Crohn's Disease and Ulcerative Colitis Treatment

There is no cure for Crohn's disease or ulcerative colitis, but you can manage the effects of inflammatory bowel disease (IBD). There are medications that decrease the inflammation and improve symptoms. Controlling inflammation will decrease the risk for tissue damage. If you have tissue breakdown, you are at a higher risk for additional issues, such as malnutrition. If you were diagnosed with IBD as a child and are close to turning 18, our IBD Transition Clinic is here to help you transition from pediatric IBD care to adult care.

In some instances, you may need surgery. We also include alternative treatments such as acupuncture and probiotics (the therapeutic use of various beneficial bacteria). We are actively investigating new therapies through clinical trials for our patients who have failed common treatments.

Throughout treatment, we monitor you to ensure the treatment is appropriate and to check for nutritional problems, bone health (which may be compromised by steroid treatment) and signs of other disease. Our program also has established care protocols for women with IBD who are pregnant.

Medications to Treat Crohn's Disease and Ulcerative Colitis

 We work with our patients to develop treatment to control the disease — taking patient preference and personal goals into consideration. We also work with your other providers to minimize drug interaction and make sure that IBD treatment does not compromise the care of your other health concerns.

A full-time clinical pharmacist is available for staff and patients alike to discuss treatment options and provide patient education and resources. You may see the clinical pharmacist one-on-one for the first doses of medication injections. The pharmacist can also work with you to quit smoking and can provide complete medication reviews to assist with medication compliance and understanding.

Click the links for the medications listed below for more information from the U.S. National Library of Medicine and the U.S. Food and Drug Administration. 

Anti-Inflammatory Drugs

Corticosteroids: These anti-inflammatory agents work quickly for IBD flares. We do not recommend long-term use of corticosteroids due to their side effects. Instead, we prescribe them to control symptoms until you start a different long-term therapy and you become stable on that medication.
Corticosteroids used to treat IBD: Budesonide, Prednisone

Aminosalicylates (5-ASA): 5-ASAs affect parts of the inflammatory response, thereby decreasing tissue irritation. There are different medications in this class that work in specific areas of your GI tract where the disease is most severe. These medications are more commonly used to treat ulcerative colitis (targeting the colon), but they can also treat mild Crohn’s disease in the colon.
Aminosalicylate used to treat IBD: Mesalamine

Immunosuppressants

Immunomodulators: Azathioprine, leflunomide, mercaptopurine, tacrolimus, tofacitinib and methotrexate are some of the most common oral immunomodulators used for Crohn’s disease and ulcerative colitis. These medications target the immune system, which contributes to inflammation. Immunomodulators work slowly, so you may not notice an immediate improvement in symptoms. Over time, they can decrease inflammation and keep you in remission, especially when combined with other medications. Drugs that affect your immune system could cause various side effects, so you will need regular labs and follow-up appointments with your doctor to monitor your health.
Immunosuppressants used to treat IBD: Azathioprine, Mercaptopurine, Leflunomide, Tacrolimus, Tofacitinib, Methotrexate

Biologics: Vedolizumab, ustekinumab, adalimumab, infliximab and natalizumab are monoclonal antibodies that bind to specific cells or proteins in the body to interfere with your body’s inflammatory pathway. These medications are effective in moderate to severe IBD and can be combined with other medications, such as immunomodulators. Due to their action, these medications are also used to treat other inflammatory diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis and uveitis. You can be on biologics for the rest of your life to keep your IBD under control.
Biologics used to treat IBD: Cimzia (certolizumab pegol), Humira (adalimumab), Simponi (golimumab), Remicade (infliximab), Inflectra (infliximab-dyyb), Tysabri (natalizumab), Entyvio (vedolizumab), Stelara (ustekinumab)

Antibiotics

You may need antibiotics for a variety of reasons during your Crohn’s disease or ulcerative colitis treatment to treat tissues injuries such as perianal disease and fistulas.

Anti-Diarrheals

Bulking agents (such as fiber) or drugs that increase muscle tone in the GI tract (such as loperamide) may reduce diarrhea. These medications do not affect your disease or inflammation in the gut, but they do help improve your quality of life.

Supplements

Your Crohn’s disease or ulcerative colitis may result in vitamin or mineral deficiencies. You may be low in these nutrients because you can't eat a “normal” diet, you have gut inflammation that decreases the absorption of nutrients or you have chronic diarrhea that decreases absorption of certain vitamins and minerals. If you have part of your intestines removed due to tissue damage, you are also at higher risk for these deficiencies. After reviewing nutrient levels in your blood test results, your doctors may prescribe vitamins or minerals such as vitamin B12, iron, calcium and vitamin D.