Goals of Therapy

What are the goals of IBD treatment?

The goal in the treatment of IBD inflammation is to make you feel better (induce remission), minimize side effects from medications, and also to induce mucosal healing. This is the actual healing of the mucosa, or lining, of your gut.

We want to not only improve your IBD symptoms but also to improve the health of your gut itself, and then maintain that improvement. A healthier gut leads to feeling better in the long term. 

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Traditional approach to treatment: step up therapy

The traditional approach to treatment of IBD inflammation is referred to as ‘step up’ therapy, which means trying lower classes of medications first and progressing to stronger medications if needed. Medications called 5-ASAs are the most common treatment if you have mild or moderate IBD.

For severe disease, corticosteroids may be used at first. Surgery may be required, and immunosuppressants and/or biologics may also be considered.

All of these types of medications are described later in this section. Talk to your IBD specialist for more information on step-up therapy.

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New approach to treatment: top down therapy

Recent studies are showing that the best way to induce mucosal healing and improve symptoms is with early aggressive therapy followed by a good long-term maintenance plan. The new approach, called ‘top-down’ therapy, starts with more aggressive therapy with biologics, potentially in combination with immunosuppressants, and then later using other drugs such as 5-ASAs.

By using a more aggressive treatment earlier on, you may achieve more complete remission and change the natural course of the disease, which can prevent flare ups down the road. Talk to your IBD specialist for more information about top down therapy.

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Importance of maintenance therapy

Since IBD never goes away, once remission is achieved, you need maintenance therapy to keep the disease under control. Before proceeding to maintenance therapy, it is important that you have discontinued and no longer require any corticosteroid treatment.

Make sure not to stop any medications just because you are feeling better, because this could lead to a flare and it might be difficult to restart medication without needing surgery or steroids.

Also, your healthcare team will try not to change your medications if you are doing well on your current drug regimen, especially if you are on biologics, because they do not want to induce a flare.

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Medications for inflammation

There are different types of medications you might take if you have IBD. These would most likely include medications for inflammation, which the information in this section focuses on. 

Other medications you might take (i.e., medications for pain or medications that treat symptoms without focusing on inflammation such as medical cannabis) are covered later in our Symptom Management section.

Stress and anxiety are important contributors to pain and your symptom experience. Strategies and treatments to manage stress an anxiety are discussed later in the Mental Health section. 

When taking medications, it is very important that you stick to your treatment regimen. This means paying attention to the instructions on the drug label (i.e., take with meals), following the frequency and dosage of your medications, and renewing your medications on time. Again, don’t stop taking your medications without first discussing it with your health care provider or IBD specialist.

IBD is chronic, and you will probably need to take some sort of medication for the rest of your life. The actual medication, amount, frequency, and dosage may vary over time. Work with your doctor and nurse practitioner to determine the medications that are best for you.

Medications that are used to treat inflammation in IBD include antibiotics, aminosalicylates (sulfasalazine or 5-ASA), immunosuppressants, corticosteroids, and biologic and biosimilar therapies. Emerging therapies that may be effective in the management of IBD include Fecal Microbiota Transplant, also known as Fecal Matter Transplant (FMT).


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