Inflammatory bowel disease is a chronic illness and no curative treatment has been discovered to date. Nevertheless, a wide range of medicines that adequately control the symptoms and improve patients’ quality of life are available.
Inflammatory bowel disease treatment is complex and varies greatly from one patient to another; hence a highly individualised approach is required. Each patient’s specific symptoms and test results serve as a guide when selecting a treatment.
The treatment aims to eradicate symptoms and restore patient quality of life by healing the injuries resulting from intestinal inflammation, thus preventing any further disease progression or complications.
As patients course with Inflammatory bowel disease the condition alternates between phases of inflammatory activity, called “flare-ups”, and asymptomatic periods, which are known as “remission periods”.
There are two types of treatment: one is used to control the condition during flare-ups, with the aim being to eliminate symptoms and prevent complications; and the other is maintenance treatment, which is intended to maintain the disease inactive and prevent symptoms from reappearing.
What treatments are available?
Treatment choice depends on the type of disease (whether ulcerative colitis or Crohn’s disease), location, degree of inflammatory activity (mild, moderate, severe), age, prior course of the disease, the patient’s prior response to medications and their needs. It is therefore very important to make a treatment choice that is individualised and customised to each patient.
Treatments available for Inflammatory bowel disease include:
Salicylates. Salicylates are a group of anti-inflammatory medicines with a local mechanism of action in the colon. They are not immunosuppressive; hence they do not reduce the body’s defences and are very safe. They can be administered orally or rectally (as a suppository, foam or enema). They are used as maintenance treatment or during mild/moderate flare-ups in patients with ulcerative colitis. Salicylates have not shown any efficacy against Crohn’s disease (only in very specific cases with mild symptoms limited to the colon).
Corticosteroids. Corticosteroids are medicines with anti-inflammatory and immunosuppressive effects. They are used to treat moderate and severe flare-ups of the disease but their administration is limited exclusively to periods of activity. This is because they produce a lot of side effects if used for extended periods and so should never be taken for maintenance during remission periods.
Immunosuppressants. Immunosuppressants modulate the exaggerated immune system response and reduce inflammation. They are administered to patients who do not respond to corticosteroids or who rely on continuous corticosteroid treatment. They maintain the disease inactive very effectively without having to take corticosteroids.
Biological therapy. A better understanding of inflammatory bowel disease has contributed to the development of new treatments that act against different immunological and inflammatory factors involved in the regulation and maintenance of the disease.
Biological therapy is used when all other conventional treatments, such as corticosteroids and immunosuppressants, have failed. It may, however, be used as a first-line treatment under certain circumstances (cases that are already severe at time of diagnosis).
Clinical trials. Clinical trials are medical research studies that assess medicines being developed with action mechanisms that differ from those already approved by the regulatory agencies. These clinical trials are necessary to obtain new treatment options and to further our knowledge of new drug therapies.
Surgery. Surgery is indicated when medical treatment fails completely. It usually involves a laparoscopy, a minimally invasive surgical technique with a short recovery period and a reduced risk of complications.