In terms of the medical treatments, the first group of drugs is called the aminosalicylates, or 5-ASA agents. These include drugs such as sulfasalazine, mesalamine, balsalazide and olsalazine, and they're good for treating mild to moderate disease.
When the disease becomes more severe, often steroids are used, although we try to avoid them if we can because of their toxicity. Steroids can be given intravenously or orally. The traditional oral drug had been prednisone, but more recently a new medication called budesonide was released which had similar efficacy but fewer side effects than prednisone.
In addition, there are medications that are called immunosuppressant drugs. These would include medicines such as 6-mercaptopurine, azathioprine, cyclosporin, methotrexate, and they're reserved for more moderate to severe cases. They can help patients come off of steroids, and they could also help treat more complicated cases of Crohn's disease that include fistulizing disease.
Antibiotics may be used in certain cases of Crohn's disease, particularly when the disease involves the perianal region. And finally, there are the newest drugs, the biologic modulators, such as infliximab, which is an antibody to an inflammatory mediator called tumor necrosis factor. This is a very potent drug which has been very effective in many cases of Crohn's disease, and there's research being done on medicines similar to infliximab which may be helpful in the future.
BETTINA GREGORY: And Dr. Heller, are there surgical options for people with severe IBD?
ARTHUR HELLER, MD: Oh, indeed. And we usually reserve surgery for people who are having severe disease. We learned early on with Crohn's disease that cutting out the diseased area doesn't end the process. It would recur. What we do now is reserve in Crohn's disease surgery for patients who have abscesses, for fistulas that don't respond to medical treatment, and for tight strictures, tight narrowings, that can cause frequent blockages.
For ulcerative colitis, we usually reserve colon removal for those individuals who are having disease that doesn't respond adequately to medical therapy or in the event of toxic mega colon, which is a pretty significant complication.
BETTINA GREGORY: Most people with Crohn's Disease and Ulcerative Colitis can lead normal, useful and productive lives. Effective treatment depends on well-educated patients and knowledgeable caregivers. We're grateful to Dr. Arthur Heller and Dr. Robert Tepper for helping us better understand the possible causes these inflammatory bowel diseases, and treatment options. I'm Bettina Gregory. Thanks for joining us.
