Inflammatory Bowel Disease (IBD) (cont.)

1. Irritable Bowel Disease Slideshow
2. Ulcerative Colitis Slideshow Pictures
3. Take the Tummy Trouble Quiz

Diet changes may be necessary for both diseases. It is important to eat a healthy diet.

• Depending on the person's symptoms, a health care professional may ask them to decrease the amount of fiber or dairy products in their diet.
• Diet has little or no influence on the inflammatory activity in ulcerative colitis. However, diet may influence symptoms. For this reason, people with inflammatory bowel disease often are placed on a variety of diet interventions, especially low-residue diets. Evidence does not support a low-residue diet as beneficial in treating the inflammation of ulcerative colitis, though it might decrease the frequency of bowel movements.
• Unlike ulcerative colitis, diet can influence inflammatory activity in Crohn's disease. Nothing by mouth (NPO status) can hasten the reduction of inflammation, as might the use of a liquid diet or a predigested formula.
• When a person becomes extremely stressed, IBD symptoms may get worse. Therefore, it is important that patients learn to manage the stress in their lives.

Medical treatment for IBD depends upon whether it is Crohn's disease or ulcerative colitis. There are a variety of medications prescribed to treat the disease and symptoms of the disease. While ulcerative colitis can be resolved with surgery, Crohn's disease cannot, and the patient may continue to suffer from the disease.

The goal of medical treatment is to suppress the abnormal inflammatory response. This allows the intestinal tissue to heal, 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 that are less benign are used.

• The amino-salicylates work on the lining of the intestine and are step I drugs under this scheme. Antibiotics are step IA drugs; they are particularly used in persons with Crohn's disease who have perianal disease or an inflammatory mass where infection is a concern.
• 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 it may take up to 2 to 3 months for these drugs to work. Examples of immune modifying agents are azathioprine (Azasan, Imuran) and 6 mercaptopurine (Purinethol).
• Biologic agents are anti TNF and non anti TNF agents. These are step IIIA drugs to be used in persons with Crohn's disease and ulcerative colitis. The biologic agents which are now approved by the FDA for treatment of Crohn's disease are infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia). Anti-TNF agents approved for ulcerative colitis are: infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). Non anti-TNF biologic agents that have been approved are: vedolizumab (Entyvio), ustekinumab (Stelera) and natalizumab (Tysabri).
• The experimental agents are step IV drugs to be used only after failure of the previous steps and only by health care professionals familiar with their use.

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

YOU MAY ALSO LIKE

---

VIEW

A Picture Guide to Inflammatory Bowel Disease

Must Read Articles Related to Inflammatory Bowel Disease (IBD)

Abdominal Pain in Adults Abdominal pain in adults can range from a mild stomach ache to severe pain. Examples of causes of abdominal pain in adults include learn more >>

Abdominal Pain in Children Abdominal pain in children can range from trivial to life-threatening. Some possible causes of learn more >>

Anatomy Involved in Crohn Disease

Crohn's disease is an infla...learn more >>

See the Entire Inflammatory Bowel Disease (IBD) Topic Guide »