Inflammatory Bowel Disease (Crohn’s disease and ulcerative colitis)
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. Anti-inflammatories include corticosteroids and aminosalicylates, such as mesalamine (Asacol HD, Delzicol,others), balsalazide (Colazal) and olsalazine (Dipentum). Which medication you take depends on the area
of your colon that’s affected.
Immune system suppressors
These drugs work in a variety of ways to suppress the immune response that releases inflammation-inducing chemicals in the intestinal lining. For some people, a combination of these drugs
works better than one drug alone.
Some examples of immunosuppressant drugs include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune) and methotrexate (Trexall).
One class of drugs called tumor necrosis factor (TNF)-alpha inhibitors, or biologics, works by neutralizing a protein produced by your immune system. Examples include infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). Other biologic therapies that may be used are natalizumab (Tysabri),
vedolizumab (Entyvio) and ustekinumab (Stelara).
Antibiotics may be used in addition to other medications or when infection is a concern — in cases of perianal Crohn’s disease, for example. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
Other medications and supplements
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your IBD, your doctor may recommend one or more of the following:
Anti-diarrheal medications. A fiber supplement — such as psyllium powder (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to your
stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.
Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others).However, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium (Voltaren) likely will make your symptoms worse and can make your disease worse as well.
Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.
Calcium and vitamin D supplements. Crohn’s disease and steroids used to treat it can increase
your risk of osteoporosis, so you may need to take a calcium supplement with added vitamin D.
Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your IBD. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.
If you have a stenosis or stricture in the bowel, your doctor may recommend a low-residue diet. This will help to minimize the chance that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage.
If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your IBD signs and symptoms, your doctor may recommend surgery.
Surgery for ulcerative colitis. Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy).
In most cases, this involves a procedure called an ileal pouch anal anastomosis. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.
In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.
Surgery for Crohn’s disease. Up to one-half of people with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease.
During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.