Inflammatory Bowel Disease Treatment

Crohn’s disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), often begin in adolescence or early adulthood, and have a chronic, episodic course, requiring long-term care.

The goal of treatment for inflammatory bowel diseases is to cause remission so that symptoms disappear, to maintain remission so flares don’t occur and to improve quality of life. Remission leads to healing of the lining of the gastrointestinal tract.

Active disease symptoms of IBD are challenging to live with. A risk of not treating IBD is a higher frequency of flares (of inflammation and symptoms) and progression of the inflammation to irreversible bowel damage. Left untreated, complications of IBD include:

• Arthritis
• Skin conditions
• Inflammation of the eye
• Liver disorders
• Kidney disorders
• Bone loss
• Increased risk of intestinal cancer
• Intestinal strictures causing bowel obstruction
• Intestinal perforation causing fistulas and abscesses

While there’s no permanent cure for IBD, you can expect the IBD Center to carefully evaluate and determine the best course of treatment for your IBD. Treatment options, including a number of medications and surgery, depend on the symptoms, prognosis and severity of the disease.

Medications

Several types of drugs are available to treat IBD. Firstly, treatment needs to get the inflammation down so symptoms are relieved and nutrients can be absorbed by the intestines. Secondly, treatment aims to maintain remission and control the chronic inflammation so that the disease is manageable and complications are prevented. Medications include:

• Aminosalicylates, or 5-ASA drugs, are anti-inflammatory medicines that can be taken orally or via suppositories or enemas to suppress inflammation in the intestine as well as relieve painful symptoms.
  • UC San Diego researchers helped lead clinical trials resulting in the approval of Asacol HD and Lialda for ulcerative colitis.
    • Once-Daily High-Concentration MMX Mesalamine in Active Ulcerative Colitis.
    • Effect of Once- or Twice-Daily MMX Mesalamine (SPD476) for UC.
    • Delayed Release Oral Mesalamine 4.8 g/day (800-mg tablet) is Effective for Patients With Moderately Active UC.
• Corticosteroids, such as prednisone, methylprednisone and hydrocortisone are powerful, fast-acting anti-inflammatory drugs. They are used by people who have moderate to severe IBD who do not respond to 5-ASA drugs. However, since these drugs trigger side effects, they’re not feasible for long-term maintenance of IBD.
• Antibiotics can be used, even though there’s no specific infectious agent associated with IBD, to reduce intestinal bacteria and suppress the intestinal bacteria.
• Immunomodulators help to weaken the activity of the immune system, which in turn reduces inflammation. Since they act very slowly, they are often paired with corticosteroids, which act quickly.
• Biologic therapies, a class of medications that includes Remicade, Humira, and Cimzia treat inflammation effectively for many people. These drugs are developed to target specific proteins that cause inflammation and suppress immune response.
  • UC San Diego researchers helped lead clinical trials resulting in Remicade for Ulcerative Colitis.
    • Inflximab for Induction and Maintenance Therapy for Ulcerative Colitis.
  • UC San Diego researchers helped lead clinical trials resulting in the approval of Humira, Cimzia and Tysabri for Crohn's Disease.
    • Adalimumab Induction Therapy for Crohn's Disease Previously Treated with Infliximab.
    • Human Anti–Tumor Necrosis Factor Monoclonal Antibody (Adalimumab) in Crohn’s Disease the CLASSIC-I Trial.
    • Adalimumab for Maintenance of Clinical Response and Remission in Patients With Crohn’s Disease- The CHARM Trial.
    • Certolizumab Pegol for the Treatment of Crohn's Disease.
    • Maintenance Therapy with Certolizumab Pegol for Crohn's Disease.
    • Natalizumab Induction and Maintenance Therapy for Crohn's Disease.
    • Natalizumab for the Treatment of Active Crohn's Disease - Results of the Encore Trial.
•  Read more at IBD Clinical Trials.

Investigational Medication

UC San Diego Health System is evaluating a variety of investigational medications for inflammatory bowel disease. Investigational medications for inflammatory bowel diseases are medications that the FDA has not yet approved for the treatment of ulcerative colitis or Crohn’s disease. Investigational medications may already be approved by the FDA for treatment of another disease, but are under investigational use for ulcerative colitis or Crohn’s disease. Alternatively, investigational medications may have not been approved for any disease, but are being studied for use to treat ulcerative colitis or Crohn’s Disease.

Investigational medications are studied in clinical trials and the information collected in the clinical trials is then evaluated by the FDA to determine whether the medication should be approved for the treatment of ulcerative colitis or Crohn’s disease. 

UC San Diego is a leader in studying new treatments for ulcerative colitis and Crohn’s disease.

Learn more about IBD Clinical Trials.

Surgery for Crohn's disease and ulcerative colitis

In the past, surgery has often been considered a last resort because of the risk factors inherent in any surgery. Also, with Crohn’s disease in particular, inflammatory bowel disease tends to recur and after repeated surgeries, patients can develop painful intestinal adhesions, or risk losing enough intestine to cause malnutrition.

However, advances in minimally invasive surgery techniques have greatly improved surgery as a treatment option for IBD. UC San Diego Health System gastrointestinal surgeons are experts in advanced laparoscopic surgical techniques. These minimally invasive procedures mean smaller incisions, less scarring and faster healing. We incorporate the use of single incision techniques, robotic assisted and transanal approaches where appropriate to provide the best outcomes possible. Read more about Colorectal Surgery and Gastrointestinal Surgery.