Anyone Tried Aminosalicylates for Gut Inflammation?

[Remy]

I've got this out of control bloating that started in 2009. I was blaming it on histamine, but maybe it is just more inflammation in general because none of the antihistamine/MCAS stuff is helping it go away already.

So I was looking at these gut NSAIDs...

balsalazide (Colazal, Giazo), mesalamine (Asacol, Canasa, Rowasa), olsalazine (Dipentum), sulfasalazine (Azulfidine)

...and wondering why I haven't heard much chatter from people with MECFS about them as a class. We certainly have our fair share of gut problems, including IBS/IBD.

So has anyone taken these drugs? Do they help reverse inflammation in the gut? Are they worth trying?

 

[Who Me?]

@Remy I've never heard of any of these. The only doc I would have bothered to tell about my gut issues is my GI and she only understands the textbook definition of disorders. She has no idea of what it's really like for someone to have any gut issues and how symptoms don't necessarily match what they learned in med school.

FYI I found the balsalazide for $50 for#90 750 mg. Balsalazide is about the same for the 400 mg., $55 for #90 800 mgs

 

[Lissa]

OMG!!!!!!! There is something to combat massive gut bloating???!!!! Sign me up!!!

I'm going out of my mind with how out of control it is lately! I have been reading up on low histamine diet, and MCAS stuff. Hoping that SOMETHING will finally work.

I've tried every diet under the sun including Elemental Yuk Shakes for 3 weeks. That helped but everything reverted back within the next 6 weeks, despite remaining careful about an anti- SIBO diet. (Treated SIBO for over a year already.)

I bloat worse and worse as the day goes on. Doesn't matter what I eat now. (The plate of ice looked good to me....). Ha ha!

Looking 7 months pregnant --- decidedly NOT funny. It's so uncomfortable that it throws my posture out of whack.

MADDENING and soooooooo disheartening to not have answers. Thanks for posting this @Remy !!

 

[Remy]

OMG!!!!!!! There is something to combat massive gut bloating???!!!! Sign me up!!!

I'm going out of my mind with how out of control it is lately! I have been reading up on low histamine diet, and MCAS stuff. Hoping that SOMETHING will finally work.

I've tried every diet under the sun including Elemental Yuk Shakes for 3 weeks. That helped but everything reverted back within the next 6 weeks, despite remaining careful about an anti- SIBO diet. (Treated SIBO for over a year already.)

I bloat worse and worse as the day goes on. Doesn't matter what I eat now. (The plate of ice looked good to me....). Ha ha!

Looking 7 months pregnant --- decidedly NOT funny. It's so uncomfortable that it throws my posture out of whack.

MADDENING and soooooooo disheartening to not have answers. Thanks for posting this @Remy !!

Wait! Wait! I'm asking if it works for bloating...I don't know that it does for sure.

It just seems odd that I haven't heard of these drugs before today. Do they not work, I wonder? It's hard to tell what's a symptom of the disease and a side effect from the IBD forums.

 

[Remy]

They also seem to worryingly cause hair loss. Just what I need would be to lose the bloating...and my hair. Ugh. Never easy. But how could a drug that reduces intestinal inflammation NOT be good for us, I wonder?

 

[Lissa]

Wait! Wait! I'm asking if it works for bloating...I don't know that it does for sure.

It just seems odd that I haven't heard of these drugs before today. Do they not work, I wonder? It's hard to tell what's a symptom of the disease and a side effect from the IBD forums.

Sorry... Even the thought of hope was too much for me! ;-)

 

[Remy]

Sorry... Even the thought of hope was too much for me! ;-)

It's not all lost yet...maybe someone will know.

And I do think that the histamine has something to do with it. Yasmina has written about her bloating and weight struggles on her low histamine chef blog too.

It's about time I had this bloat baby already!!

 

[Who Me?]

I do better with a low residue diet but it's not perfect. Some days I drink water and I cramp.

Today I ate some cooked baby carrots and it was like someone started to pump air
Into my guts. It just kept going and going? I wanted to jam a needle in and burst it like a balloon!

And this is weird but when I bloat I feel pressure in my thighs! Wtf is that about?

 

[Remy]

So the more I read, the more surprised I am that so few people seem to be using these drugs in our population. Except for the fact that they seem to be full of side effects (but it's hard to tell what is a side effect and what is the disease). Still they are considered a first line treatment for IBS/IBD, so it's surprising to me that they haven't at least been offered to more of us.

This is what I read today about the aminosalicylates...

A variety of different mechanisms have been proposed by which aminosalicylates work in inflammatory bowel disease. The main mechanism includes the inhibition of cyclooxyrgenase and lipoxygenase pathways to reduce the production of prostaglandins and leuokotrienes, respectively (Kaiser et al 1999).

Mesalamine also reverses the antiproliferative effects of TNF-alpha thus disrupting the effect of cytokines by reducing intestinal cell transcription of inflammatory mediators (Kaiser et al 1999).

Other processes described include inhibition of platelet activating factor and production of oxygen radicals and other anti-inflammatory factors (Egan et al 1999; Hanauer 2004).

By reducing inflammatory prostaglandin production and the formation of other potent chemotactic substances including leukotriene B4 and certain hydroxy fatty acids (Grisham 1994), mesalamine plays a significant role in halting the perpetuation of a chronic inflammatory state.

The article goes on to talk about the different forms of the drugs in this class...mainly they differ in the pH of where they release the drug along the alimentary canal or if they are attached to an azo group to create a pro-drug that is converted by bacteria in the colon. The latter seems like it might be a bit of a problem for some of us if our colons are not properly populated due to antibiotic use.

Different preparations have been designed in accordance to delivery site depending where the highest activity of disease is located. There have been two major forms of delivery systems currently available.

One method is coating 5-ASA with a pH sensitive resin or a semipermeable membrane.

An alternative approach is a prodrug system which is to link the 5-ASA with another molecule by an azo bond (Figure 2).

The enteric coated formulations include Asacol (Procter & Gamble Pharmaceuticals, Cincinatti OH, USA), coated with Eudragit S, which dissolves at pH 7.0 or above since pH reaches this level in the distal ileum and colon.

Salofalk (Dr Falk Pharma GmbH, Feiburg, Germany), coated with Eudragit L, releases the active ingredient at pH 6.0 and above.

Pentasa (Shire US, Inc., Wayne PA, USA) is a time released formulation containing a semipermeable membrane and releases the drug at pH greater than 6.0.

Olsalazine (Dipentum; Celltech Parmaceuticals, Inc., Rochester NY, USA) and balsalazide (Salix Pharmaceuticals, Inc., Morrisville, NC, USA) are prodrugs, where one 5-ASA is bound covalently through an azo linkage to another 5-ASA and the release of the 5-ASA is by bacterial azo reduction in the colon.

Variability may exist in the absorption of 5-ASA, most commonly due to the failing of the active drug to reach the appropriate pH in the small intestine.

The therapeutic effect of these compounds is dependent on releasing of active drug in the colon which will therefore improve clinical response.

Because of adherence issues, a newer high-strength 1.2 gram mesalamine formulation has been developed which utilizes a multimatrix (MMX) technology to produce a slow and homogenous delivery of mesalamine to the entire colon and rectum (Prantera et al 2005). Once dissolved above pH of 7.0, the core reveals a hydrophilic matrix that turns into a gel mass upon exposure to intestinal fluid, and pieces of the gel are distributed in different parts of the colon. With this higher concentration tablet and slow dissolution, the aim is to increase adherence by minimizing the number of tablets required.

 

[Edie]

Food allergies are a big problem for us. Dairy and sugar was the worst and then a lot more food allergies showed up as time went on. I found a 'NAET' practitioner who cleared me of most of them. If interested, google 'NAET'. I also have to take digestive enzymes with everything I eat or I get the terrible bloating and stomach pain/spasms. PANPLEX 2 PHASE is an excellent digestive enzyme and can be bought on line from www.totalhealthdiscountvitamins.com, a US company. In Canada, I also like 'MEGA DIGESTIVE ENZYMES' from 'SANGTERS' health food stores. Hope this information is of help!

 

[Lissa]

Food allergies are a big problem for us. Dairy and sugar was the worst and then a lot more food allergies showed up as time went on. I found a 'NAET' practitioner who cleared me of most of them. If interested, google 'NAET'. I also have to take digestive enzymes with everything I eat or I get the terrible bloating and stomach pain/spasms. PANPLEX 2 PHASE is an excellent digestive enzyme and can be bought on line from www.totalhealthdiscountvitamins.com, a US company. In Canada, I also like 'MEGA DIGESTIVE ENZYMES' from 'SANGTERS' health food stores. Hope this information is of help!

Yes! I take Panplex 2 also. I take it at the beginning of meals because I can never remember to take it early. When do you take it? Does it make a difference?

 

[Edie]

Yes! I take Panplex 2 also. I take it at the beginning of meals because I can never remember to take it early. When do you take it? Does it make a difference?

Hi Lissa. My Naturopath Doctor told me to eat a bit of food and then take the digestive enzyme. I find that 1/4 into the meal works for me. It may be different for someone else. If I forget to take it till I've eaten 1/2 my meal, I will experience some stomach pain awhile later. I forgot to mention in my previous comment that PANPLEX 2 PHASE is made by 'INTEGRATIVE THERAPEUTICS'. I've read in the last year from 2 different sources that you need a healthy T3 (thyroid) for producing digestive acid which in turn gets the digestive enzymes to work. My T3 is very low, and my ND cannot get the T3 anymore due to some draconian regulation in my Province, although it's available in other Provinces. GO FIGURE!

 

[Remy]

Funny, I just read a post somewhere where one of KDM's patients was just put on mesalamine...

 

[Seven]

I get very painful gas, I use "star Anise" + anise + peppermint tea (all 3 in one tea) and problem solved. This Anise is what they use in my country for gassy babies and works like a charm. I do not need anything else.

I use Canasa (mesalamine) suppositories for colitis (US$80 , usually oral Canasa is given for Chrons. It helps the imflmation for me but nothing for the gas I have to do tea, I guess because mine is local to colon.