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Pharmacologic therapy for inflammatory bowel disease

S Hirschfeld¹, H R Clearfield

¹Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA.

American Family Physician

|June 1, 1995

Summary

This study reviews stepwise pharmacologic management for ulcerative colitis and Crohn's disease, detailing initial treatments, advanced therapies for severe cases, and steroid-sparing agents for frequent relapses.

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Area of Science:

Gastroenterology
Internal Medicine
Pharmacology

Background:

Ulcerative colitis and Crohn's disease are chronic inflammatory bowel diseases (IBD) requiring tailored treatment strategies.
Current management often follows a stepwise approach based on disease severity and location.

Purpose of the Study:

To outline the stepwise pharmacologic management of ulcerative colitis and Crohn's disease.
To discuss various therapeutic agents and their roles in different disease presentations.

Main Methods:

Review of current pharmacologic treatments for IBD.
Description of initial, advanced, and steroid-sparing therapeutic options.
Inclusion of treatments for specific disease manifestations like rectal and perianal disease.

Main Results:

Initial therapy often involves oral sulfasalazine or 5-aminosalicylic acid (5-ASA), with topical options for rectal disease.
Oral corticosteroids are used for active inflammation, while intravenous steroids and antibiotics are for fulminant disease.
Steroid-sparing agents like azathioprine and 6-mercaptopurine, and intravenous cyclosporine are options for refractory or severe cases.

Conclusions:

The management of IBD is complex, requiring careful consideration of individual patient needs.
Balancing the risks and benefits of monotherapy versus combination therapy is crucial.
Metronidazole is specifically noted for its utility in managing perianal Crohn's disease.

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