Maintenance treatment in IBD
Almost all patients with inflammatory bowel disease (IBD) have symptoms that include abdominal discomfort or pain and/or change in bowel habits (usually diarrhoea).
The distinguishing features of IBD are ‘red flag’ symptoms or signs, such as:
• Rectal bleeding
• Weight loss
• Abdominal mass
• Fever
• Nocturnal symptoms
• Pallor; or
• Tachycardia; and
Clues from simple screening blood tests, such as:
• Elevated C-reactive protein;
• White cell and/or platelet count; or
• Erythrocyte sedimentation rate; or
• Pus cells on faecal microscopy (when bowel infection is sought but no pathogens detected).
The diagnosis is usually secured by findings from flexible sigmoidoscopy or colonoscopy that should include ileoscopy, together with compatible histopathological features on multiple biopsies.
Mesalazine (5-aminosalicylic acid, 5-ASA) preparations are the mainstay of maintenance therapy for ulcerative colitis (UC). They will reduce the chance of relapse by two thirds and should be recommended for all patients except those with mild proctitis.
Once symptoms have settled and patients are in remission, maintenance treatment is recommended. Maintenance treatment has been shown to reduce the number of flare-ups. Medication adherence is the key to successful prevention of relapse.
Healing in Crohn’s disease (CD) is more difficult to achieve. Therapeutic approaches in CD are moving towards more aggressive therapy early in the course of the disease. Recently there has been a shift from steroids and mesalazine to immune suppressants such as azathioprine and methotrexate, biological agents such as infliximab, and, to a lesser extent, antibiotics.
Attention to patient education, nutrition, and issues of living with IBD is an essential part of good management.
Useful URLs
Gastroenterological Society of Australia www.gesa.org.au
Australian Crohn’s and Colitis Association www.acca.net.au