IBD Rx

1) ULCERATIVE COLITIS- (sulfasalazine most effective to maintain remission)

1. Well balanced diet
2. Colectomy if
   1. refractory to medical Tx or
   2. if have cancerous changes
3. Colonoscopy surveillance recommended starting 7 yrs from time of diagnosis
4. Meds:
   1. mild-mod disease –  sulfasalazine high dose for 12-16 weeks (6-8gms/day)
      1. once in remission then maintenance dose 2gms/day divided QID
   2. Severe disease- prednisone 30-60mg/day tapering to 0mg over 12-16 weeks,
      1. if in remission add maintenance dose sulfasalazine
      2. if poor control iv steroids/azathioprine/surgery
5. NO NSAIDS
6. asacol/mesalamine is a sulfasalazine with a different coating to release active ingredient
7. Use extreme caution when prescribing narcotics and anticholinergic drugs in pts with active ulcerative colitis due to risk of toxic megacolon

2) CROHNS- (prednisone is most effective to maintain remission)

1. stop smoking, adequate calorie intake (don‘t arbitrarily limit food)
2. surgery for
   1. strictures/abscesses
   2. psychological support
3. Meds:
   1. mild disease-induce remission with sulfasalazine over 10-16 weeks
   2. mod disease-induce remission with prednisone 40-60mg over 10-16 weeks,
      1. once in remission use sulfasalazine,
      2. if no remission use immunosuppressive therapy
      3. e.g. azathioprine/imuran or methotrexate or cyclosporine, po cipro/flagyl also used
   3. severe disease-iv steroids x 3-14 days
      1. then PO steroids or surgery if no response
4. If terminal ileum resected may require cholestyramine or antidiarrheals and B12 supps
5. In crohns disease, only use sulfasalazine as maintenance Tx for those at high risk for relapse based on previous disease.
6. NO NSAIDS