Frequently Asked Questions About IBD

1. Is there a cure?

No, IBD cannot be cured. There will be periods of remission when the disease is not active. Medicines can reduce inflammation and increase the number and length of periods of remission, but there is no cure.

2. How long will IBD last?

IBD is a lifelong (chronic) condition. A few patients find their disease becomes milder (“burned out”) after age 60, but many do not.

3. Do I have to take medicine forever?

Probably. IBD is a chronic disease, and most patients need to take medicines to ease symptoms and reduce the number and severity of flares. You may have both maintenance medicines to prevent flares and rescue medicines during the time of an active flare. Most maintenance medicines act fairly slowly, but rescue medicines act more quickly to reduce inflammation and ease your symptoms.

4. Are there some medicines that can get me out of a flare quickly?

Yes. These are not used long term because of side effects. Patients will often change over from rescue medicines to long-term maintenance medicines. Rescue medicines include steroids like prednisone, and cyclosporine.

5. Why do I need to keep taking maintenance medicines when I feel well?

These medicines reduce the chances for a flare and the number of flares you will have. Some of these medicines (like infliximab, adalimumab, and certolizumab) prevent the formation of antibodies against the medicine. The formation of antibodies can lead to allergic reactions and the medicine will no longer work for you. Taking these medicines regularly keeps them helping you.

6. Will surgery cure my IBD?

No, but surgery can be very helpful. For patients with ulcerative colitis, removal of 97% of the colon greatly reduces symptoms. Surgery is no picnic, but it can often improve quality of life if you have severe colitis. There are several ways to reconnect the intestine after the colon is removed, each of which has good and bad effects.

The effect of surgery for Crohn’s disease can often be like pushing a giant reset button. The surgery can remove scarred tissue and strictures, fistulas, and abscesses that cause a lot of symptoms for which medicines are not very effective. After surgery for Crohn’s disease maintenance medicines often work better and help prevent further complications and may prevent future surgery.

7. Is it dangerous to suppress (weaken) the immune system for the rest of my life?

There are some risks in taking medicines to suppress your immune system. Viruses that stay in your body, like the chicken pox virus, are more likely to be activated (cause shingles) in people taking immunosuppressives like azathioprine and methotrexate. Bacterial infections of the skin and soft tissues are more likely in people taking anti-TNF medicines. However, for many, all these risks are outweighed by the risks of complications of IBD, which occur over time.
You can reduce some of these risks. Ask your doctor if vaccines would be helpful to you. Also, after some years in remission some people take a “drug holiday” and stop the immunosuppressive medicine, but this needs to be done with your doctor so that you can be closely monitored for any isgns of inflammation.. If you are on anti-TNF therapy and you are in the final trimester of pregnancy or going to have surgery, your dose may need to be adjusted.

8. Could anything other than IBD be causing my symptoms?

Yes, patients with IBD can get IBD-like symptoms for other reasons. Infections can cause diarrhea. Previous inflammation can cause increased sensitivity of the nerves in the intestine and make you very sensitive to stomach cramps. Too much bacteria in the small intestine can cause cramping and gas. But because you cannot be sure, call your health care team if there is a change in your symptoms because it might be something other than a flare of IBD.

9. Are narcotics used to treat my painful symptoms?

Narcotics treat the symptoms, not the cause (inflammation) of IBD. Narcotics can make the inflammation worse. Research has shown that patients with IBD who use narcotics are more likely to have severe abdominal infections (abscesses), strictures, and intestinal obstruction. Narcotics are therefore only used very carefully and with severe symptoms.

10. Why not just take prednisone whenever I have a flare?

Prednisone has many side effects, including bone loss, diabetes, cataracts, emotional distress, and severe acne,. In addition, the longer prednisone or other steroids are used, the less likely they are to work. That’s why prednisone is only used when (and if) you really need it to rescue you from a flare. Maintenance medicines are used to reduce you’re the number of flares and how severe your symptoms. Therefore, you shouldn’t need to take prednisone as often. There is also evidence that taking maintenance medicine to reduce inflammation in the colon lowers your risk for colon cancer.