Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.

Pharmacologic therapies play a pivotal role in the management of Inflammatory Bowel Disease (IBD), aiming to control symptoms and impede disease progression. Here, we will explore the various classes of drugs used in the pharmacologic management of IBD.

Aminosalicylates

The first pharmacologic agents are aminosalicylates, such as sulfasalazine, which are effective in preventing and treating the recurrence of inflammation and are indicated as first-line agents. These drugs, containing 5-aminosalicylic acid (5-ASA), target UC and Crohn's disease by suppressing proinflammatory cytokines and interfering with arachidonic acid metabolism, offering versatile administration through oral, rectal, and intravenous forms for targeted treatment throughout the digestive tract.

Corticosteroids

Corticosteroids, like prednisone, prednisolone, budesonide, and dexamethasone, emerge as potent anti-inflammatory drugs. Administered at high doses, they prove helpful for acute flare-ups of most IBD forms when 5-ASA compounds prove insufficient. However, their role is restricted to acute flares, lacking efficacy in remission maintenance. These corticosteroids can be taken orally, rectally, or intravenously based on individual requirements.

Immunomodulators

Immunomodulators, also termed immunosuppressants, including azathioprine, mercaptopurine, methotrexate, and cyclosporine, alter the pathologic immune response in IBD, effectively reducing inflammation and diminishing the need for corticosteroids, hospitalization, and surgery. For instance, azathioprine and its metabolite 6-mercaptopurine inhibit T-cell function, inducing T-cell apoptosis, demonstrating long-term efficacy, diminished corticosteroid requirements, and remission maintenance for years. However, they have a delayed onset of action and are unsuitable for acute flare-ups.

Biologic therapies

Biologic therapies constitute an advanced category of treatments targeting specific proteins responsible for inflammation in Inflammatory Bowel Disease (IBD). This category includes anti-tumor necrosis factor (anti-TNF) medications, such as intravenously administered Infliximab, integrin blockers like vedolizumab (administered intravenously), and interleukin blockers like ustekinumab (administered via subcutaneous injection or intravenous infusion). Anti-TNF medications inhibit TNF-α-associated inflammatory responses, preventing chronic inflammation and tissue damage. Integrin blockers impede white blood cell infiltration into the GI tract, and interleukin blockers target interleukin-12 and interleukin-23, pivotal proteins associated with GI tract inflammation.

Antibiotics

Antibiotics contribute to IBD treatment by altering gut microbiota, reducing bacterial overgrowth, and exhibiting anti-inflammatory effects. Metronidazole and ciprofloxacin are commonly used antibiotics for IBD, aiding in managing complications like infections, fistulas, or abscesses in Crohn's disease.

Symptom management

The management of IBD symptoms typically involves a comprehensive approach, often combining anti-inflammatory medications with other strategies. It includes antidiarrheal medications, pain relievers, supplements, and dietary adjustments tailored to individual needs.

Conclusion

Different pharmacologic therapies have their considerations and potential side effects. Regular monitoring through blood tests and close follow-up with a gastroenterologist or IBD specialist is crucial for optimizing treatment and preventing complications.