Inflammatory Bowel Disease
How Is Inflammatory Bowel Disease Treated? continued...
If the first drugs don't provide the adequate relief, the doctor will likely prescribe a corticosteroid, which is rapid-acting anti-inflammatory agent. Corticosteroids tend to provide rapid relief of symptoms along with a significant decrease in inflammation. However, because of side effects associated with their long-term use, corticosteroids are used only to treat flare-ups and are not used for maintaining remission.
Immune modifying agents are the next drugs to be used if corticosteroids fail or are required for prolonged periods. These medications are not used in acute flare-ups, because they may take as long as 2 to 3 months to take action. Examples of immunosuppressives are Azathioprine and 6-mercaptopurine.
Infliximab (Remicade) is a drug approved by the FDA to treat moderate to severe Crohn's disease when standard medications have been ineffective. It belongs to a class of drugs known as anti-TNF agents. TNF (tumor necrosis factor) is produced by white blood cells and is believed to be responsible for promoting the tissue damage that occurs with Crohn's disease. Other anti-TNF agents approved for Crohn's disease are Cimzia (certolizumab), Humira (adalumimab), and Tysabri (natalizumab). Remicade, Humira, Cimzia, and Simponi are anti-TNF drugs currently approved by the FDA for ulcerative colitis. Anti-TNF drugs are part of a group of medications called biologics. Another biologic used to treat Crohn's disease is Entyvio.
If you are not responding to the drugs recommended for IBD, talk with your doctor about enrolling in a clinical trial. Clinical trials are the way new treatments for a disease are tested to see how effective they are and how patients respond to them. You can find out about clinical trials at the Crohn's & Colitis Foundation of America Web site.
Is Surgery Ever Used To Treat Inflammatory Bowel Disease?
Surgical treatment for IBD depends upon the disease. Ulcerative colitis, for instance, can be cured with surgery, because the disease is limited to the colon. Once the colon is removed, the disease doesn't come back. However, surgery will not cure Crohn's disease, although some surgeries may be used. Excessive surgery in people with Crohn's disease can actually lead to more problems.
There are several surgical options available for people with ulcerative colitis. Which one is right for you depends on several factors:
- The extent of your disease
- Your age
- Your overall health
The first option is called a proctocolectomy. It involves the removal of the entire colon and rectum. The surgeon then makes an opening on the abdomen called an ileostomy that goes into part of the small intestine. This opening provides a new path for feces to be emptied into a pouch that's attached to the skin with an adhesive.
Another commonly used surgery is called ileoanal anastomosis. The surgeon removes the colon and then creates an internal pouch that connects the small intestine to the anal canal. This allows feces to still exit through the anus.