The management of patients with ulcerative colitis and Crohn’s disease comprises general measures, supportive treatment and specific pharmacological and surgical therapies (Table 6.1). The aims of the anti-inflammatory and immunomodulatory treatments used are to induce and then maintain full clinical and endoscopic remission (Table 6.2).
General considerations
IBD care must be patient centered. It should be high quality, safe, given as close as possible to where patients live and responsive to their needs. As with all types of chronic disease, the patient with IBD must be looked upon as a person rather than a case; the importance of a holistic approach to the patient and their family and carers is clear. Indeed, an integrated service, in which the patient is assessed and supported psychosocially as well as medically from diagnosis, is increasingly advocated.
Explanation. Patients with newly diagnosed IBD need a full explanation from their doctor and/or specialist IBD nurse about their disease and its implications in order to share control of therapeutic decisions with their multidisciplinary IBD team. They also need advice as to how best to help themselves (Table 6.3).
The process of learning about IBD can be facilitated by written information and other services provided by patient support groups (see Useful resources, page 148). The services offered by such groups include:
• educational literature, websites and helplines
• lecture and discussion meetings at which patients and their families can share their problems
• general advice for individuals with particular difficulties relating to their illness
• direction to appropriate social agencies to help with employment problems, and to insurance companies for life, travel and motor insurance
• political pressure to maximize accessibility of healthcare services to patients with IBD
• raising funds for research.
TABLE 6.1 | |
General measures Explanation • physicians, specialist nurses, pharmacist • patient support groups Specialist multidisciplinary hospital care • monitoring disease activity, nutrition, therapy • checking for extraintestinal complications • colonoscopic cancer surveillance • vaccination as necessary Self-help (see Table 6.3) | |
Supportive treatment Dietary and nutritional advice Psychological support Drugs • antidiarrheal agents (not in active colitis) • colestyramine or colesevalam for bile salt diarrhea (ileal Crohn’s disease or resection) • hematinics (iron, folate, vitamin B12) • vitamins, electrolytes • osteoporosis prophylaxis and treatment • heparin, administered subcutaneously (inpatients with active IBD) | |
Drugs to avoid • antidiarrheal drugs (in active colitis) • non-essential NSAIDs, antibiotics, delayed-release drugs | |
Specific treatment (according to presentation) Drugs • corticosteroids • aminosalicylates • immunomodulatory drugs (azathioprine/MP, ciclosporin [cyclosporine], methotrexate) • antibiotics • anti-TNFα therapy Nutritional therapy (Crohn’s disease only) • liquid formula diet Surgery | |
MP, mercaptopurine; NSAID, non-steroidal anti-inflammatory drug; TNF, tumor necrosis factor. | |
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