Inflammatory Bowel Disease Treatment

Salicylates. Salicylates are a group of anti-inflammatory medicines with a local mechanism of action in the colon. They are not immunosuppressive; hence they do not reduce the body’s defences and are very safe. They can be administered orally or rectally (as a suppository, foam or enema). They are used as induction and maintenance treatment in patients with mild-moderate ulcerative colitis. Salicylates have not shown any efficacy against Crohn’s disease (only in very specific cases with mild symptoms limited to the colon, at high doses).

Corticosteroids. Corticosteroids are medicines with anti-inflammatory and immunosuppressive effects. They are used to treat moderate and severe flare-ups of the disease (Chron's and colitis) but their administration is limited exclusively to to induction treatment (never maintenance). This is because they produce a lot of side effects if used for extended periods.

Immunosuppressants. Immunosuppressants modulate the exaggerated immune system response and reduce inflammation. They are administered to patients who do not respond to corticosteroids or in combination with biological therapy. They are effective for the induction and maintenance of remission. This includes conventional immunosuppressants (e.g., azathioprine and methotrexate) and more recent small molecule drugs (e.g., JAK inhibitors and S1P receptor modulators), administered orally.

Biological therapy. A better understanding of inflammatory bowel disease has contributed to the development of new treatments that act against different factors involved in the immune system. 

Biological therapy is used when all other conventional treatments, such as corticosteroids and conventional immunosuppressants (azathioprine and methotrexate), have failed. It may, however, be used as a first-line treatment under certain circumstances (cases that are already severe at time of diagnosis).

Clinical trials. Clinical trials are medical research studies that assess medicines being developed with action mechanisms that differ from those already approved by the regulatory agencies. These clinical trials are necessary to obtain new treatment options and to further our knowledge of new drug therapies.

Surgery. Surgery is indicated when medical treatment fails completely or in complicated cases of Crohn’s disease (with stenosis, fistulas or perianal disease). It usually involves a laparoscopy, a minimally invasive surgical technique with a short recovery period and a reduced risk of complications.