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Treatment of Inflammatory bowel disease

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The two main goals in the treatment of active Inflammatory bowel disease are the induction and maintenance of long-term remission.

Medical management

Sulfasalazine

A 5-aminosalicylic acid (5-ASA) agent, sulfasalazine, is the most widely prescribed drug for Inflammatory bowel disease patients. Sulfasalazine in low-dosage is used to maintain remission, whereas a higher dosage is used to treat active ulcerative colitis. 

Side effects: 
Side-effects of sulfasalazine such as headache nausea, epigastric pain and diarrhea are dose-related.6 Other 5-ASA preparations such as mesalazine, olsalazine sodium and pentasa are better tolerated by patients who have prob­lems with sulfasalazine.

 

Corticosteroids 

Corticosteroids such as oral prednisone, budesonide or intravenous hydrocortisone and topical suppositories are potent antiinflammatory agents for moderate-to-severe relapses of both ulcerative colitis and crohn’s disease. They have no role in maintenance therapy for either disease.

Side effects:
However, due to undesirable side-effects such as cosmetic effects, growth suppression in children and osteopenia, long-term use ofcorticosteroids is not recommended.

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Immunosuppressants

Immunosuppressants such as azathioprine, mercaptopurine and methotrexate are used as an adjunct in patients with intractable Inflammatory bowel disease or complex, inoperable perianal disease.

Side effects: 
Although they have significant side-effects, they are safer and better tolerated than long-term corticosteroid therapy. However, immunosuppressants should not be used in young patients who are candidates for surgery or in patients who refuse to return for periodic monitoring.

 

Nutritional intervention

As Inflammatory bowel disease patients are prone to malnutrition and its detrimental effects, nutritional intervention is often used to control disease activity, correct deficiencies and to provide adequate calories to reverse growth failure in children.

Patients with Inflammatory bowel disease are givena daily multivitamin and calcium supplementation if their milk in take is suboptimal and oral iron preparations if they have iron deficiency anemia.

 

Surgical intervention

Surgical treatment is an important part of Inflammatory bowel disease therapy, as it can alleviate symptoms, address serious complications and occasionally, be life saving. Operative treatment of crohn’s disease is usually indicated due to complications or ineffective medical treatment. However, recurrence and need for reoperation is common.

Surgical indications in ulcerative colitis include presence of complications such as hemorrhage, perforation and toxic colitis, and prevention of cancerous transformation. The introduction of laparoscopic methods has resulted in better postoperative outcome and improved quality of life.1     

Written by: Healthplus24 team
Date last updated: September 29, 2012