Antispasmodic medications could be prescribed for patients with profuse diarrhea, as anti-cholinergic drugs could precipitate toxic megacolon in patients with active inflammation, and make situations worse. In patients with CD, who might be suffering from bile-salt malabsorption, could be given doses of bile-binding resins like cholestyramine for relief.
Patients with exacerbations and flare-ups are given doses of corticosteroids for instant relief. These include doses of intravenous (methylprednisolone, hydrocortisone), oral (prednisone, prednisolone, budesonide, dexamethasone), or topical (enema, suppository, or foam preparations) corticosteroids. It is to be noted that they are also related to reduction in bone density, which is why, for people with more than 3 months of prescribed corticosteroid therapy, a calcium supplement or supplementary treatment with bisphosphonates is recommended (especially in women). Fluid and electrolyte dysfunctions, cataract and glaucoma, peptic ulcers and endocrine dysfunctions are few other documented side-effects of corticosteroid use. If avoiding corticosteroid use, immunomodulators like azathioprine, 6-mercaptopurine, methotrexate, or anti-TNF agents like infliximab, adalimumab, certolizumab pegol are preferred, depending on the severity of flare-ups. However, they have a slower effect as compared to corticosteroids. Adverse effects of immunomodulators include pancytopenia, neutropenia, rashes, bone marrow depression and pancreatitis in some cases. Routine blood cell counts and liver function tests need to be carried out in order to maintain the patient’s health. Hence the choice of flare-up therapy is more of a calculated move depending upon the patient’s health and the ability to sustain the dosage.
Aminosalicylates are known to treat flare-ups in IBD patients most effectively, with four major cvarieties of the drug being approved for use in the USA. These include sulfasalazine, mesalamine, balsalazide and olsalazine. It is to be kept in mind that these classes of drugs are more effective in treating UC and mild forms of CD. Administration of pro biotic supplements could help to restore the bowel microflora and reduce symptoms to some extent.
The main antibiotics that are used to treat diarrheal symptoms in patients with IBD are ciprofloxacin and metronidazole. There is always an associated risk of developing antibiotic associated pseudomembranous colitis in patients with an overdose of antibiotics. Antibiotics are mostly preferred in patients with Crohn’s disease with perianal symptoms, infected abscesses with purulent exudates and intra-abdominal lesions.
Lastly, some of the agents under clinical trials are used in patients with moderate to severe forms of the disease (mostly CD), to check for the patient’s responsiveness in case no other therapy works, or in aid of further trials which could prove beneficial in the long run. Some of these agents include, T-cell markers and mesenchymal stem cells for CD and anti-inflammatory proteins for UC.
Supportive nutritional and hydration therapies should always be carried out along with the main treatment regimens. Depending on laboratory findings and severity, this can be done orally or intravenously. A consultant should always monitor the changes in health and switch dosage of medicines appropriately. Physical fitness plays a key factor in determining progress of treatment hence it should not be neglected. Proper diet and exercise should be monitored upon. It is by combining routine check-ups and abiding by the consulting doctor’s rules, can a patient hope to revert close to a normal and healthy lifestyle