Treatment by Type of IBD

Inflammatory bowel disease (IBD) refers to 2 main conditions: Crohn’s disease and ulcerative colitis (UC). Both types of IBD cause inflammation and damage to the gastrointestinal (GI) tract. This damage leads to symptoms like diarrhea, belly pain, and rectal bleeding.¹

Treatment for both types of IBD is similar but will vary depending on which type you have, your symptoms, and their severity. Treatments may include:¹

• Medicines
• Surgeries
• Dietary changes

Goals of IBD treatment

There is currently no cure for IBD. But it is important to treat the condition as soon as possible. Untreated inflammation caused by IBD can lead to serious complications, such as:¹

• Scarring of the intestinal wall (fibrosis)
• Sores (abscesses) or holes (microperforations) in the intestinal wall
• Narrowing of the intestines (strictures) that can block the passage of food
• Abnormal connections between the bowel and other organs (fistulas)
• Increased risk of colon cancer

Specific treatments for IBD vary. But they typically focus on reducing inflammation. This can relieve symptoms and help prevent long-term damage and complications. With proper treatment, many people have long periods with few or no symptoms (remission).^2,3

Medicines for IBD

Prescription medicines are a key part of IBD treatment. Several types of drugs can help reduce inflammation along the GI tract and help the intestinal wall heal.⁴

Some of these drugs can decrease symptoms quickly, leading to periods of remission. Others can help maintain remission and reduce how often symptoms flare up over time. In some cases, a combination of treatments is most effective.^4,5

Medicines commonly prescribed to treat IBD include:^5-7

• Aminosalicylates – These drugs contain 5-aminosalicylic acid, which helps reduce inflammation. They are most commonly prescribed for people with UC. But they may help some people with mild symptoms of Crohn’s disease.
• Corticosteroids – Also known as steroids. These drugs can reduce inflammation quickly. But they also have long-term side effects. So they are usually used only for short periods.
• Immunosuppressants – Also known as immunomodulators. These drugs calm the immune system to reduce inflammation. They may be used to manage frequent flare-ups in people with moderate to severe IBD.
• Biologics and biosimilars – Biologics are drugs made from living cells to target certain proteins. Biosimilars are drugs that are made to work just like biologics. Types of biologics for IBD include TNF blockers as well as IL-12 and IL-23 inhibitors. They are used for people with moderate to severe UC or treatment-resistant Crohn’s.
• Targeted synthetic small molecules – These drugs target specific parts of the immune system that are involved in intestinal inflammation. Types include JAK inhibitors and S1P inhibitors. Like biologics, they may be prescribed to people with moderate to severe UC or treatment-resistant Crohn’s.

Doctors usually prescribe medicines that have been approved by the US Food and Drug Administration (FDA) to treat a specific type of IBD. These drugs are listed below. But doctors may choose to prescribe other drugs “off-label” to help with symptoms. This means the drugs have not been approved specifically for Crohn’s or UC.^6,8

Crohn’s disease medicines

Medicines approved by the FDA to treat Crohn’s disease include:⁸

• Corticosteroids – prednisone, prednisolone, methylprednisolone, and budesonide
• Immunosuppressants – azathioprine, methotrexate, mercaptopurine, tacrolimus
• Biologics and biosimilars – infliximab, adalimumab, certolizumab pegol, vedolizumab, ustekinumab, risankizumab, natalizumab
• Targeted synthetic small molecules – upadacitinib

In people with Crohn’s, infections can lead to complications like abscesses or fistulas. Antibiotics may be needed to clear the infection and treat complications. Common antibiotics used for infections related to Crohn’s include ciprofloxacin and metronidazole.^3,9

UC medicines

Medicines approved by the FDA to treat UC include:⁸

• Aminosalicylates – sulfasalazine, mesalamine, olsalazine, and balsalazide
• Corticosteroids – prednisone, prednisolone, methylprednisolone, and budesonide
• Immunosuppressants – azathioprine, cyclosporine, mercaptopurine, tacrolimus
• Biologics and biosimilars – infliximab, adalimumab, mirikizumab, vedolizumab, ustekinumab, risankizumab, natalizumab, guselkumab, golimumab
• Targeted synthetic small molecules – upadacitinib, etrasimod, tofacitinib, ozanimod

Surgery for IBD

Prolonged inflammation can cause severe damage to the intestines over time. In this case, surgery may be needed to remove the damaged parts of the GI tract. About half of people living with IBD eventually need surgery.¹

Crohn’s disease surgeries

At some point, up to three-fourths of people with Crohn’s disease need surgery to treat their condition. Even after surgery, almost one-third will likely need another surgery in the future. Surgery does not cure Crohn’s. But it can improve symptoms and quality of life.⁴

Surgery often involves removing damaged parts of the intestines and then rejoining the healthy parts. This is called a resection. People with Crohn’s may need surgery to repair complications such as:^4,9

• Fistulas
• Bowel perforations
• Blockages

UC surgeries

Up to one-third of people with UC will eventually need a surgery called a colectomy. In this procedure, a surgeon removes the entire colon and rectum. There are 2 types of colectomy:^10,11

• Colectomy with ileal pouch – The surgeon first removes the colon and rectum. Then, they create an internal pouch that connects the small intestine to the anus.
• Colectomy with ileostomy – Here, the surgeon removes the colon, rectum, and anus. They then create a hole in the abdomen (stoma) and connect it to an external pouch called an ostomy bag.

Dietary changes for IBD

There is no specific diet proven to prevent or treat Crohn’s disease or UC. But eating a healthy, well-balanced diet is important to make sure you get the nutrients you need. If your symptoms make you unable to get enough nutrients from food, you may need enteral feeding. This is also called tube feeding.^4,10

IBD is not caused by what you eat. But certain foods may trigger your symptoms. Work with your doctor to find out whether you have dietary triggers so you can avoid them. Keeping a log of your symptoms along with what you eat can help you find any foods that trigger your IBD.¹

Certain foods are considered common IBD triggers. These include:^1,4,10

• Dairy
• Gluten
• High-fiber foods
• Spicy foods
• Artificial sweeteners
• Alcohol and caffeine

Some people find that taking nutritional supplements helps improve their symptoms. For example, probiotics or omega-3 fatty acid supplements may help improve inflammation. But always talk to your doctor before starting a new supplement or making major changes to your diet.¹