IBD facts

Treatments

 

Treatments

Your doctor will have discussed the different treatments open to you. The aim of all of these is to improve your quality of life by controlling inflammation, maintaining remission and preventing complications.

The four main treatment options are medication, diet (although this is of limited benefit in ulcerative colitis), rest and surgery.

Medication

Several types of medicine can be used to treat inflammatory bowel disease; doctors often recommend a combination:

Anti-inflammatory drugs: work by minimising the degree of active inflammation in the intestine, so giving the damaged intestinal lining time to heal. The two main types are aminosalicylates (sometimes called 5-ASA), which have been found to increase the periods of remission, and corticosteroids, which are used to treat inflammation.

Antibiotics: are used to treat infections and bacterial overgrowth which can cause inflammation in the intestine.

Immunosuppressive drugs: suppress the immune system and enable the dosage of corticosteroids to be reduced without causing a relapse.

Cholestyramine: is a resin that binds to bile salts. It is used to treat diarrhoea that is caused when bile salts (which are normally absorbed in the small intestine) spill into the large intestine.

Vitamin and mineral supplements: are used to help maintain the levels of certain vitamins and minerals.

Bulking agents: help to relieve proximal or right-sided constipation caused by inflammation in the rectum or left colon of people with ulcerative colitis. These can also be helpful in controlling diarrhoea and urgency by bulking and regulating the stools. Adequate fluid intake must be maintained when taking bulking agents.

Rehydration solutions: help to restore the vital fluid and salts lost during diarrhoea.

Diet

Crohn's disease

A change of diet may be chosen instead of medication. Trials with elemental diets (i.e. complete nutritional drinks containing pre-digested protein, carbohydrates and fat) have shown an initial 90% remission of active Crohn's disease.

Occasionally, if the intestine is not working properly, all food is stopped and a drip feed into one of the patient's veins is given instead. This is called total parenteral nutrition or TPN. It allows the intestine to 'rest' and also has an effect on the inflammation. Once remission is achieved, food is reintroduced under the guidance of the dietitian.

Ulcerative colitis

There is no evidence that diet has any effect on the treatment of ulcerative colitis, although a high-calorie, high-protein diet can help replace nutrients lost because of diarrhoea.

Rest

Frequent diarrhoea can be very tiring and it is important to conserve your energy and allow healing to take place. Try to avoid situations that you find stressful, as this may make the inflammation worse.

Surgery

The majority of patients with inflammatory bowel disease never require surgery. However, it may be advised if the disease is severe and does not respond to medical treatment.

Surgical treatment of ulcerative colitis involves removal of the colon. This cures the disease completely.

Surgery is avoided if possible in Crohn's disease, except when medical treatment fails to induce remission, or in the presence of a fibrotic stricture.

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