These drugs include 5-ASA (5-aminosalicylic acid) — sulfasalazine, olsalazine and mesalamine — that are also prescribed for patients with rheumatoid arthritis, as well as corticosteroids (prednisone).
- 5-ASA agents
These drugs are similar to aspirin in chemical make-up and thus have anti-inflammatory properties. They are often the first line of therapy and have been used for many years in treating patients with inflammatory bowel disease (IBD). This class of drugs includes mesalamine, sulfasalazine, and olsalazine. They are delivered both topically, such as in enema form, or orally. Patients who are allergic to aspirin should not take 5-ASA agents, and those with a sensitivity to sulfa medications should not take sulfasalazine.
Corticosteroids are the next line of therapy when 5-ASA agents are not effective in controlling inflammation. Corticosteroids suppress the immune system and thus keep inflammation in check. Prednisone is a very effective corticosteroid in controlling inflammation but when used long term has significant side effects, such as weight gain, a rounding ("moon shape") of the face, high blood pressure, insomnia, depression and irritability. Corticosteroids can be taken either as an enema or in pill form.
Budesonide is a corticosteroid that acts only in the bowel (nonsystemic) and has fewer side effects.
Immune system modulators
Immune system modulators suppress the body's immune system by interfering with the development of cells and proteins that lead to inflammation. These medications include 6-mercaptopurine (6-MP), azathioprine, cyclosporine and methotrexate. They may be taken in conjunction with a corticosteroid.
TNF inhibitors prevent the body from using tumor necrosis factor-alpha, a natural protein made by white blood cells to fight infection or cancer. Overproduction of this protein can cause inflammation. Patients with IBD have been found to have unusually high levels of TNF-alpha. Infliximab, adalimumab, and certolizumab pegol are examples of this class of drugs used in patients with IBD. However, because they block TNF-alpha in the body, patients are at higher risk of bacterial, viral and fungal infections.
Two antibiotics, metronidazole and ciprofloxacin, suppress inflammation in the colon and often are used together, but cannot be taken long term because of neurological side effects (metronidazole).
- Investigational drugs
Newer medications coming onto the market are available within clinical trials, as are drugs used for other conditions that have been found to be effective against chronic ulcerative colitis and Crohn's disease. The Digestive Disease Institute at Virginia Mason is a leading center for investigational studies using these therapies.
One such drug is abatacept for treatment of active ulcerative colitis. Abatacept is an immune system modulator approved by the FDA for rheumatoid arthritis. It also has been investigated in other studies for juvenile rheumatoid arthritis, lupus, psoriasis and multiple sclerosis.
Surgery to remove the colon may be recommended when medications are no longer effective or when severe cases (universal or fulminant colitis, for example) are present. Your gastroenterologist and surgeon will talk with you in more detail about this treatment option.
- Nutritional counseling
Patients with colitis and chronic ulcerative colitis often are at risk of malnutrition from the loss of nutrients as food and liquids make their way through the digestive tract. Specialists within the Digestive Disease Institute at Virginia Mason help patients manage all aspects of their care, including nutritionists to help with nutritional needs. A nutritionist also can answer questions about what foods and liquids to avoid, such as milk products, alcoholic beverages, grains, and spicy foods that can make cramping and diarrhea worse when the disease recurs.
- Vitamin D and calcium supplements
Patients with IBD are at a higher risk of developing brittle bones and osteoporosis because nutrients and vitamins are not being absorbed by the intestines. Long-term treatment with a corticosteroid also can lead to osteoporosis.
- Vitamin B supplements
Vitamin B is absorbed by the ilium, the part of the small intestine most affected by Crohn's disease. Vitamin B is important in preventing anemia and for healthy nerve function. You may be given regular shots of vitamin B to prevent a deficiency in this vitamin.
- Iron supplements
Anemia and iron deficiency can develop when there is bleeding from ulcers in the intestines.
- Vitamin D and calcium supplements
- Preventive measures
Eating a healthy diet (more natural foods), knowing — and avoiding — foods that can cause a flare-up, and stopping smoking and ingesting alcoholic beverages are lifestyle choices that can play a big role in controlling symptoms associated with IBD. Adopting these measures in conjunction with appropriate medical therapy helps many patients manage their symptoms.