How Inflammatory Bowel Disease (IBD) Is Treated

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Inflammatory bowel diseases (IBD) is a chronic issue that must be consistently managed for symptom control. There currently is no cure for any form of the disease, but there are effective IBD treatment options that can be considered, including medications, lifestyle changes, and, for some, surgery.

Treatments approved for IBD fall into two categories: those for Crohn's disease and those for ulcerative colitis. Patients with indeterminate colitis, the third type of IBD, are typically given treatments approved for ulcerative colitis.

There isn't one standard of treatment that's used for every person with IBD. There are evidence-based guidelines offered by medical societies, but treatment ultimately needs to be customized to fit the needs of each patient.

Prescriptions

There are several classes of drugs that may be used to treat IBD. Pharmaceutical treatments have a two-fold goal: to get a flare-up under control and into remission, and then to keep remission going and prevent more flare-ups.

Some drugs are used for either one of those goals, while others are used for both.

Class Drug Approved for Crohn's Approved for Ulcerative Colitis
Aminosalicylates (5-ASA) Azulfidine (sulfasalazine)   X
  Asacol, Pentasa, Lialda, Apriso, Delzicol (mesalamine)   X
  Canasa (mesalamine suppositories)   X
  Colazal (balsalazide)   X
  Dipentum (olsazine)   X
  Rowasa (mesalamine enemas)   X
Antibiotics Cipro (ciprofloxacin) X  
  Flagyl (metronidazole) X  
Biologics Cimzia (certolizumab pegol) X  
  Entyvio (vedolizumab) X X
  Humira (adalimumab) X X
  Inflectra (infliximab-dyyb) X X
  Remicade (infliximab) X X
  Simponi (golimumab)   X
  Stelara (ustekinumab) X  
  Tysabri (natalizumab) X  
Corticosteroids Cortenema (hydrocortisone) X X
  Deltasone (prednisone) X X
  Entocort (budesonide) X X
  Medrol (methylprednisolone) X X
  Proctofoam-HC (hydrocortisone acetate, rectal foam) X X
  Uceris (budesonide)   X
Immunomodulators Imuran, Azasan  (azathioprine) X X
  Folex, Rheumatrex (methotrexate) X  
  Prograf (tacrolimus) X X
  Purinethol, 6-MP (6-mercaptopurine) X X
  Sandimmune, Neoral (cyclosporine A) X X

Over-the-Counter (OTC) Therapies

There are a few OTC treatments recommended for patients with IBD. Your doctor may suggest:

  • Fiber supplements: Chronic mild-to-moderate diarrhea is often treated with a fiber supplement, such as Metamucil (psyllium powder) or Citrucel (methylcellulose). Fiber helps add bulk to stool, making it firmer. 
  • Anti-diarrheal medications: For severe diarrhea, your doctor may recommend an OTC anti-diarrheal medicine, such as Imodium A-D (loperamide).
  • Acetaminophen: OTC pain relievers, such as Tylenol, may be helpful for mild pain. Acetaminophen is recommended over other pain relievers, which may irritate the stomach and worsen symptoms. 
  • Iron: People with chronic intestinal bleeding may develop iron deficient anemia. Supplementing with iron is often recommended, though a common side effect of this is constipation. Talk to your doctor about brands you should try. All-natural liquid iron supplements, such as Floradix Floravital, are non-binding and may be more gentle on your gastrointestinal tract. 
  • Calcium and vitamin D: If your IBD is treated with steroids, you may need to supplement with calcium and vitamin D. Both corticosteroid use and Crohn’s disease itself can increase your risk of osteoporosis, and these supplements may help to improve bone density.

Always speak to your healthcare provider before taking non-prescription medications to treat IBD.

Lifestyle

Getting appropriate nutrition can be challenging with IBD, as a number of foods may cause a flare of symptoms. There is no standard list of what to avoid because each patient is different. 

Low-Residue Diet

Your doctor may recommend a low-residue diet, specifically if you have stenosis or stricture in the bowel. This can reduce the likelihood that undigested food will get stuck in the narrowed part of the bowel and lead to a blockage. 

A low-residue diet restricts high-fiber foods, like whole grains, nuts, seeds, fruits, and vegetables.

Enteral or Parenteral Nutrition

Some IBD patients may require nutrition given through a feeding tube (enteral nutrition) or into a vein (parenteral nutrition). This is typically reserved for severe cases.

Feeding tubes can be placed through your nose for short-term nutrition or surgically placed through the abdomen into the stomach. After the initial tube placement, tube feeding can be done at home. 

Parenteral nutrition, sometimes called total parenteral nutrition (TPN), is a sterile liquid chemical formula given through an intravenous catheter (IV) and bypasses the gastrointestinal tract to go directly into the bloodstream. 

The catheter is placed into a large vein leading to the heart, typically under sedation. TPN can be delivered in an outpatient hospital setting or at home.

Surgeries

Some patients with IBD may require surgery, and different procedures are used for Crohn's disease and ulcerative colitis. This is because of the different ways these diseases affect the digestive system and how surgery improves symptoms and quality of life for patients.

If medications aren't helping with inflammation or there are complications, surgery may be recommended. In addition to the above, the type of surgery is based on the location of the inflammation and how far it has spread.

Surgery is not a cure. In some patients, inflammation may return in another location.

Procedures for Crohn's Disease

Surgery for Crohn's disease is often done with minimally invasive techniques (such as laparoscopic surgery), which cuts down on time in hospital and the recovery period.

A few of the more common types of surgery done to treat Crohn's disease include:

  • Resection: This is the most common surgical option to treat Crohn's disease. A resection is when a portion of inflamed or disease intestine is removed, and the two ends of healthy tissue are stitched back together again (also called an anastomosis). This can be done in the small intestine or the large intestine.
  • Strictureplasty: Crohn's disease can cause scar tissue that builds up and may cause a narrowing in the intestine. When a portion of the intestine becomes too narrow, it might be opened up again during strictureplasty surgery.
  • Proctocolectomy (ileoanal anastomosis, straight pull-through): In some people with Crohn's disease, where there is no disease in the rectum, a restorative proctocolectomy might be done. The large intestine is removed and the end of the small intestine is connected directly to the anus. This means that a stoma isn't needed and stool can be passed out the rectum. This type of surgery is usually only done in a particular group of patients.
  • Ostomy surgery: Some people with Crohn's disease that affects the colon will have surgery to create an ileostomy. This is when the colon is removed and a stoma is created on the abdomen. Stool passes out of the body through the stoma, and an ostomy appliance is worn on the abdomen to catch it. Most people with Crohn's disease will not need ostomy surgery.

Procedures for Ulcerative Colitis

The Crohn's and Colitis Foundation of America estimates that anywhere between 23% and 45% of ulcerative colitis patients have surgery. The surgical options for ulcerative colitis include the removal of the large intestine (colectomy) with the creation of either a stoma or an internal pouch to collect stool.

The surgical options for ulcerative colitis include:

  • Protocolectomy with the creation of pelvic pouch (ileal pouch-anal anastomosis, IPAA): After the colon is removed to treat ulcerative colitis, an internal pouch is created out of the last section of the small intestine (the ileum). With this pouch, there is no external ostomy bag or a stoma because the pouch acts like a rectum. Pelvic pouches can be made in a few different shapes, but the one that's most often used is the j-pouch.
  • Protocolectomy with creation of ileostomy: After the colectomy, some patients with ulcerative colitis have an end ileostomy created. A stoma is created on the abdomen for the passage of stool and an ostomy appliance is worn over the stoma.

The idea of having a stoma may seem intimidating, but most patients with ulcerative colitis have a higher quality of life after having ileostomy surgery and do very well with their stoma.

A Word From Verywell

There are more options available today to treat Crohn's disease and ulcerative colitis than ever before. The IBD treatments that have become available in recent years are more effective, and there are more being studied.

The most important part of treating IBD successfully and getting it into remission is in seeing a gastroenterologist regularly and taking medication on time. With the variety of medications available, many patients can bring down the inflammation, prevent complications, and improve the quality of their lives.

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