Therapy
The therapy of a chronic inflammatory bowel disease depends on whether an acute episode needs to be treated or whether the symptom-free interval should be extended and a new episode delayed. To treat the acute inflammatory flare, mainly anti-inflammatory drugs such as cortisone are used. As already mentioned, Crohn’s disease patients should generally refrain from smoking, as this worsens the course of the disease.
Care should be taken to ensure a balanced diet and sufficient nutrient intake. Alcohol and certain foods that are not well tolerated should also be avoided. In case of malabsorption, missing substrates such as vitamins, calories, protein, zinc and calcium should be substituted.
In the case of Crohn’s disease, surgical intervention can also be performed in emergencies. However, this is only in emergencies such as perforation (rupture of the bowel). Crohn’s disease is mainly treated with medication and cannot be cured by surgery.
In contrast, in ulcerative colitis with a severe course, surgical removal of the rectum (rectum) and colon (large intestine), a so-called proctocolectomy, is often necessary. To excrete stool, either an artificial bowel outlet is created or an “ileonal pouch” is formed. An ileonal pouch is a connection between the small intestine (ileum) and the anus and represents the standard procedure.
Since ulcerative colitis usually only affects the large intestine and rectum, it is cured by surgical removal. In the case of milder courses of the disease, substitution of nutrients such as iron should also be considered. Drug treatment depends primarily on whether the disease is an acute inflammatory flare or an inflammation-free interval.
Drug treatment of Crohn’s disease differs from that of ulcerative colitis: In mild acute attacks of Crohn’s disease, local treatment with glucocorticoids such as budesonide is used. In more severe attacks or if local therapy is not sufficient, systemic glucocorticoid administration with e.g. prednisolone is used. For courses of disease that cannot be controlled with glucocorticoids, the administration of immunosuppressive drugs must be considered.
TNF-alpha-antibodies are mainly used for this purpose. In order to delay the next acute inflammation as far as possible, immunosuppressive drugs such as azathioprine or Infliximab (TNF-alpha antibodies) are also given. In the acute therapy of mild ulcerative colitis, so-called 5-ASA preparations (e.g. mesalazine), which have an anti-inflammatory effect, are used locally.
Antibiotic therapy is required for bacterial infections. Glucocorticoids are additionally administered in the case of moderate attacks. If the attack is severe, immunosuppressive drugs such as ciclospoprin A, tacrolism or Infliximab are prescribed.
For long-term therapy between relapses, patients take 5-ASA preparations rectally or orally. In case of a bacterial infection, treatment with antibiotics is necessary.
