May 26, 2017

How can I stop the bleeding from Ulcerative Colitis?

Q: We are dealing with some blood in my daughter’s poop again, after almost a year of remission from Ulcerative Colitis following several weeks of fecal microbiota transplants (FMT) administered at home in consultation with a doctor.  We’ve decided now to try a course of Vancomycin.  If that doesn’t work, I am looking into other things to try.  Can you tell me a little more about the anti-depressants you used, and what you think they helped in you?  I want to move quickly this time and not let her get too sick, so we are in a time crunch.  It looks like some of those take a really long time to kick in.  Any feedback you can give would be awesome.

 

A: Thank you for writing and sorry to hear that the Colitis appears to have come back. However given that your daughter was able to sustain remission without drugs for a year I’m confident that she can get back to good health very soon. I have some solutions based on my experience that I think will restore your daughter to health.

Antibiotics like Vancoymcin may help bring the current flare into remission. The antibiotic drug Cipro helped me during my initial flare of Colitis in 1999 after 60 mg of Prednisone and 12 400 mg tablets of Asacol each day were not enough.  I also had a sudden remission when I was briefly given Vancomycin in the hospital for a skin infection on my leg which I believe was related to treatment with Remicade and Prednisone.

While Vancomycin is used to treat Colitis caused by Clostridium Difficile bacteria, and is often used before treatment with fecal transplants, it is very expensive and cannot be used as a treatment long term. Also I don’t see any reason why Vancomycin by itself would lead to remission without the Colitis coming back at some point. It could be helpful if you follow-up with another round of fecal transplants to the point where a stable bacterial colony becomes established

After being given nearly every prescription drug used to treat Ulcerative Colitis without success, two of the most helpful treatments in addition to fecal transplants were protein shakes and the anti-depressant drugs Bupropion (brand names: Wellbutrin, Zyban.)

Protein for healing Ulcers

First, I’ll discuss the protein shakes. I know you are probably asking, how can this help, and what is the reasoning behind why they are helpful?  When I was facing surgery in early 2011, the colo-rectal surgeon who would have performed my surgery told me that my blood albumin levels were low. This meant that the amount of available protein (albumin) in my blood stream for my body to use to repair tissue was lower than ideal for a quick recovery from surgery. He recommended I take meal replacement shakes for the following month to boost my protein levels. I was told that a diet with not enough protein in it as well as chronic inflammation which required my body to constantly use high amounts of protein was to blame. At the time the surgeon also wanted me to taper off Prednisone from the 40 mg I was on at the time before surgery.

This was a problem, I was used to tapering off Prednisone after I got a flare under control, not during a flare. However I started the meal replacement shakes, I ended up going with Muscle Milk over Ensure because it had a much higher amount of protein per serving and was available in powder form which I could mix. Plus, I’ll admit it, I liked the sound of muscle! So I set out to drink about 30 grams of protein 3 times a day while starting to taper down the Prednisone. Interestingly enough the bleeding began to subside, I still had watery stool but at least no blood. I finished tapering off Prednisone, remaining on just Apriso and mesalamine suppositories and regained energy and body weight. This made me question whether surgery was really necessary for me and once I found out about fecal transplants I decided to cancel surgery to give FMT a try first.

Since protein is needed for the body to repair or rebuild damaged tissue, athletes and body builders need it to recover from workouts and build muscle mass. This is also why patients need plenty of protein to recover from surgery. So it stands to reason that the body needs adequate protein to heal ulcers in the large intestine too.  If my available protein levels were low this could explain why I was no longer quickly recovering from flares.

Bupropion for Ulcerative Colitis

Fast forward a few months to where I had done fecal transplants every day for 5 weeks. During the fecal transplants a flare started again. I reluctantly went back on Prednisone and started to run out of it. My doctor wanted me to stop the fecal transplants and I was willing to take a little break at this point. However I somehow ran into a discussion thread discussing the use of Bupropion for Crohn’s Disease. The story was compelling, so I looked for some research. I found a published medical journal article discussing two Crohn’s Disease patients who had sustained remission from Bupropion. Then a study by Glaxo Smith Kline “A Trial of Wellbutrin for the treatment of Crohn’s Disease,” however for some reason they did not publish any results from the completed study. I also read that a study found Bupropion was found to be a TNF-a inhibitor in mice. Since TNF-a inhibitors such as Remicade and Humira are used to treat Crohn’s and Ulcerative Colitis is seemed reasonable that Bupropion could help.

Other advantages of Bupropion include its relatively low cost (less than $100) compared to the other drugs which inhibit TNF-a which cost several thousand dollars per month for treatment. Bupropion also has a low incidence of dangerous side effects at dosage levels of 300 mg a day or less.  By contrast I believe Remicade contributed to two different skin infections which were difficult to treat and in rare cases can cause a form of Lymphoma cancer. Bupropion on the other hand is one of the most commonly prescribed anti-depressant drugs and has been used since 1987 and secondary infections are not listed as a known problem. While the incidence of seizures at doses above 300  mg a day does start to increase with Bupropion, the risk at 300 mg a day or less are the same or less than almost all other anti-depressant drugs.

I ended up going to the psychiatrist who had treated me for ADHD and periodically for seasonal depression to go get a prescription. In addition to Bupropion I also got Silenor at 6 mg for sleep maintenance. The doctor also told me that Silenor which is a low dose of the generic anti-depressant drug Doxepin could also help for IBS symptoms like diarrhea. So I filled the prescription around noon that day and by the end of the following day I had a well-formed bowel movement with no blood in it for the first time in a long, long time.

Since my great remission in July 2011 I have wondered how much of it could be attributed to fecal transplants having reset the bacterial colony in my gut and how is attributable to the addition of other drugs such as Bupropion. Recently I had been having watery, foul-smelling diarrhea for every day for about two weeks. It wasn’t quiet like Ulcerative Colitis, there was no blood and bowel movements were only 2 – 3 times a day. But it was still starting to worry me. Then I started taking Bupropion again for about a week and my stool was once again quite well-formed. As I did not dramatically change my diet or take any other drugs I believe that Bupropion seemed to help once again.