Management of Inflammatory bowel disease
Inflammatory bowel disease should be considered when a young person
presents with:
• bloody diarrhoea and mucus
• colonic pain and fever
• extra-abdominal manifestations such as arthralgia, low back pain
(spondyloarthropathy), eye problems (iridocyclitis)
Two important diseases are ulcerative colitis and Crohn disease which
have equal sex incidence and can occur at any age, but onset peaks at
20–40 yrs.
The main symptom of ulcerative colitis is bloody diarrhoea and of Crohn
disease is colicky abdominal pain.
Management principles for both diseases
• Treat under consultant supervision.
• Treatment of acute attacks depends on severity of the attack and the
extent of the disease:
– mild attacks: manage out of hospital
– severe attacks: hospital, to attend to fl uid and electrolyte balance
• Pharmaceutical agents (the following can be considered):
– 5-aminosalicylic acid derivatives (mainly UC)
• sulfasalazine (mainstay) 1–2 g (o) 2–4 times/d
• olsalazine; mesalazine
– corticosteroids
• oral
• parenteral
• topical (rectal foam, suppositories or enemas)
– immunosuppressive drugs (e.g. azathioprine, cyclosporin (acute
UC), methotrexate and infl iximab (Crohn)
• Surgical treatment: reserve for complications.
Inflammatory bowel disease should be considered when a young person
presents with:
• bloody diarrhoea and mucus
• colonic pain and fever
• extra-abdominal manifestations such as arthralgia, low back pain
(spondyloarthropathy), eye problems (iridocyclitis)
Two important diseases are ulcerative colitis and Crohn disease which
have equal sex incidence and can occur at any age, but onset peaks at
20–40 yrs.
The main symptom of ulcerative colitis is bloody diarrhoea and of Crohn
disease is colicky abdominal pain.
Management principles for both diseases
• Treat under consultant supervision.
• Treatment of acute attacks depends on severity of the attack and the
extent of the disease:
– mild attacks: manage out of hospital
– severe attacks: hospital, to attend to fl uid and electrolyte balance
• Pharmaceutical agents (the following can be considered):
– 5-aminosalicylic acid derivatives (mainly UC)
• sulfasalazine (mainstay) 1–2 g (o) 2–4 times/d
• olsalazine; mesalazine
– corticosteroids
• oral
• parenteral
• topical (rectal foam, suppositories or enemas)
– immunosuppressive drugs (e.g. azathioprine, cyclosporin (acute
UC), methotrexate and infl iximab (Crohn)
• Surgical treatment: reserve for complications.