Inflammatory Bowel Disease: Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-05-24 12:25

Inflammatory bowel disease: therapy

According to the current state of medical knowledge, Crohn's disease and ulcerative colitis cannot yet be treated causally, ie a cure is not possible. The focus of the therapy is therefore on reducing or eliminating inflammation in the intestine as well as largely extending symptom-free phases (remission) while maintaining the highest possible quality of life. The function of the affected intestinal sections should be preserved…

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• Continue reading
• more on the subject
• Advice, downloads & tools
• Therapy depending on disease activity
• Anti-inflammatory drugs, immunosuppressants, and biologics
• Operative methods
• Aftercare
• Whom can I ask?
• How are the costs going to be covered?

Therapy depending on disease activity

The respective therapy steps take place depending on the activity and spread of the disease: During an active episode of the disease, the therapy is different than in a symptom-free resting phase (remission).

The treating doctor decides which package of measures is most suitable for the person affected, taking into account the living situation and the patient's ideas and the activity of the disease. In Crohn's disease, it mainly depends on which areas of the intestine are affected.

In the first place, drug therapies are available, with different groups of active ingredients and forms of application being possible. On the one hand, they can be applied locally as an enema, suppository or foam, or they can be swallowed (orally) or administered intravenously.

Nutritional therapeutic measures can also be carried out. If the options available are not (no longer) successful, an operation on the affected intestinal sections may be necessary. In addition, accompanying psychosomatic therapy can be helpful.

Therapy modules for IBD at a glance:

• medicinal (anti-inflammatory drugs, immunosuppressants, biologics),
• nutritional therapy (enteral, parenteral),
• operational measures.

Note In the case of severe acute flare-ups, hospitalization may be necessary.

Anti-inflammatory drugs, immunosuppressants, and biologics

In the case of high inflammatory activity, so-called immunosuppressants may be used in addition to anti-inflammatory drugs, which reduce the excessive reaction of the immune system. Another drug therapy option is available with biologics. These drugs are used in consultation with the attending physician if steroids (cortisone) and immunosuppressants do not or no longer work or lead to severe side effects and an operation is not necessary.

Overview of drug therapy for IBD:

• Painkillers, anti-spasmodics (antispasmodics) and preparations for diarrhea: for minor complaints.
• Anti-inflammatory drugs such as mesalazine (5-ASA), sulfasalazine. For swallowing (orally), if the colon (colitis) is affected, also in the form of suppositories, enemas or foam.
• Anti-inflammatory steroids, cortisone preparations such as locally acting budesonide, prednisolone. Administered for swallowing or intravenously (systemically), sometimes also used locally.
• Immunosuppressants such as azathioprine, 6-mercaptopurine, methotrexate, cyclosporine A, tacrolimus, mycophenolate.
• Biologics such as tumor necrosis factor (TNF) -alpha inhibitors (antibodies) e.g. infliximab, adalimumab, golimumab and anti-integrin vedolizumab.
• Crohn's disease: Proton pump inhibitors (PPIs) that reduce the production of stomach acid when the stomach is infected.
• Ulcerative colitis: probiotics such as bacterial preparation (E. coli, strain Nissle 1917)
• if necessary antibiotics.

Note Since smoking has a negative effect on the course of the disease in Crohn's disease, smoking cessation should be a central component of therapy! For more information, see Stop smoking.

If there is an undersupply of certain nutrients, vitamins or minerals such as protein, iron, vitamin D, vitamin B 12, folic acid, zinc, these are supplemented with tablets or infusions (substitution).

Note As the immune system is impaired in the case of inflammatory bowel disease due to drug therapy with immunosuppressants and possible malnutrition, the vaccination status should be clarified precisely - especially before traveling.

Operative methods

Chronic bowel disease may require bowel surgery as the disease progresses.

Intestinal operations can occur if..

• the drug therapy no longer works,
• there are constrictions (stenoses) in the intestine,
• an intestinal obstruction threatens,
• internal fistulas / abscesses exist,
• Bleeding in the bowel cannot be stopped,
• There are indications of colon cancer (pre-stages),
• an intestinal rupture occurs (emergency operation) or
• this is expressly requested by the patient.

In Crohn's disease, only those areas of the intestine that are severely affected by the inflammation and that absolutely need to be eliminated are removed. The economical removal of the intestinal sections prevents the development of short bowel syndrome. In addition, fistulas can lead to surgery. An artificial anus (stoma) may rarely be required.

Pouch and stoma

Ulcerative colitis may sometimes require surgical removal of the large intestine. During this procedure, the end of the small intestine is shaped into a pouch so that it can be used as a stool reservoir in the future. This pouch is sewn to the anal canal so that a normal chair exit is possible. Sometimes an artificial anus (ileostomy) may be necessary.

Alternative treatments

For alternative treatment methods such as frankincense, omega-3 fatty acids, fish oil, pork tapeworm eggs, stool transplants etc. there are no reliable data and they are therefore currently not recommended.

Aftercare

In ulcerative colitis in particular, the bowel should be checked for cancerous changes. Because as the disease spreads and continues, the risk increases. Regular examinations using colonoscopy and biopsy are therefore particularly important in ulcerative colitis and should begin after eight to ten years of illness.

In Crohn's disease, the risk of colon cancer depends primarily on which parts of the intestine are affected. If the colon is affected, colonoscopies are recommended as a check-up after the disease has existed for many years. The intervals at which these examinations take place is at the discretion of the doctor.

A concomitant disease of the liver (primarily sclerosing cholangitis) also increases the risk of cancer, and annual controls for cancerous changes should take place here. When taking immunosuppressants, the risk of skin cancer increases - you should therefore pay particular attention to intensive sun protection.

Whom can I ask?

With regard to the therapy of inflammatory bowel disease, you can contact the following offices:

• General practitioner
• Specialist in internal medicine (specializing in gastroenterology and hepatology)
• Outpatient departments for gastroenterology (IBD outpatient departments)

How are the costs going to be covered?

All necessary and appropriate therapies are covered by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

The costs will only not be charged directly if you use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. In this case, you pay the resulting amount directly to the doctor and submit the invoice to your health insurance provider. You will be reimbursed a maximum of 80 percent of the tariff that a contract doctor or a contract outpatient clinic charges the health insurance provider.

If a hospital stay is required, the hospital costs will be invoiced. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription by the general practitioner or specialist.

For more information, see What does a hospital stay cost?