Treatment
The type of treatment varies from patient to patient. It is determined by the symptoms, severity, and other characteristics of the disease and then customized to fit individual needs. There are a wide variety of medications used to treat Crohn’s disease and ulcerative colitis.
Medications
| Category |
Description |
Aminosalicylates
Mesalamine
-(Asacol®, Pentasa®, Lialda®)
Balsalazide (Colazol®)
Olsalazine (Dipentum™)
Sulfasalazine (Azulfidine®) |
These are the most frequently used medications for people with mild to moderate Ulcerative Colitis. They are used to control inflammation by changing the way the body launches and maintains its inflammatory process. They are sometimes used for Crohn’s disease. |
Corticosteroids
Prednisone
Methyl-prednisolone
Budesonide (Entocort®) |
As the second most commonly used set of medications, they are mostly used during flare-ups because of their fast action in patients with moderate to severe disease. They reduce inflammation, decrease activity of the immune system, and help control flare-ups on a short-term basis because of their strength. Steroids have significant side effects so they are best used for only a few weeks or months. |
Antibiotics
Metronidazole (Flagyl®)
Ciproflaxin (Cipro®) |
These drugs are mostly used to treat infections, such as abscesses, as well as other perianal complications. Additionally, antibiotics may also have some antiinflammatory effects. |
Immunomodulators
Azathioprine (Imuran®)
6-Mercaptopurine
-(6-MP, Purinethol®)
Methotrexate
Cellcept® |
This group of medications is used to regulate your immune system and prevent ongoing inflammation. It is usually used as a long-term maintenance drug. |
| Cyclosporine and Tacrolimus |
Immunosuppressants that are not commonly used, but have specific uses such as when inflammation is unresponsive. |
Biologics
Infliximab (Remicade®)
Adalimumab (Humira®) |
These are used for patients with moderate to severe active disease often in combination with azathioprine, 6-MP, or methotrexate. The biologics that are currently used are antibodies to tumor necrosis factor, a protein that plays an active role in inflammation. Many new drugs in this class are being developed
This class of drugs are antibodies that are given either intravenously (through the vein) or injected into the skin (subcutaneously). |
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SURGERY
Ulcerative Colitis
Possible conditions leading to surgery
- Lack of response or intolerance to medications
- Inability to maintain diet
- Lifestyle changes
- Dysplasia (pre-cancer)
When perforation and massive bleeding occur, emergency surgery is usually performed. Because there is a higher risk of colon cancer in patients with ulcerative colitis, especially in patients with long-standing disease, surgery may also be performed if there are pre-cancerous or cancerous changes in the colon. Disease is only found in the colon, so once the colon is removed the disease is markedly improved. Procedures can be done either openly or laparoscopically. Sometimes, two or even three separate surgeries are required to complete the process.
Proctocolectomy – A surgery, which removes the colon and rectum. This is sometimes referred to simply as a "coloectomy." Sometimes a permanent ileostomy is formed. Other times an ileoanal pouch anastomosis is performed.
Ileostomy – This procedure follows a proctocolectomy. It involves bringing the end of the small intestine (ileum) through a hole, or stoma, in the abdominal wall. This allows drainage of the intestinal contents (waste) out of the body into an external bag worn by the patient.
Ileoanal pouch anastomsis – Also called a "restorative proctocolectomy." The patient is able to continue to pass stool through the anus by having this procedure. It is done by removing the colon and rectum, then turning the ileum into a pouch and connecting it to the anus. An external ostomy bag is worn for a duration of about 12 weeks to allow time for the internal pouch to heal.
Subtotal colectomy – Sometimes only a portion of the colon is removed leaving the rectum or rectum and part of the sigmoid colon (last 10-20 cm).
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Crohn's Disease
Possible conditions leading to surgery
- Decreased response or intolerance to medications
- Complications: strictures, perforations, and/or bleeding
- Abscesses or fistulas that do not respond to medications
When surgery is performed on a patient with Crohn’s disease, the disease is not cured, but symptoms and quality of life might be drastically improved. However, usually the disease reappears in another area of the digestive system, particularly the area where the surgery was performed. About two-thirds to three-quarters of people with Crohn’s will eventually have surgery, so it is important to be educated on the types of procedures performed.
Fistula – The usual procedure is a resection (removal of affected part) and anastomosis (reconnecting healthy parts).
Abscesses – Can either be drained by a needle inserted through the skin or surgically removed by resectioning.
Resection – This is the most common type of surgery done for Crohn’s disease. There is removal of part of the intestine and two healthy ends of the intestine are reattached, which is called an anastomosis.
Strictureplasty – A procedure done to widen a narrowing (stricture) in the small intestine. A lengthwise incision is made by the surgeon along the narrowed area and then is sewed up crosswise.
Colectomy – A procedure in which the entire colon is removed. Sometimes an ileostomy is performed, or sometimes the small intestine is attached to the rectum.
Proctocolectomy – A procedure that involves the removal of both the colon and the rectum.
Ileostomy – This procedure is done most commonly after a proctocolectomy. It involves bringing the end of the small intestine (ileum) through a hole, or stoma, in the abdominal wall. This allows drainage of the intestinal contents (waste) out of the body into an external bag worn by the patient.
Some quick numbers and tips:
- Up to 70% of IBD patients will require surgery at some point.
- Talk with your doctor or a dietitian about a proper diet before and after surgery.
- Be open with your doctor and learn as much as you can about the surgical procedure. Understanding what is going to occur will aid in eliminating surprises throughout the process.
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