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Inflammatory Bowel Disease (cont.)

Medical Treatment

The goal of medical treatment is to suppress the abnormal inflammatory response. This allows the intestinal tissue to heal, thereby relieving the symptoms of diarrhea and abdominal pain. Once the symptoms are under control, medical treatment is used to decrease the frequency of flare-ups and to maintain remission.

A stepwise approach to the use of medications for inflammatory bowel disease may be taken. With this approach, the most benign (least harmful) drugs or drugs taken for a short period of time are used first. If they fail to provide relief, drugs from a higher step are used.

The aminosalicylates and symptomatic agents are step I drugs under this scheme. Antibiotics are a step IA; they are particularly used in persons with Crohn disease who have perianal disease or an inflammatory mass.

Corticosteroids constitute step II drugs to be used if the step I drugs fail to provide adequate control of the IBD. They tend to provide rapid relief of symptoms as well as a significant decrease in inflammation.

The immune modifying agents are step III drugs to be used if corticosteroids fail or are required for prolonged periods. These agents are not used in acute flare-ups because the time from initiation of treatment to the onset of significant action may be as long as 2-3 months. Infliximab is a step IIIA drug to be used in persons with Crohn disease. As of this writing, the medications approved by the US FDA for the treatment of Crohn disease are prednisone, budesonide, and infliximab.

The experimental agents are step IV drugs to be used only after failure of the previous steps and only by health care providers familiar with their use.

Note that drugs from all steps may be used additively; in general, the goal is to wean off the corticosteroids as soon as possible to prevent long-term side effects. There may be different opinions regarding the use of certain agents in this stepwise approach.