Inflammatory Bowel Disease Therapy

Question 1

What are the aims of treating IBD?

Answer 1

To control inflammation and heal mucosa
To restore normal bowel habit
Improve quality of life
Avoid long-term complications

Question 2

What lifestyle advice is given to patient’s with IBD?

Answer 2

Stop smoking (if they do so)
Improve diet

Question 3

What drug therapy can be given for patients with UC?

Answer 3

5-ASA
Steroids
Immunosuppressants
Anti-TNF therapy

Question 4

What drug therapy can be given for patient’s with Crohn’s?

Answer 4

Steroids
Immunosuppressants
Anti-TNF therapy

Question 5

Explain the use of 5-ASA

Answer 5

5-ASA reduces inflammation by inhibiting COX and LOX. Common 5-ASA drugs include sulfasalzine, mesalazine and asacol

Question 6

How can 5-ASA be administered topically?

Answer 6

Suppositories (only coat first 20cm of rectum but have better mucosal adherence)
Enemas (poorer mucosal adherence but better spread by reflex contraction)

Question 7

Describe the use of immunosuppression in treating IBD

Answer 7

Used when more potent suppression of inflammation is required
Common immunosuppressants include:
Azathioprine
Methotrexate
Azathioprine is directly broken down to metabolites which can be measured

Question 8

Describe the use of anti-TNF therapy in treating IBD

Answer 8

Tumour necrosis factor (TNF) is a proinflammatory cytokine - antibodies to TNF include infliximab and adalimumab, which promote apoptosis of activated T lymphocytes
Approved for Crohn’s and moderate-severe UC

Question 9

Summarise the drug treatment of IBD

Answer 9

IBD is treated as a therapy treatment consisting of:
5-ASA (only in UC)
Steroids
Immunosuppression
Anti-TNF