What is IBD?
Inflammatory Bowel Disease (IBD) are chronic diseases characterized by inflammation of the intestines (your gut). Crohn’s disease (CD) can involve anywhere from “gum to bum”, while ulcerative colitis (UC) involves the colon only. Although the exact cause of IBD is unclear, scientists have determined that risk factors include genes, environment (diet, smoking, bacteria, drugs), microbiome, and immune system.
Approach to treating IBD
Inflammatory Bowel Disease (IBD) are chronic diseases. This means that people with IBD often need to take medications daily, weekly, monthly, or every few months in order to keep the disease under control. Most common approaches to treating IBD are the “step up approach” and the “top down approach” although many treatment approaches are in between.
If you have IBD, your physician and health care team will help you through the management of your IBD. Here, we briefly go over general approach to managing IBD. Speak with your physician and health care team to learn more about your treatments.
“step up approach”
In this approach, the IBD is first treated with non-immunosuppressive agents (e.g. 5-aminosalicylate) and then “stepped up” to immunosuppressants (e.g. thiopurines, methotrexate) and/or biologics if the non-immunosuppressive agents fail, or if their disease is too severe for non-immunosuppressive agents.
“top down approach”
In the “top down approach” the IBD is treated with immunosuppressants and/or biologics earlier or as the first medication used. Clinicians have been moving towards this approach as research studies have shown that getting control of the IBD earlier in the disease course can lead to better outcomes, likely due to preventing complications of IBD from happening (e.g. fistulas, malnutrition, colectomy).
Surgery should be discussed at any stage in the “step up approach” or “top down approach”. Surgery should not be considered a “failure of treatment” – as in many cases, surgery may be the best option for the person. IN some cases, medications may be started “too late” in the disease course, after complications (e.g. strictures) have already developed – in these cases, surgery AND medications together may be the best option
Clinical trials offer new therapies for patients with IBD
- they can be existing medications (in various doses or forms)
- new medications that target different proteins or pathways
- new combinations of medications
- new strategies of treatment are being studies
If you are planning to become pregnant in the near future, and are in a clinical trial, you should inform your physician and the research coordinator. As you cannot become pregnant while participating in a clinical trial of medications.