Skip to main content
SpringerLink
Log in

Treatment of inflammatory bowel disease (IBD)

  • Review
  • Published:
Pharmacological Reports Aims and scope Submit manuscript

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract, which includes Crohn’s disease (CD) and ulcerative colitis (UC). These diseases have become important health problems. Medical therapy for IBD has advanced dramatically in the last decade with the introduction of targeted biologic therapies, the optimization of older therapies, including drugs such as immunomodulators and 5-aminosalicylic acid (5-ASA), and a better understanding of the mucosal immune system and the genetics involved in the pathogenesis of IBD. The goal of IBD therapy is to induce and maintain remission. The current treatment paradigm involves a step-up approach, moving to aggressive, powerful therapies only when milder therapies with fewer potential side effects fail or when patients declare themselves to have an aggressive disease. This review focuses on the current treatments for inflammatory bowel disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

5-ASA:

5-aminosalicylic acid

CD:

Crohn’s disease

CDAI:

Crohn’s disease activity index

CRP:

C-reactive protein

DHA:

docosahexaenoic acid

DNBS:

2,4-dinitrobenzene sulfonic acid

EPA:

eicosapentaenoic acid

IBD:

inflammatory bowel disease

IgE:

immunoglobulin E

IL:

interleukin

MMF:

mycophenolate mofetil

NF-κB:

nuclear factor kappa B

SCG:

sodium cromoglycate

TNF:

tumor necrosis factor

UC:

ulcerative colitis

References

  1. Aberra FN, Lewis JD, Hass D, Rombeau J, Osborne B, Lichtenstein G: Corticosteroids and immunomodulators, postoperative infectious complication risk in inflammatory bowel disease. Gastroenterology, 2003, 125, 320–327.

    Article  CAS  PubMed  Google Scholar 

  2. Arnold GL, Beaves MR, Pryjdun VO, Mook WJ: Preliminary study of ciprofloxacin in active Crohn’s disease. Inflamm Bowel Dis, 2002, 8, 10–15.

    Article  PubMed  Google Scholar 

  3. Barnes PJ, Karin M: Nuclear factor-кB. A pivotal transcription factor in chronic inflammatory diseases. N Engl J Med, 1997, 336, 1066–1071.

    Article  CAS  PubMed  Google Scholar 

  4. Bello C, Goldstein F, Thornton JJ: Alternate-day prednisone treatment and treatment maintenance in Crohn’s disease. Am J Gastroenterol, 1991, 86, 460–466.

    CAS  PubMed  Google Scholar 

  5. Bibiloni R, Fedorak RN, Tannock GW, Madsen KL, Gionchetti P, Campieri M, De Simone C, Sartor RB: VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol, 2005, 100, 1539–1546.

    Article  PubMed  Google Scholar 

  6. Camma C, Giunta M, Rosselli M, Cottone M: Mesala-mine in the maintenance treatment of Crohn’s disease, A meta-analysis adjusted for confounding variables. Gastroenterology, 1997, 113, 1465–1473.

    Article  CAS  PubMed  Google Scholar 

  7. Carrier J, Medline A, Sohn KJ, Choi M, Martin R, Hwang SW, Kim YI: Effects of dietary folate on ulcerative colitis-associated colorectal carcinogenesis in the in-terleukin 2- and β2-microglobulin-deficient mice. Cancer Epidemiol Biomarkers Prev, 2003, 12, 1262–1267.

    CAS  PubMed  Google Scholar 

  8. Connell WR, Kamm MA, Dickson M, Balkwill AM, Ritchie JK, Lennard-Jones JE: Long-term neoplasia risk after azathioprine treatment in inflammatory bowel disease. Lancet, 1994, 343, 1249–1252.

    Article  CAS  PubMed  Google Scholar 

  9. Cuzzocrea S, Mazzon E, Dugo L, Caputi AP, Riley DP, Salvemini D: Protective effects of M40403, a superoxide dismutase mimetic, in a rodent model of colitis. Eur J Pharmacol, 2001, 432, 79–89.

    Article  CAS  PubMed  Google Scholar 

  10. Dotan I, Rachmilewitz D: Probiotics in inflammatory bowel disease, possible mechanisms of action. Curr Opin Gastroenterol, 2005, 21, 426–430.

    PubMed  Google Scholar 

  11. Farrell RJ, Alsahli M., Jeen YT, Falchuk K, Peppercorn M, Michetti P: Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn’s disease, A randomized, controlled trial. Gastroenterology, 2003, 124, 917–924.

    Article  CAS  PubMed  Google Scholar 

  12. Farrell RJ, Murphy A, Long A, Donnelly S, Cherikuri A, O’Toole D, Mahmud N et al.: High multidrug resistance (P-glycoprotein 170) expression in inflammatory bowel disease patients who fail medical therapy. Gastroenterology, 2000, 118, 279–288.

    Article  CAS  PubMed  Google Scholar 

  13. Faubion WA Jr, Loftus EV, Harmsen WS, Zinmeister AR, Sandborn WJ: The natural history of corticosteroid therapy for inflammatory bowel disease, a population-based study. Gastroenterology, 2001, 121, 255–260.

    Article  CAS  PubMed  Google Scholar 

  14. Feagan BG, McDonald J, Hopkins M: A randomised controlled trial of methotrexate (MTX) as a maintenance therapy for chronically active Crohn’s disease (CD). New Eng J Med, 2000, 342, 1627–1632.

    Article  CAS  PubMed  Google Scholar 

  15. Fernandes-Banares F, Hinojoso J, Sanchez-Lombrana JL: Randomised clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol, 1999, 2, 427–433.

    Google Scholar 

  16. Fiocchi C: Inflammatory bowel disease, etiology and pathogenesis. Gastroenterology, 1998, 115, 182–205.

    Article  CAS  PubMed  Google Scholar 

  17. Francella A, Dyan A, Bodian C, Rubin P, Chapman M, Present D: The safety of 6-mercaptopurine for childbear-ing patients with inflammatory bowel disease, A retrospective cohort study. Gastroenterology, 2003, 124, 9–17.

    Article  CAS  PubMed  Google Scholar 

  18. Furrie E, Macfarlane S, Kennedy A, Cummings JH, Walsh SV, O’Neil DA, Macfarlane GT: Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis, a randomised controlled pilot trial. Gut, 2005, 54, 242–249.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gionchetti P, Rizzello F, Helwig U: Prophylaxis of pouchitis onset with probiotic therapy, a double-blind, placebo-controlled trial. Gastroenterology, 2003, 124, 1202–1209.

    Article  PubMed  Google Scholar 

  20. Greenberg GR, Feagan BR, Martin F, Sutherland L, Thomson A, Williams N, Nilsson L, Persson T: Oral budesonide for active Crohn’s disease. New Eng J Med, 1994, 331, 836–841.

    Article  CAS  PubMed  Google Scholar 

  21. Grisham MB: Oxidants and free radicals in inflammatory bowel disease. Lancet 1994, 344, 859–861.

    Article  CAS  PubMed  Google Scholar 

  22. Guslandi M, Giollo P, Testoni PA: A pilot trial of Sac-charomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol, 2003, 15, 697–698.

    Article  PubMed  Google Scholar 

  23. Haber CJ, Meltzer SJ, Present DH, Koreitz BI: Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology, 1986, 91, 982–996.

    Article  CAS  PubMed  Google Scholar 

  24. Hanauer SB, Baert F: Medical therapy of inflammatory bowel disease. Med ClinNorth Am, 1994, 78, 1413–1426.

    Article  CAS  Google Scholar 

  25. Hawthorne AB, Daneshmend T, Hawkey C, Belluzzi A, Everitt S, Holmes G, Malkinson C et al.: Treatment of ulcerative colitis with fish oil supplementation, a prospective 12 month randomized controlled trial. Gut, 1992, 33, 922–928.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Herias MV, Koninkx JF, Vos JG, Huis in’t Veld JH, van Dijk JE: Probiotic effects of Lactobacillus casei on DSS-induced ulcerative colitis in mice. Int J Food Microbiol, 2005, 25, 103, 143–155.

    Article  Google Scholar 

  27. Hofer KN: Oral budesonide in management of Crohn’s disease. Ann Pharmacother, 2003, 37, 1457–1464.

    Article  CAS  PubMed  Google Scholar 

  28. Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, Welfare MR: Influence of dietary factors on the clinical course of ulcerative colitis, a prospective cohort study. Gut, 2004, 53, 1479–1484.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Karimi O, Pena AS, van Bodegraven AA: Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn’s disease, a pilot study. Drugs Today (Barc), 2005, 41, 453–459.

    Article  CAS  Google Scholar 

  30. Korelitz BI, Adler DJ, Mendelsohn RA, Sacknoff AL: Long-term experience with 6-mercaptopurine in the treatment of Crohn’s disease. Am J Gastroenterol, 1993, 88, 1198–1205.

    CAS  PubMed  Google Scholar 

  31. Korelitz BI, Hanauer S, Rutgeerts P: Post-operative prophylaxis with 6-MP, 5-ASA, or placebo in Crohn’s disease, a 2-year multicenter trial. Gastroenterology, 1998, 114, A4141.

    Article  Google Scholar 

  32. Langmead L, Dawson C, Hawkins C, Banna N, Loo S, Rampton DS: Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease, an in vitro study. Aliment Pharmacol Ther, 2002, 16, 197–205.

    Article  CAS  PubMed  Google Scholar 

  33. Langmead L, Feakins RM, Goldthorpe S, Holt H, Tsironi E, De Silva A, Jewell DP, Rampton DS: Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther, 2004, 19, 739–747.

    Article  CAS  PubMed  Google Scholar 

  34. Langmead L, Makins RJ, Rampton DS: Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro. Aliment Pharmacol Ther, 2004, 19, 521–527.

    Article  CAS  PubMed  Google Scholar 

  35. Lichtinger S, Present DH, Kornbluth A, Gelernt I, Bauer J, Galler G, Michelassi F, Hanauer S: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med, 1994, 330, 1841–1845.

    Article  Google Scholar 

  36. Macfarlane S, Furrie E, Kennedy A, Cummings JH, Macfarlane GT: Mucosal bacteria in ulcerative colitis. Br J Nutr, 2005, 93, S67–72.

    Article  CAS  PubMed  Google Scholar 

  37. MacLean CH, Mojica WA, Newberry SJ, Pencarz J, Garland RH, Tu W, Hilton LG et al.: Systematic review of the effects of omega-3 fatty acids in inflammatory bowel disease. Am J Clin Nutr, 2005, 82, 611–619.

    Article  CAS  PubMed  Google Scholar 

  38. Malolepszy J, Kuczymska-Sekieta K, Chachaj W: Sodium cromoglycate therapy in ulcerative colitis. Acta Allergol, 1977, 13, 82–86

    PubMed  Google Scholar 

  39. Mazzon E, Muia C, Di Paola R, Genevose T, De Sarro A, Cuzzocrea S: Thalidomide treatment reduces colon injury induced by experimental colitis. Shock, 2005, 23, 556–564.

    CAS  PubMed  Google Scholar 

  40. Meister D, Ghosh S: Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture, differential effects on ulcerative colitis and Crohn’s disease. World J Gastroenterol, 2005, 21, 11, 7466–7472.

    Article  Google Scholar 

  41. Meyers S, Sachar DB: Medical therapy of Crohn’s disease. In: Inflammatory Bowel Disease. 4th edn., Eds. Kersnar JB, Shorter RG, Williams and Wilkins, Baltimore, 1995, 695–714.

    Google Scholar 

  42. Middleton SJ, Naylor S, Woolner J, Hunter JO: A double-blind, randomized, placebo-controlled trial of essential fatty acid supplementation in the maintenance of remission of ulcerative colitis. Aliment Pharmacol Ther, 2002, 16, 1131–1135.

    Article  CAS  PubMed  Google Scholar 

  43. Panaccione R, Colombel JF, Sandborn WJ, Rutgeerts P, D’Haens GR, Robinsonn AM, Chao J et al: Adalimumab sustains clinical remission and overall clinical benefit after 2 years of therapy for Crohn’s disease. Aliment Pharmacol Ther, 2010, 31, 1296–1309.

    Article  CAS  PubMed  Google Scholar 

  44. Papadakis KA, Targan SR: The role of chemokines and chemokine receptors in mucosal inflammation. Inflamm Bowel Dis, 2000, 6, 303–313.

    Article  CAS  PubMed  Google Scholar 

  45. Pearson DC, May GR, Fick GH, Sutherland LR: Azathioprine and mercaptopurine in Crohn’s disease. A meta-analysis. Ann Intern Med, 1995, 123, 132–142.

    Article  CAS  PubMed  Google Scholar 

  46. Prantera C, Cottone M, Pallone F: Mesalamine in the treatment of mild to moderate active Crohn’s ileitis, results of a randomised multicenter trial. Gastroenterology, 1999, 116, 521–526.

    Article  CAS  PubMed  Google Scholar 

  47. Present DH, Rutgeerts P, Targan S, Hanauer S, Mayer L, Hogezand R, Podolsky D: Infliximab for the treatment of fistulas in patients with Crohn’s disease. New Eng J Med, 1999, 340, 1398–1405.

    Article  CAS  PubMed  Google Scholar 

  48. Rutgeerts P, Feagan BF, Lichtenstein GR, Mayer L, Schreiber S, Colombel J, Rachmilewitz D et al.: Com parison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology, 2004, 126, 402–413.

    Article  CAS  PubMed  Google Scholar 

  49. Rutgeerts P, Hiele M, Geboes K, Peeters M, Penninckx F, Aerts R, Kerremans R: Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology, 1995, 108, 1617–1621.

    Article  CAS  PubMed  Google Scholar 

  50. Ryder SD, Walker RJ, Jones H, Rhodes JM: Rectal bismuth subsalicylate as therapy for ulcerative colitis. Aliment Pharmacol Ther, 1990, 4, 333–338.

    Article  CAS  PubMed  Google Scholar 

  51. Sakamoto N, Kono S, Wakai K, Fukuda Y, Satomi M, Shimoyama T, Inaba Y et al.: Dietary risk factors for inflammatory bowel disease, a multicenter case-control study in Japan. Inflamm Bowel Dis, 2005, 11, 154–163.

    Article  PubMed  Google Scholar 

  52. Sandborn WJ: A critical review of cyclosporine therapy in inflammatory bowel disease. Inflamm Bowel Dis, 1995, 1, 48–63.

    Article  Google Scholar 

  53. Sandborn WJ, Feagan BG, Stoinov S, Honiball PJ, Rutgeerts P, Mason D, Bloomfield R, Schreiber S: Certolizumab pegol for the treatment of Crohn’s disease. N Engl J Med, 2007, 357, 228–238.

    Article  CAS  PubMed  Google Scholar 

  54. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA et al.: Infliximab maintenance therapy for fistulizing Crohn’s disease. New Engl J Med, 2004, 350, 876–885.

    Article  CAS  PubMed  Google Scholar 

  55. Sartor RB: Current concepts of the etiology and pathogenesis of ulcerative colitis and Crohn’s disease. Gastroenterol Clin North Am, 1995, 24, 475–485.

    CAS  PubMed  Google Scholar 

  56. Sartor RB: Microbial factors in the pathogenesis of Crohn’s disease, ulcerative colitis and experimental intestinal inflammation. In: Inflammatory Bowel Disease. 5th edn., Eds. Kirsner JB, Hanauer S, Saunders, Philadelphia, 1999, 153–178.

    Google Scholar 

  57. Shah SB, Hanauer SB: Treatment of diarrhea in patients with inflammatory bowel disease, concepts and cautions. Rev Gastroenterol Disord, 2007, 7, S3–10.

    PubMed  Google Scholar 

  58. Steinhart AH, Ewe K, Griffiths AM, Modigliani R, Thomsen OO: Corticosteroids for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev, 2003, CD000301.

    Google Scholar 

  59. Sutherland L, Singleton J, Sessions J, Hanauer S, Krawitt E, Rankin G, Summers R et al.: Double blind, placebo-controlled trial of metronidazole in Crohn’s disease. Gut, 1991, 32, 1071–1075.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present D, Braakman T, DeWoody K et al.: A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor a for Crohn’s disease. New Eng J Med, 1997, 337, 1029–1035.

    Article  CAS  PubMed  Google Scholar 

  61. Taylor BS, Shao L, Gambotto A, Ganster RW, Geller DA: Inhibition of cytokine-induced nitric oxide synthase expression by gene transfer of adenoviral IкBα. Surgery, 1999, 126, 142–147.

    Article  CAS  PubMed  Google Scholar 

  62. Vakil N, Sparberg M: Steroid-related osteonecrosis in inflammatory bowel disease. Gastroenterology, 1989, 96, 62–67.

    Article  CAS  PubMed  Google Scholar 

  63. Vasiliauskas EA, Kam LY, Abreu MT: An open-label, step-wise dose-escalating pilot study of low-dose thalidomide in chronically active, steroid-dependent Crohn’s disease. Gastroenterology, 1999, 117, 1278–1287.

    Article  CAS  PubMed  Google Scholar 

  64. Wahl C, Liptay S, Adler G, Schmid RM: Sulfasalazine, a potent and specific inhibitor of nuclear factor kappa B. J Clin Invest, 1998, 101, 1163–1174.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology, L.M. College of Pharmacy, Navrangpura, Ahmedabad, 3800 09, Gujarat, India

    Anand B. Pithadia & Sunita Jain

Authors
  1. Anand B. Pithadia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunita Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anand B. Pithadia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pithadia, A.B., Jain, S. Treatment of inflammatory bowel disease (IBD). Pharmacol. Rep 63, 629–642 (2011). https://doi.org/10.1016/S1734-1140(11)70575-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1734-1140(11)70575-8

Key words

Search

Navigation