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General Overview of IBD Treatment Options

Nowadays there is no medical cure for Inflammatory Bowel Disease, but you sure can control the symptoms and thus make your life more comfortable. IBD (Inflammatory Bowel Disease) is a group of chronic diseases that include the large or small intestine inflammation. Crohn's disease (CD) and ulcerative colitis (UC) are the most common of its types. IBD is rather common in children of “school age”.

It is very important that the treatment is started as the first symptoms of IBD occur, in order to quickly control them and to avoid complications from all treatment medications. As together with IBD main symptoms (rectal bleeding, diarrhea) other symptoms may develop, such as kidney stones, arthritis, liver disease, etc. There are two options for treating IBD: with medications and with the help of surgery in case of more severe cases of the disease. Changes in diet and lifestyle are also included. Treatment is different for each person, depending on:

  • the patient’s food and life habits
  • the situations when the symptoms occur
  • the severity of symptoms
  • what part of the intestine is affected
  • what other diseases the patient has (and what drugs he or she takes)
  • what medications are more likely to help this patient with minimum side effects
  • changes in symptoms (or its severity) over some time of treatment
  • some other factors

You doctor will help you to find the most effective category of medication for every stage of the treatment. There are five of them:

Basic category

/

What is it

What for

Methods of delivery

Examples

1.       Aminosalicylates

(5-ASA drugs) These are anti-inflammatory medicines that contain 5-aminosalicylic acid (5-ASA)

Medications that control the inflammation that occurs during a flare-up, relieve painful symptoms ,prevent relapses and help to maintain positive results

Used in treating mild-to-moderate episodes of CD

oral

Sulfasalazine; and 5-ASA without sulfapyridine: balsalazide, mesalamine, olsalazine

 
 
alternative

Suppositories (rectal), enema formulations, local mesalamine preparations and delayed (extended )-release preparations

2.       Corticosteroids

(steroids)

Fast-acting anti-inflammatory medications with powerful effect (recommended for short-term use and lowest possible dosage only)

For people with moderate to severe active disease and for more severe cases of UC (work fast but have immunosuppressive effect), but not effective in preventing flare-ups

oral

Prednisone, hydrocortisone, methylprednisolon (sometimes together with aminosalicylate drugs)

 
 
rectal

Suppositories, enemas, foams (for mild-to-moderate UC)

 
 
intravenous (IV)
Methylpredisone and hydrocortisone

There is also a new class of corticosteroids - nonsystemic steroids

For treating mild-to-moderate Crohn's disease (affect only certain parts of the intestine directly)

oral
Budesonide
3.     Immunomodulators

Medications that are used for those who do not respond well to aminosalicylates, corticosteroids and antibiotics

For decreasing the inflammatory response while modulating the activity of the immune system (weaken it), for maintaining remission in UC and CD

oral

Azathioprine, 6-mercaptopurine (6-MP), cyclosporine A

, tacrolimus
 
 
intravenous (IV)
Cyclosporine A (in case of active CD)
 
 
applied topically

Tacrolimus (in case CD affects the perineal area or mouth)

 
 
in injections
Methotrexate

4.       Antibiotics

Medications that are used for people with CD who have fistulas or local recurrent abscesses (long-term), not effective for UC (except toxic megacolon)

Used without any specific infections  for reducing intestinal bacteria and suppressing the intestinal immune system

Oral or intravenous (IV)

Broad-spectrum antibiotics, such as metronidazole and ciprofloxacin

5.    Biologic therapies

These are genetically engineered medications (the newest class of drugs in treating IBD) that is made from proteins, genes, antibodies and other living organisms

Used for treating inflammation at various stages; unlike corticosteroids these medications suppress only part of the immune system selectively (what is defected), and not the whole system

They deal with the symptoms and prevent flare-ups

via intravenous infusion
anti-TNF agents (infliximab)
 
 
in injections

anti-TNF agents (adalimumab, certolizumab pegol)

 
 
in IV infusion
integrin receptor antagonists (natalizumab)
 
 
 

Other biologic therapies (such as thalidomide, GM-CSF, alicaforsen, IL-12, etc.)

 

For successful treatment your doctor will also watch over all the changes (in smallest details) in your symptoms in order to maintain the positive result from treatment and to minimize the side effects from medications. Some patients may require surgery after the treatment with medications, some of them may need it from the moment the IBD is diagnosed. But in most cases IBD symptoms is well controlled with the individual treatment plant and doctor’s supervision.

Valentyna Ant.


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