To date, there is no known cause of or cures for Inflammatory Bowel Disease (IBD). Fortunately there are many effective treatments to help control the symptoms. However the medications used to treat Crohn’s disease and ulcerative colitis are not necessarily effective for all patients all of the time.
The two main goals of treatments for IBD are:
- Achieving remission (defined as the absence of symptoms)
- Maintaining remission (defined as preventing flare-ups of disease)
These goals may be achieved with a combination of over-the-counter, prescription medications or surgery, depending on each individual case. Doctors will customize treatment to the individual’s needs based on the type and severity of symptoms. Medications may be given in different dosages, formulations, and for different lengths of time.
Medications can be given in oral form (by mouth), intravenously (through a vein), or subcutaneously (by injection under the skin). Topical therapies are administered rectally, as suppositories, enemas, creams, and ointments.
A person’s therapeutic needs may change over time. What works at one point during the disease may not be effective during another stage. It is important for the patient and doctor to thoroughly discuss which course of therapy is best, balancing the benefits and risks of each treatment option.
The most commonly prescribed medications fall into the following categories:
Aminosalicylates
These medications work by inhibiting certain pathways that produce substances that cause inflammation. They are thought to be effective in treating mild-to-moderate episodes of IBD, and are useful as a maintenance treatment in preventing relapses.
They work best in the colon and are not particularly effective if the disease is limited to the small intestine. These are often given orally in the form of delayed release tablets to target the colon, or rectally as enemas or suppositories.
Side effects of these drugs vary but may include;
- Abdominal pain and cramps
- Hair loss
- Diarrhea & gas
- Headaches and dizziness
- Nausea
Some of these medications are linked to kidney problems. Patients on long term use are monitored regularly for any signs of decreased kidney function or pancreatitis.
Corticosteroids
These medications affect the body’s ability to begin and maintain an inflammatory process. In addition, they work to keep the immune system in check. Corticosteroids are used depending on the severity and type of Crohn’s disease or ulcerative colitis.
They can be administered orally, rectally, or intravenously. They are effective for short-term control of disease activity (flares); however, they are not recommended for long-term or maintenance use because of their side effects.
Side effects can include;
- Swelling
- Increased risk of infection
- Weight gain
- Mood swings
- Hair growth
- Cataracts
- Acne
- Stretch marks
- Rounding of the face
- High blood sugar levels
- Insomnia
- Weakened bones
Immunomodulators
This class of medications modifies the body’s immune system so that it cannot cause ongoing inflammation. Usually given orally, immunomodulators are typically used in people for whom aminosalicylates and corticosteroids haven’t been effective, or have only been partially effective.
They may be useful in reducing or eliminating reliance on corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take up to three months to begin working.
All patients on immunomodulators need to be monitored closely for side effects wich can include;
- Bone marrow problems
- Headache & nausea
- Irritation of the liver
- Irritation of the pancreas
- Vomiting, diarrhea and a general feeling of illness
Biologic Therapies
These therapies are bioengineered proteins that target very specific molecules involved in the inflammatory process. These are not drugs but antibodies (types of proteins) that target the action of other proteins that cause inflammation.
These medications are indicated for people with moderately to severely active Crohn’s and ulcerative colitis. They also are effective for reducing fistulas. Fistulas, which may occur with Crohn’s disease, are small tunnels connecting the intestine to another area of the body to which it is not usually connected.
Biologics may be an effective strategy for reducing steroid use, as well as for maintaining remission. While on biologics, you should not receive any live vaccines.
Side effects of these drugs can include;
- Breathing problems
- Allergic reactions
- Headache, rash & coughing
- Viral infections
- Stomach pain
- Bronchitis & pneumonia
- Dizziness & nausea
- Difficult or painful breathing and chest pain
- Diarrhoea
- Fever
Antibiotics
Antibiotics may be used when infection such as an abscess occurs. They are also used to treat pouchitis, which is an inflammation of the ileal pouch, a surgically constructed internal pouch for those who have had their large intestine removed and for prevention of recurrent Crohn’s disease after surgery.
These medications, currently available as tablets, are broken down in the gastrointestinal tract after ingestion and are directly absorbed into the bloodstream via the intestinal wall. Due to the small size of these chemically active substances, they can be transported through the bloodstream to nearly any site in the body, including the immune system.
Unlike some of the other tablet-based agents these agents work more quickly and can induce and maintain remission.
Surgery
Even with proper medication and diet, people with Crohn's disease or ulcerative colitis may require or opt for surgery at some point during their lives. While not a cure, surgery has the potential to dramatically improve quality of life.
Medication may not adequately control symptoms for everyone with IBD, and some people with these conditions develop complications that need more aggressive treatment. In these cases, surgery may be recommended or required.
About 23 to 45 percent of people with ulcerative colitis and up to 75 percent of people with Crohn’s disease will eventually require surgery. Some people with these conditions have the option to choose surgery, while for others, surgery is an absolute necessity due to complications of their disease.
Some people with IBD decide to have surgery because they can no longer bear the symptoms of their disease or they are no longer responding to their prescribed medication.
Some patients do well on a particular medication for a time, and then, for unknown reasons, they stop responding. Other people experience many side effects which they find difficult to tolerate. Surgery will be considered if a person’s quality of life has been severely impacted despite medical treatment or if the side effects of the medications are significant.
Elective surgery may also be recommended for some people with IBD to eliminate the risk of colorectal cancer. Patients with ulcerative colitis and Crohn’s disease have a higher risk for colorectal cancer than the general population. Colorectal cancer rarely occurs in the first eight to ten years after initial diagnosis of IBD. The risk increases the longer a person lives with the disease.
