Treatment

Treatment can be:

1. Medical
2. Surgical

Medical treatment for both Crohn disease (CD) and ulcerative coilitis (UC) is geared towards managing the inflammation and the symptoms.

Managing inflammation

Medications for managing inflammation in IBD can be categorized into 5 different classes:

1. aminosalicylates: Bowel-specific anti-inflammatory drug similar to NSAIDS
2. antibiotics: decreases infection that can cause inflammation
3. cortico-steroids: powerful anti-inflammatory drug
4. immuno-modifiers: changes how the body mounts an inflammatory response
5. biologics: prevents and reduces inflammation

IBD Treatment Pyramid

Medical treatment of IBD uses a step-wise approach, sometimes called the treatment pyramid. First line treatments, those at the bottom of the pyramid, have lower efficacy but higher safety margins. In contrast, experimental treatments at the top of the pyramid have high efficacy but also a high risk of serious side effects. (ref:http://www.d.umn.edu/~jfitzake/Lectures/DMED/LowerGI/IBD/Pyramid.html) Drugs from any level of the pyramid may be used alone or in combination with other drugs.

It is important to note that medical treatment for IBD requires an individualized approach because of the tricky act of balancing the side effects of medication.

Test yourself: You are the nurse for a patient with Crohn disease and he asks you why his medications are different than his neighbour's since they both have Crohn disease. How do you respond?

1. Let me call the doctor to verify.
2. There is no standard treatment for IBD because every patient is different.
3. option c
4. option d

Managing symptoms

1. Diarrhea:
   • Anti-diarrheals (e.g. loperamide)
   • Bulk forming agents - (e.g. psyllium) a fibre supplement that absorbs water in the intestines, creating bulk in the stools
   • Stool softeners (e.g. docusate, senna) - increases absorption of water and fat into stool, making it softer
2. Hemorrhoids: (frequency of bowel movements causes inflammation of the peri-anal area)
   • Topical steroids (e.g. hydrocortisone) - can reduce inflammation, swelling, and itchiness.
   • Zinc oxide (topical) - a mild astringent (shrinks mucous membranes of exposed tissues to reduce moisture, similar to anti-perspirants) with antimicrobial properties
   • Sitz bath - helps to alleviate symptoms by calming the inflammed tissues
3. Abdominal cramps:
   • Anti-spasmodics - relaxes the muscles of the GI tract
   • Bile-salt binders - bile salts bind fat for excretion, but it is irritating to the gut if it is left behind rather than excreted
   • Acid-reducing drugs (e.g. pantoprazole) - reduces acid that may cause heart burn
4. Pain:
   • Analgesics
   • NSAIDS - for control of joint pain, but can aggravate abdominal pain
5. Nutritional deficiency: (can be caused by excessive diarrhea, malabsorption, and side effects of medications that impairs absorption)
   • Vitamin and mineral supplements

Surgery

Ulcerative coilitis

In ulcerative coilitis, complete surgical removal of the large intestine (called a colectomy) is considered to be a "cure" as the inflammation will not return to other sections of the GI tract once the colon is removed. However, a colostomy bag will be needed to collect waste material.

Crohn disease

For Crohn disease, because inflammation can occur anywhere along the GI tract, removal of the colon will not prevent inflammation from occurring elsewhere. (ref) For this reason, surgery is not considered a cure. Despite this fact, 75% of individuals with Crohn disease will end up having bowel resections (ref) (that is, having part of their bowels surgically removed). The most common reason for bowel resections in individuals with Crohn disease is a bowel obstruction.

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