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5‐ASA suppositories, enemas or foam for induction of remission in ulcerative colitis

Ulcerative colitis (UC) is a chronic condition wherein the innermost lining of the large bowel becomes inflamed. If UC affects only the last part of the bowel (distal UC), medications can be given rectally. 5‐Aminosalicylic acid (5‐ASA) is used commonly to treat mild to moderately active UC. A review of the literature was undertaken to determine how effective rectal 5‐ASA (e.g. enemas, suppositories or foam) is for treating distal UC. Thirty‐eight studies met the criteria for inclusion in the review. Pooled results from these studies show that rectal 5‐ASA is superior to placebo (fake suppositories, enemas or foam) for improving symptoms, improving the appearance of the bowel lining at colonoscopy, and improving the appearance of biopsies of the bowel examined microscopically. Rectal 5‐ASA is also superior to rectal steroids for improving symptoms. Side effects were generally mild in nature and included abdominal pain or distention, nausea and anal discomfort or irritation. From these results, it was concluded that rectal 5‐ASA should be a first‐line treatment for patients with mild to moderately active distal UC.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Using medication: Injections, suppositories and other dosage forms

For medications to reach the right place inside the body, a suitable dosage form is selected when they are produced. Tablets and ointments are just two of the many different possible dosage forms.The dosage form depends on various things, including what physical and chemical properties the drug has and where it should take effect. For example, medicine that should have an effect on the lungs can be breathed in. Drugs for treating a vaginal infection can be inserted using a vaginal suppository. Drugs that are absorbed into the body through the mucous membranes lining the mouth can also be taken in the form of chewing gum. One well-known example is nicotine gum for helping to quit smoking.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 31, 2012

Rectal 5‐aminosalicylic acid (suppository, foam or liquid enema) for maintenance of remission in ulcerative colitis

5‐aminosalicylic acid (5‐ASA) is a commonly used medication for treatment of mild and moderately active ulcerative colitis (UC) and UC in remission. When UC affects only the lower third of the colon, 5‐ASA can be delivered as a rectal suppository, foam or liquid enema. This review includes nine randomized trials with a total of 484 participants. The limited data available suggest that rectal 5‐ASA is effective and safe for maintenance of remission in UC. Rectal 5‐ASA was found to be superior to placebo (e.g. enema or suppository with no active medicine). There was no difference in the incidence of side effects between rectal 5‐ASA and placebo groups. Side effects were generally mild in nature and common side effects included anal irritation and abdominal pain. Studies comparing rectal 5‐ASA with oral 5‐ASA (pills) found no differences in effectiveness for maintenance therapy. Well designed randomized trials are needed to investigate different doses of rectal 5‐ASA for maintenance therapy, Future studies should assess the effectiveness of combination therapy of oral 5‐ASA with rectal 5‐ASA as this has been found to be effective in active UC and has not been investigated for maintenance therapy. Future studies should also compare rectal 5‐ASA with rectal corticosteroids.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Rectal analgesia for pain from perineal trauma following childbirth

Rectal suppositories give short‐term pain relief for perineal trauma after childbirth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Enlarged hemorrhoids: How can you relieve the symptoms yourself?

There is a lot of advice out there about how to relieve the symptoms of enlarged hemorrhoids yourself – including things like avoiding constipation, and using special ointments or warm baths. Some of these approaches can actually help, but many of them have not been tested in good scientific studies.If someone has enlarged hemorrhoids (also known as “piles”), trying to prevent constipation and changing their toilet habits can make an important difference. Various medications and other measures can also be tried out to relieve the symptoms. But this will not make enlarged hemorrhoids shrink again.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 29, 2014

Several antibiotic agents, including metronidazole, ciprofloxacin, and rifaximin, as well as oral probiotics, may be effective treatments for pouchitis.

Some patients with ulcerative colitis have their colon and rectum removed with construction of a reservoir or pouch (made from a loop of small intestine) to serve in place of the rectum. This is known as an ileal pouch‐anal anastomosis (IPAA) surgery. Pouchitis is acute inflammation of the surgically constructed pouch which may cause diarrhea and other problems. The exact cause of pouchitis is not known, but it may be caused by an imbalance in bacteria (similar to an infection) and can be treated by antibiotics, probiotics (bacteria important for the health of the bowel), or other agents that may reduce or prevent inflammation. Metronidazole and Ciprofloxacin (two antibiotics), budesonide enemas (a topical steroid that may decrease inflammation), and oral probiotic therapy with VSL#3 all appear to be effective therapies for acute and/or chronic pouchitis. Current evidence does not support the use of lactobacillus GG (a different probiotic), bismuth (a metal that may be useful in some diarrheal disorders), butyrate and glutamine (two nutrients required by the bowel), allopurinol (a gout medication which may decrease inflammation), or inulin (a non‐absorbable sugar which may decrease inflammation). So far the research performed has generally consisted of small studies that were not reproduced, so more research is needed to determine which of these different medications are best for treatment of pouchitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Bacterial vaginosis: Overview

In bacterial vaginosis (sometime abbreviated as BV) much larger numbers of bacteria grow inside of the vagina than would normally just be there. This increase in bacteria is usually not dangerous and it often goes unnoticed, but it can cause a strong-smelling vaginal discharge and be very unpleasant. It also increases the risk of a vaginal infection. Antibiotics can provide effective treatment.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 22, 2015

Nausea and Vomiting (PDQ®): Patient Version

Expert-reviewed information summary about nausea and vomiting as complications of cancer or its treatment. Approaches to the management of nausea and vomiting are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 12, 2013

Progestogens To Prevent Preterm Birth: A Review of the Research About Progestogens for Women at Risk

This summary will tell you about the risk of preterm birth. It also tells you what the research says about the benefits and harms of taking a progestogen to prevent preterm birth. You can use this information to talk with your doctor about whether taking a progestogen is the best treatment option for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 21, 2012

Treating migraine with medication

Migraine attacks can be treated with different types of medication. Apart from commonly used painkillers, products for nausea or special migraine medication called triptans can also be used.Most people will use one or more medications to help them through an attack, especially if the migraine is very painful. Which medications people use depends on how serious the migraine attack is: A "basic" painkiller from a pharmacy might be enough to relieve moderate pain. But a stronger medication is needed for more severe migraines. People who have frequent migraines will often keep a variety of medications ready to be used if needed.The types of medication most commonly used by adults with migraines are:Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid (ASA, the drug in "Aspirin"), ibuprofen, diclofenac or naproxen, and acetaminophen (paracetamol)Nausea medication like metoclopramide or domperidoneSpecial migraine medication (triptans) such as almotriptan or eletriptanAnother substance some migraine prescription drugs are based on  is ergotamine, which is derived from a grain fungus called ergot. For almost a century this was the only medicine specifically used to treat migraines. Nowadays, ergotamine is used less because it has more side effects than the triptans. In Germany, ergotamine products are no longer approved for preventing migraines as of 2014.Different types of medication serve different purposes. Some people mainly want relief as quickly as possible. They might go for a drug that acts faster, even if another might provide more relief but take longer to kick in. For others, maximum relief is the most important thing, even if it takes a little longer to start working. People whose migraines last for a long time might prefer drugs with a longer-lasting effect. Some people's options are limited, for example because they have heart disease and are therefore advised not to use triptans.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 20, 2012

Pain (PDQ®): Patient Version

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 10, 2014

Sumatriptan (all routes of administration) for acute migraine attacks in adults

Migraine is a complex condition with a wide variety of symptoms. For many people, the main feature is a painful, and often disabling, headache. Other symptoms include disturbed vision; sensitivity to light, sound, and smells; feeling sick; and vomiting. Migraine affects about 1 person in 8, mainly women, and mainly in the age range of 30 to 50 years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Management of faecal incontinence and constipation in adults with central nervous system diseases

Individuals with central nervous system disease or injury have a much higher risk of loss of bowel control and severe constipation than other people. This is called neurogenic bowel dysfunction (NBD). It can be very difficult to treat constipation without causing bowel leakage, or to prevent bowel leakage without causing constipation. The time spent on emptying the bowel is nearly always much greater for these individuals. Bowel problems like this cause a lot of anxiety and distress and can reduce the quality of life of those who suffer them. This review of research about NBD could be of interest to individuals with any damage to the central nervous system caused by disease or injury, or present at birth, which has a long term effect on how their bowel works.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Artemisinin derivatives for treating severe malaria

Artemisinin drugs improve survival in severe malaria. Artemisinin drugs come originally from a plant that has been used since ancient times in China as a traditional medicine for fever and malaria. They are fast acting and effective against malaria parasites that have developed resistance to quinine. The review shows that treatment with artemisinin drugs may be better than quinine at preventing death in adults and children with severe and complicated malaria. There is no evidence so far against early treatment with suppositories in rural areas whilst patients are transferred to hospital. Few side effects have been reported with these drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns

Background: Newborn infants have the ability to experience pain. Newborns treated in neonatal intensive care units are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gastrointestinal Complications (PDQ®): Patient Version

Expert-reviewed information summary about constipation, impaction, bowel obstruction, and diarrhea as complications of cancer or its treatment. The management of these problems is discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 12, 2015

Medication list

It can be helpful to list all medications you are taking before seeing a doctor. This may also make it easier for you to keep track yourself.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 7, 2013

Using medication: Topical medications

Applying medication to the skin or mucous membranes allows it to enter the body from there. Medication applied in this way is known as topical medication. It can also be used to treat pain or other problems in specific parts of the body.Topical medication can also be used to nourish the skin and protect it from harm. Some topical medications are used for local treatment, and some are meant to affect the whole body after being absorbed through the skin.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 31, 2012

Using medication: Overview

Taking medication sounds easy enough but can be complicated, for example if you have to take a lot of different medications for a long time. What is the best way to keep track of it all? And what is important to know when using  antibiotics? And how can you make sure children get the right dose?

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 4, 2013

Topically applied anaesthetics for treating perineal pain after childbirth

Not enough evidence to say if local anaesthetics applied to the perineum help to relieve perineal pain after childbirth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Systematic Reviews in PubMed

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