Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation. It is commonly treated with anti-inflammatory drugs, such as corticosteroids and biologics.
Although experts have yet to uncover a tried-and-true cure for IBD, anti-inflammatory drugs remain among the most common treatment options for minimizing symptoms. This drug therapy involves decreasing digestive tract inflammation.
These drugs can greatly reduce symptoms and improve day-to-day quality of life in people with IBD. However, these medications also come with many side effects, ranging from nausea and fatigue to some that are potentially life threatening.
It’s important to speak with a doctor if you’re concerned about any side effects after beginning a new medication.
Here’s what to know about the most common treatment options for IBD.
Aminosalicylates contain the active ingredient 5-ASA, which works to reduce inflammation in the GI tract. They were the
Aminosalicylates include:
- sulfasalazine (Azulfidine)
- mesalamine (Asacol)
- olsalazine (Dipentum)
- balsalazide (Giazo)
Aminosalicylates are most effective for mild to moderate conditions. They typically come in the form of slow-release tablets or enemas, which work to cover the digestive tract.
5-ASAs are typically well-tolerated but can lead to some side effects,
- nausea
- kidney issues
- rashes
- common cold symptoms
- reduced sperm count
- stomach pain
- headaches
- low blood white cell count
- blood in urine
Corticosteroids work by suppressing the immune response, which can reduce inflammation throughout the body.
Drug names include:
- prednisolone (Deltacortril)
- methylprednisolone (Medrol)
- budesonide (Budenofalk)
Corticosteroids are
Side effects may include the development of comorbid (two or more severe) conditions
Immunomodulators also work to suppress the immune system’s response, reducing inflammation and preventing damage to the gastrointestinal tract. Doctors typically prescribe immunomodulators when aminoacylated and corticosteroids fail to work.
They include:
- azathioprine (Imuran)
- tacrolimus (Prograf)
- cyclosporine (Gengraf)
- 6-mercaptopurine (Purinethol)
Immunomodulators help IBD remain in remission, though it may take several months before people notice an improvement. They come in the form of tablets or capsules.
It is important to keep in mind that the Food and Drug Administration (FDA) hasn’t yet approved immunomodulators to treat IBD. However, a doctor may prescribe them off-label to treat the condition when other options fail to work.
Side effects may include:
- fatigue
- nausea
- rash
- infections
- kidney issues
- fever
- hepatotoxicity
- respiratory tract infections
In rare cases, immunomodulators may be potentially life threatening, but this is rare.
Biologics are another immunosuppressant. They specifically block tumor necrosis factor-alpha (TNF-α), an inflammatory protein involved in the development of IBD.
Drug names include:
- infliximab (Remicade)
- adalimumab (Amgevita)
- vedolizumab (Entyvio)
Biologics are ideal for people with moderate to severe IBD. They typically come in the form of injectables or IV drips.
According to a 2020 report by the American Gastroenterological Association (AGA), infliximab and vedolizumab are the most effective biologics for those with moderate to severe symptoms.
Side effects can be mild to severe and may
- headache
- vomiting
- nausea
- stomach pain
- infections
- vertigo
- sore throat
- achy or swollen joints
- fatigue
- low blood pressure
JAK inhibitors are a relatively new treatment for IBD. They block Janus kinase enzymes that help signal inflammation in the body.
Due to more severe side effects, the AGA only recommends taking this drug if you’ve tried biologics (specifically tumor necrosis factor alpha (TNF-α) inhibitors) and they’ve failed to work.
Upadacitinib (Rinvoq) is a common JAK inhibitor that has been approved for Crohn’s and ulcerative colitis.
Due to side effects, this oral medication is only recommended in the case of severe IBD. They may include:
- cardiac issues
- cancer
- blood clots
Though surgery was considered a last resort for treating IBD for decades, in recent years, some experts consider it a preferable alternative to ongoing drug therapy.
In a 2018 report, researchers note that quality of life is reportedly better in people who undergo surgery than those on maintenance biologic treatment, for instance. In part, this is due to the fact that total remission of IBD symptoms with biologics is rarely achieved.
Still, surgery is typically only recommended in moderate to severe cases. But today, surgery for IBD can be minimally invasive with a recovery time of 2 to 4 weeks. Short and long-term surgical complications have also been greatly reduced thanks to advances in medical technology and techniques.
Ultimately, though, the decision about whether to undergo surgery will occur between you and a team of healthcare professionals. In some cases, surgery may be combined with therapy.
Some common surgeries for IBD include:
- Small or large bowel resection: This involves removing damaged sections of the intestines and adhering the healthy parts back together.
- Proctocolectomy: This involves removing the large intestine and rectum. This procedure is reserved for severe cases, as it involves relieving waste through a stoma.
Though surgical advancements have come a long way, they still come with serious risks, including:
- infection
- abscesses or fistulas
- intestinal obstructions
- damage to the bowel
- uncontrollable bleeding
If you’re experiencing any signs of IBD, it’s a good idea to visit a doctor as soon as possible for a diagnosis. If IBD is untreated, fatigue, nutritional deficiencies, and other more serious issues like stomach ulcers can develop.
Common IBD symptoms to look out for include:
- stomach pain
- diarrhea
- fatigue
- sudden loss of appetite
- unexplained weight loss
- gas and bloating
- mucus or blood in stool
A primary care doctor can evaluate your symptoms and, if necessary, refer you to a gastroenterologist for further support.
What does IBD stand for?
IBD stands for inflammatory bowel disease. It refers to Crohn’s disease and ulcerative colitis.
How do you prevent an IBD flare-up?
You can prevent an IBD flare-up by avoiding triggers, such as certain foods, staying well-hydrated, and getting enough rest until you begin to feel better.
If your symptoms are severe or not improving, it is important to speak with a doctor immediately.
How long does a flare-up of IBD last?
The duration of an IBD flare-up can
Anti-inflammatory therapy remains among the most common treatment options for IBD and is associated with a higher quality of life in people with the condition. However, most options come with many side effects.
For that reason, the therapy with the least risk of adverse effects, 5-ASA drugs, is typically recommended first.
In severe cases, therapy may also be accompanied or followed by surgical measures, like removing damaged portions of the intestine. With an individualized treatment plan, you can find relief from IBD symptoms and live well.