacist. The 10mg tablet is a lower dose than usually prescribed but is an effective treatment for milder symptoms. The effect for most people will be better than Ranitidine or Gaviscon (also available directly from the Pharmacy) although if the symptoms are infrequent - say once a week or less then Ranitidine as required might be the best option. It is certainly an advance to now have a range of products available without a prescription. For frequent and troublesome symptoms you should go directly to your doctor. For more details on Losec (omeprazole) see the section on heartburn. 2011 Losec 20mg has become available directly from the pharmacy. This is gives even more choice for those people with mild and occasional symptoms of heartburn. The duration of treatment that can be obtained from your chemist have now been extended to 30 days

The funding for Humira treatment for Crohn's disease is a major step forward for treatment in NZ. The criteria is restricted but most patients with moderate to severe disease not responding to azathioprine or methotrexate are now able to gain access to this treatment. The treatment is given as an injection every 2 weeks. This given by a self-injecting pen that is easy to use. The results are excellent but close review by your gastroenterologist is required

Ondasentron (previously known as Zofran) is now available without part charge and does not need a special authority. This is a powerful drug for nausea that has been used extensively for control of nausea as a result of chemotherapy but may have much wider applications. Other drugs such as metoclopramide (Maxalon), Stemetil and Motilium need to be tried first but it is useful to now have another alternative.

Funding criteria have been extended for Entocort. This is a steroid like Prednisone that have minimal side-effects. The drug works in the gut but the absorption to the rest of the body (systemic absorption) is limited to 5-10%. This drug was developed for Crohn's disease of the terminal ileum - the last part of the small bowel - but does have other potential uses Entocort works very well for microscopic colitis. This is a relatively uncommon form of inflammation of the colon that causes watery diarrhoea. Most of the time the cause of this condition is unknown. The symptoms can last for only a few months but can be a recurring problem for several years. Entocort works very quickly and can be used on an intermittent basis depending on response

Treatments that target specific parts of the body's inflammatory pathway are called monoclonal antibodies. The most exciting target molecule to date is called TNF and therefore these treatments are called anti-TNF antibodies. The first treatment in this group is called infliximab - marketed in NZ as Remicaide. This needs to be given by intravenous infusion in a hsopital outpatient setting. A new anti-TNF treatment is called adulimamab - marketed as Humira. This has the significant advantage of being able to given as a subcutaneous injection every fortnight. This treatment may also have less allergic reactions. Humira is now available through your gastroenterologist and is fully funded provided your fulfill some treatment criteria. Generally this treatment is only used for severe Crohn's disease. Usually the duration of treatment will be for more than 1 year - perhaps several years depending on your response

The widely accepted drug for reflux called Losec is no longer fully funded by PHARMAC. The only preperation available is called Dr Reddy's omeprazole. This is the same compound (omeprazole) but is significantly cheaper and hence there is a sole funding arrangement is for this drug. The evidence to date would suggest that this is comparable to Losec but time will tell whether this proves to be as effective in clinical practice. Some people have chosen to pay the extra for the established brand

The funding of entecavir, a new tablet treatment for Hepatitis B, has given a much better choice of treatments for this infection. In particular, this new drug has much lower rates of resistance over time and is the preferred option if starting treatment for the first time. You will need to be referred to a specialist gastroenterologist who will need to apply for a Special Authority for this drug. Previous treatment with Lamivudine (Zeffix) is a contra-indication for this treatment.

The government has announced that there will be a screening programme to detect colon cancer at an early stage - before symptoms occur and at a stage when surgery is curative. This will involve testing a sample of faeces for the presence of blood. The test kit will be easy to use and hopefully a good proportion of the target population (over 55 years) will take this opportunity. The planning is continuing but may be ready to start in 2 years. The best screening is to have a colonoscopy at 50 years. This cannot be funded by the taxpayer but for those serious about prevention - this is the best approach. See section on polyps and cancer for more details