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How IBD is Treated

Treatment of IBD is based on an individual assessment regarding the type of disease (ulcerative colitis or Crohn's disease) and what area/s of the gut is affected. Several medical treatments are available and discussion relating to the type of medication, its use, and side-effects is important.

Treatment of Crohn's disease

Treatment for Crohn's disease is based on identifying the location, amount and severity of inflammation within the large bowel. Initial therapy may involve 3-4 weeks of oral anti-inflammatory medications such as mesalazine.

If there is no improvement, your doctor may prescribe antibiotics and/or oral steroids (e.g., prednisolone). Again, the type and form of medication will depend based on several factors, including your symptoms and location of disease activity.

When symptoms/disease activity continue to occur despite use of anti-inflammatory, antibiotics, and steroids your doctor may recommend hospitalization and/or use of immunomodulators (drugs that act to suppressive the immune system), such as azathioprine, 6-mercaptopurine, or methotrexate. Immunomodulators are more commonly used (and often earlier) in the treatment of Crohn’s disease when compared to individuals with ulcerative colitis.

On rare occasions, if medication treatment continues to be ineffective and/or the bowel leaks/and/or becomes blocked, sections of bowel may be surgery removed. Unlike ulcerative colitis, Crohn's disease cannot be cured by surgery. When surgery is performed for Crohn's disease, a conservative approach is usually recommended to try to keep as much of the healthy gastrointestinal tract as possible.

Throughout all times of your treatment, it is important that you are able to discuss with your doctor the options for treatment and associated benefits/ side-effects.

Treatment of ulcerative colitis

Like Crohn's disease, treatment for ulcerative colitis is based on identifying the location, amount and severity of inflammation within the large bowel. Medications (e.g., mesalazine or steroids) in suppository/ enema form are used to treat mild inflammation within the lower section of the large bowel.

Often when inflammation affects most of the large bowel, a combination of oral and suppository/ enema medications are used. Common oral medications include:

  • Sulphasalazine (Salazopyrin)
  • Coated mesalazine (Mesasal, Salofalk)
  • Balsalazide (Colazide)
  • Olsalazine (Dipentum)

On some occasions, due to significant inflammation, your doctor may recommend steroid medications such as prednisolone. Steroids can help to reduce the inflammation.

Side effects of steroid medication can include mood changes; skin problems (e.g., acne, dry skin) sweating; headache, dizziness, changes in the shape or location of body fat. Bone and muscle loss are difficult to reverse.

It is important that you discuss with your doctor issues relating to steroid use, including the dosage, length of steroid use and possible side effects.

Due to inflammation, your bowel can have a reduced ability to remove water from stools, resulting in diarrhea. Due to this, your doctor may be scribe anti-diarrhoeal medicines, such as loperamide (Imodium). These drugs can be dangerous in acute colitis as they can precipitate a toxic megacolon requiring urgent surgery.

It is important that you discuss any changes in your symptoms with your doctor. If you develop diarrhea, talk to your doctor about this, as it may indicate a change in your disease activity. This may result in your doctor recommending further investigation and possible changes in your medications.

Treatment of severe IBD activity

Some individuals with IBD, experience a form of IBD that is associated with multiple flare-ups and/or involves severe inflammation resulting in front-line medications (e.g., mesalazine) and steroids being ineffective. In these cases, often hospitalization is recommended. While distressing, this will provide individual with the best and most immediate form of care to help treat the disease.

During periods of severe disease activity and/or limited success with front-line medications, doctors may prescribe medications such as azathioprine (Imuran or Thioprine), 6-mercaptopurine (6-MP or Puri-Nethol) or methotrexate. These medications are called immunomodulator drugs due to their suppressing actions upon the immune system.

If severe inflammation continues to occur, despite the use of azathioprine, 6-mercaptopurine or methotrexate, doctors may recommend the use stronger intravenously immunosuppressant drugs. On rare occasions, if medication treatment continues to be ineffective, removal of the large bowel by surgery is the final option. Throughout all times of your treatment, it is important that you are able to discuss with your doctor the options for treatment and associated benefits/side-effects.

Maintenance treatment

When ulcerative colitis symptoms have reduced and bowel movements return to normal, this is called remission. During episodes of remission, your doctor may ask you to continue to take medications (such as mesalazine), although at a lower dose. This ongoing medication to reduce chances of relapse (return of symptoms) is referred to as maintenance treatment.

Maintenance treatment has been shown to:

  • Reduce the chances of flare-ups and major relapses
  • Increase health
  • Promote normal bowel movements

For more detailed information relating to IBD and treatment the various options, please go to the Gastroenterological Society of Australia website.




MORE LINKS

If you are interested in other gastrointestinal-focused information and intervention websites developed and hosted at
Swinburne University of Technology,
please go to:

IBSclinic.org.au for individuals with Irritable Bowel Syndrome

Gastroparesisclinic.org for individuals with Gastroparesis

DISCLAIMER

This website and its content is not intended or recommended as a substitute for medical advice, diagnosis or treatment. Always seek advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

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