What is the medical approach to treatment of inflammatory bowel disease (IBD)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Answer

The medical approach for patients with IBD is symptomatic care (ie, relief of symptoms) and mucosal healing for mild disease (eg, erythema without ulceration) following a stepwise approach to medication, with escalation of the medical regimen until a response is achieved (“step-up” or “stepwise” approach) for mild disease (eg, erythema without ulceration), such as the following:

  • Step I – Aminosalicylates (oral, enema, suppository formulations): For treating flares and maintaining remission; more effective in UC than in CD

  • Step IA – Antibiotics: Used sparingly in UC (limited efficacy, increased risk for antibiotic-associated pseudomembranous colitis); in CD, most commonly used for perianal disease, fistulas, intra-abdominal inflammatory masses

  • Step II – Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only

  • Step III – Immunomodulators and biologics: Effective for steroid-sparing action in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates

  • Step IV – Clinical trial agents: Tend to be disease-specific (ie, an agent works for CD but not for UC, or vice versa)

Moderate to severe disease warrants more aggressive initial treatment (eg, immunomodulators or biologic agents) in order to prevent complications of the disease.


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