1.What kind of Crohn’s patients are suitable for enteral nutrition therapy?
(1) children with Crohn’s disease; (2) combined with malnutrition; (3) there is already incomplete intestinal obstruction, the ordinary diet will intermittently appear obstructive symptoms; (4), the lesion is in the active stage, enteral nutrition support is feasible to induce remission.
2.What products are included in enteral nutrition and what are the advantages and disadvantages of each?
(1) Amino acid type, such as Vivo, is a pre-digested amino acid preparation, which is dregs-free and can be absorbed without digestive juices or very little digestive juices; (2) Short peptide type, such as Peptole (suspension) and Peptoxin (powder), etc. The protein contained is protein hydrolysate, which can be easily used by the body and almost completely absorbed, with low dregs, requiring little digestive juices for absorption and little fecal discharge. At the same time, it does not contain lactose, avoiding a series of problems such as diarrhea and lipid metabolism disorder caused by lactose intolerance; (3) whole protein type, such as Ansol, Risu, Raidai (diabetic type), Rui Neng (tumor applicable type), etc.
3.What is the difference between oral and nasal feeding of Bepril?
The effect of nasal feeding is better than oral feeding, especially for the patients with incomplete obstruction, just like the sewer is not quite usual, if a basin of water is poured down, it is easy to lead to complete blockage of the sewer, but if the water is adjusted to a small amount and flow down drop by drop, the probability of blockage is much smaller. The disadvantage of nasal feeding is the nasopharyngeal discomfort caused by the feeding tube and its appearance. For patients who need to go to work during the day, it is recommended to take it orally at work and nasal feeding at night after inserting the nasogastric tube by oneself.
4.What should I pay attention to when nasal feeding nutrition solution at home?
(1) In the process of home nutrition support, attention should be paid to the elevation of head and neck when sleeping to prevent aspiration, as aspiration pneumonia is a potentially fatal complication; (2) In winter, as the nutrition solution is cooler, it can be warmed up in warm water before nasal feeding; (3) After nasal feeding, rinse the tube with warm water to ensure that there is no residue in the tube to prevent blockage of the feeding tube; (4) Patients who use total enteral nutrition (i.e. no other food) for a long time should pay attention to their electrolytes and blood sugar. (5) For patients with nasopharyngeal discomfort, they should first check whether the tube is correctly positioned, usually pay attention to tube care, prevent mucosal abrasions, but when taking lozenges and Golden Throat Health Spray to relieve symptoms.
5.What should I do if I have diarrhea with enteral nutrition?
For total enteral nutrition support, especially for patients who receive 2000ml of nasal nutrition solution daily, the possible causes of diarrhea 3-5 times a day are more common: long-term failure to eat, initial nasal feeding, too fast infusion rate, malabsorption, too high concentration, lactose intolerance, or Crohn’s disease itself diarrhea symptoms. The first time should start with low concentration, gradually increase the concentration and reduce the infusion speed; for lactose intolerant patients, lactose-free formula should be given, and attention should be paid to water-electrolyte disorders caused by diarrhea, such as dehydration and low potassium, etc., and timely adjustment.
6.What should I pay attention to when recovering from enteral nutrition to normal diet?
It should be gradually overdone and should not be rushed. For example, change from the first 4 bottles of Bupleurum daily to 3 bottles of Bupleurum daily + thin rice, and then further increase the amount of thin rice, noodles and other soft food if there is no sign of relapse for a few days, and the whole process of transition should be at least 10 days.
7.What drugs are currently available to treat Crohn’s disease?
Commonly used therapeutic drugs include 5-salicylic acid, salicylic acid, salicylic acid, antibiotics, hormones, ralston, immunosuppressive drugs, enteral nutrition, probiotics and monoclonal antibodies.
8.What kind of Crohn’s disease needs to be treated with class grams?
(1) Induction of remission: patients with moderately to severely active CD who have been treated with regular therapy, i.e. corticosteroids or immunosuppressants (e.g. azathioprine, etc.), who are ineffective or hormone-dependent, or who are intolerant (contraindications or serious adverse effects). patients with CD combined with enterocutaneous fistula, anal fistula or rectovaginal fistula who have been treated with regular therapy (including antibiotics, immunosuppressants, etc.).
(2) Maintenance of remission: the above patients, who are effectively treated by infliximab or who have achieved remission.
9.What are the contraindications to the use of classical grams for the treatment of Crohn’s disease?
(1) Active infection, chronic infection or a recent history of recurrent infection. Among them, special attention should be paid to tuberculosis infection and hepatitis B virus infection in China.
(2) Congestive heart failure.
(3) Malignant neoplasm (including current and past history).
(4) Demyelinating lesions of the nervous system.
(5) Hypersensitivity to rodent-derived protein components.
(6) Pregnancy.
10.What is the price of Classac?
It is more expensive: 100mg per dose, the price is 6600 RMB. If the dose is 5mg/kg of body weight, a 50kg patient can get about 250mg at a time, i.e. 2-3 injections, which is about 13,000-20,000 RMB.
11.Does the use of classical gram necessarily relieve the symptoms?
In the clinical study, it was found that although Infliximab could provide rapid remission in some patients, the remission rate was not significant with long-term use alone, mainly because of the high recurrence rate, and 1/3 of the patients still needed surgery at a later stage.
12. Are there any side effects of classical gram?
In recent years, some side effects related to immunity and infection have been observed with the long-term use of analogues. The common side effects during the use of analogues include headache, dizziness, nausea, skin irritation at the injection site, flushing of the face, chest pain, difficulty in breathing and itching. In addition, analogs can also cause anti-double-stranded helix DNA antibodies (dsDNA, 23.3%-34%), anti-nuclear antibodies (ANA, 46%-56%), drug-induced systemic reactions (0.2%), upper respiratory and urinary tract infections (30%-34%), and opportunistic bacterial infections (Nocardia, cytomegalovirus, histoplasmosis, invasive pulmonary aspergillosis), in the body. acute tuberculosis infection, lymphoma, optic neuritis, multiple motor neuron disease, and drug-induced lupus.
13.What is fecal transplantation (intestinal flora transplantation)?
Intestinal flora transplantation, commonly known as fecal transplantation. It refers to the injection of fecal suspension of healthy people into the intestine of Crohn’s disease patients through enema or nasal intestinal tube. Since the fecal suspension of healthy people contains a large amount of normal intestinal flora, through this alternative treatment, we try to correct the abnormal intestinal flora of Crohn’s disease patients to achieve therapeutic effect.
14.How effective is fecal transplantation in Crohn’s disease?
This therapy is still in the preliminary stage of exploration, and its therapeutic mechanism and clinical application prospects still need further research.
15.My symptoms have improved, when can I stop the medication?
So far, Crohn’s disease is still a disease that cannot be completely cured. Even if some patients have their symptoms relieved after treatment, or even the endoscopic lesions are completely healed, it does not mean that the disease is cured or that the treatment can be stopped. This is called “maintenance therapy” and can greatly reduce the frequency of relapses. Since most of the patients are young and busy, many of them “forget the pain when they are well” and stop taking the medication as soon as the symptoms disappear. As a result, the symptoms of diarrhea and blood in the stool may reappear in a short time. There is no cure for this disease, but it can be managed with medications for a long period of time to live in peace with these diseases. Therefore, the goal of treatment for Crohn’s disease is never “cure” but “control”.