There is no cure for inflammatory bowel disease, but steps can be taken to help those who have it. A key step is to reduce symptoms of IBD, which include Crohn’s disease and ulcerative colitis. The symptoms-management focus starts with monitoring the mucosal healing process and, when needed, prescribing medicines that can help. Mucosal healing refers to healing the inflammation in the mucus lining the gut.
Reducing bowel inflammation is the first step in treating IBD. Two often-used anti-inflammatory agents are corticosteroids and aminosalicylates, or 5-ASAs.
Doctors prescribe corticosteroids for bowel-disease exacerbations and flare-ups. They can be given intravenously, by mouth, or directly to the bowel. Intravenous versions include methylprednisolone and hydrocortisone. Oral versions include prednisone, prednisolone, budesonide and dexamethasone. Versions applied directly to the bowel include enemas, suppositories or foam. Doctors’ choice of corticosteroid depends on the area of the colon that is affected.
Corticosteroids can have unpleasant side effects. One associated with long-term treatment is a reduction in bone density, or osteoporosis. Doctors often prescribe a bone-density-maintaining therapy to patients over 65 who must take corticosteroids more than three months. Those therapies include a calcium supplement or a bisphosphonate.
Other side effects of corticosteroids include fluid and electrolyte dysfunction, the eye problems cataract and glaucoma, stomach ulcers, and endocrine dysfunctions. Electrolytes are minerals essential to the body’s functioning. The endocrine system is a collection of glands that secrete hormones.
If a patient must avoid corticosteroids, doctors prescribe immunomodulators or tumor necrosis factor inhibitors. Immodulators change the function of the immune system. TNF inhibitors suppress the body’s response to tumor necrosis factor, which plays a role in inflammation.
Immodulators include azathioprine, 6-mercaptopurine, and methotrexate. TNF inhibitors include infliximab, adalimumab, and certolizumab pegol. Which anti-inflammatory agent a doctor prescribes depends on the severity of the bowel-disease flare-up.
Immodulators and TNF inhibitors work slower than corticosteroids. They also have a number of side effects. Immunomodulators reduce the number of white bloods cells called neutrophils. They can also lead to rashes; bone marrow depression, or an inability of marrow to produce red blood cells, white blood cells and blood platelets; and in some cases pancreatitis, or inflammation of the pancreas.
When patients are on these therapies, doctors need to monitor their blood cell counts and give them liver function tests to ensure the treatments are not causing other health problems.
Another class of drug that doctors use to treat bowel-disease flare-ups is aminosalicylates. The United States has approved four: Azulfidine (sulfasalazine), Apriso (mesalamine), Colazal (balsalazide), and Dipentum (olsalazine). These drugs are particularly useful for treating ulcerative colitis and mild forms of Crohn’s disease.
Doctors use antibiotics to treat infections, abscesses, and fistulas in bowel-disease patients. The main ones they prescribe are Cipro (ciprofloxacin) and Flagyl (metronidazole). Doctors often prescribe antibiotics to patients with Crohn’s disease who have symptoms affecting the anus.
Researchers have administered drugs that are still under development to bowel-disease patients taking part in clinical trials. The hope is they will help those with moderate to severe forms of bowel disease — particularly Crohn’s — who havfailed to respond to approved therapies. Some of these agents include T-cell markers, mesenchymal stem cells for Crohn’s, and anti-inflammatory proteins for ulcerative colitis.
Some researchers believe lifestyle contributes to IBD flare-ups, although there is no definitive evidence of that yet.
Diet seems to play a role, however. Some foods appear to trigger flare-ups. Patients who are able to identify trigger foods can change their diet to help manage their IBD. Other lifestyle changes that can help reduce flare-ups are stopping smoking and mild exercise.
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