Inflammatory Bowel Disease Treatment

The main goal of treatment¹⁸ for inflammatory bowel disease is to reduce the inflammation that causes flares. While this is usually aimed at relieving severe symptoms, it may, in some cases, lead to long-term remission and reduce the risk of developing complications from IBD.

Treatment for IBD commonly involves either medication therapy or surgery. However, many patients have also found success in careful diet management.

Inflammatory bowel disease medications

Several types of medication¹⁹ are used to treat IBD, including:

• Aminosalicylates: These medications, which contain 5-aminosalicylic acid (5-ASA), are often used as the first line of treatment for inflammatory bowel disease due to their anti-inflammatory nature. Mesalamine (generic Asacol HD, Delzicol) and sulfasalazine (generic Azulfidine) are the most commonly used aminosalicylates.
• Immunosuppressants: Because the immune system is overactive in people with IBD, immunosuppressants, or medications that suppress the immune response, can help reduce inflammation within the intestinal lining.

Some immunosuppressants commonly used to treat IBD include azathioprine (generic Azasan, Imuran), cyclosporine (generic Gengraf, Neoral, Sandimmune), methotrexate (generic Trexall), and mercaptopurine (generic Purinethol, Purixan).

• Tumor necrosis factor (TNF)-alpha inhibitors: These medications, commonly referred to as biologics, also work to suppress the immune response by neutralizing a protein produced by the immune system. Examples of biologics include adalimumab (generic Humira) and infliximab (generic Remicade).
• Antibiotics: Antibiotics may be used alongside other medications when a patient is at risk of infection (as is the case with perianal Crohn’s disease). Commonly prescribed antibiotics include ciprofloxacin (generic Cipro) and metronidazole (generic Flagyl).
• Oral glucocorticoids: These medications, which include budesonide (generic Entocort, Uceris) and prednisone (generic Rayos, Prednisone Intensol, Deltasone) are often used during flares to help induce remission.

Some over-the-counter medications may be used to help manage the signs and symptoms of IBD, including:

• Antidiarrheal medications: Loperamide (generic Imodium A-D) may be used to help relieve mild to moderate diarrhea in patients with IBD (but not in those at risk for bowel obstruction).
• Pain relievers: The over-the-counter pain reliever acetaminophen (generic Tylenol, others) can help relieve mild to moderate pain and discomfort associated with IBD. It’s important to avoid ibuprofen (generic Advil, Motrin), naproxen sodium (generic Aleve), and diclofenac sodium (generic Voltaren), however, as these can worsen IBD’s symptoms and the disease itself.
• Iron supplements: Iron supplements are often used to help replace the iron that’s lost as a result of chronic intestinal bleeding caused by IBD.
• Calcium and vitamin D supplements: Crohn’s disease, as well as the steroids used to treat it, can increase the risk of developing osteoporosis, a condition that causes the bones to weaken and become brittle. Calcium and vitamin D supplements can help slow or stop the progression of this disease.

Your provider may prescribe the following medications for IBD:

Inflammatory bowel disease diet

There is no one diet that’s prescribed to patients with IBD. However, keeping a food log and monitoring what foods worsen or improve your symptoms can help you determine what diet works best for your condition.

Certain foods are known to aggravate symptoms (especially during a flare), including²⁰:

• Dairy products: Many patients with IBD find that limiting or eliminating their consumption of dairy products helps improve problems such as diarrhea, abdominal pain or cramping, and excess gas.
• High-fiber foods: Eating foods high in fiber, such as whole grains and fresh fruits and vegetables, may worsen the symptoms of IBD. Foods that have been found to be especially aggravating include nuts, seeds, corn, popcorn, and foods in the cabbage family (such as cauliflower and broccoli).
• High-fat foods: Patients with Crohn’s disease of the small intestine may be unable to properly digest or absorb fats. For this reason, eating food high in fats can cause diarrhea to worsen.
• Other problem foods known to potentially aggravate symptoms include alcohol, caffeine, and spicy foods.

Some patients with IBD have found success by following these tips²¹ for diet management:

• Eating four to six smaller meals a day rather than three large ones
• Drinking plenty of fluids (avoid carbonation or drinking with a straw, as both can cause gas)
• Keeping a food log and monitor how different foods affect your symptoms
• Visiting a specialist, such as a dietician

Surgery for IBD

Surgery²² for IBD may be necessary in cases where medication, diet management, or other treatments aren’t sufficient to improve the signs and symptoms of the disease.

Surgery for ulcerative colitis is often effective in eliminating the disease entirely. However, this generally means removing the colon and rectum (proctocolectomy).

This usually involves undergoing a procedure called ileal pouch-anal anastomosis. In this procedure, a pouch constructed from the end of the small intestine is attached directly to the anus. This allows a patient to pass waste relatively normally and without the need for a colostomy bag (an external bag that collects stool when the intestines have been removed).

When this procedure is not possible, a permanent opening called an ileal stoma is created in the abdomen. Waste passes through the stoma and collects in an external bag.

Surgery for Crohn’s disease does not cure the condition. Despite this, up to one-half of patients with Crohn’s will require at least one surgical procedure.

Some surgeries involve removing any damaged section of the digestive tract and reconnecting the healthy portions to each other. Other surgeries may be used to drain abscesses and close fistulas that have formed.

Unfortunately, the benefits of surgery for Crohn’s disease usually aren’t permanent. The disease commonly returns, especially near the site at which the damaged tissue was removed during surgery. In most cases, surgery is followed by medication treatment to help minimize the risk of recurrence.