Inflammatory Bowel Disease (IBD) Treatments By Amber J. Tresca | Reviewed by Emmy Ludwig, MD Updated September 29, 2016 Print Inflammatory bowel diseases (IBD), which include Crohn's disease, ulcerative colitis, and indeterminate colitis, are chronic diseases of the digestive system. There currently is no cure for any form of IBD, but there are effective treatment options. Here we discuss the approved treatments for two main forms of IBD: Crohn's disease and ulcerative colitis. Patients with indeterminate colitis (which is estimated to include about 10 percent of patients with IBD) are typically given treatments that are approved for ulcerative colitis. Take a look at how ulcerative colitis affects the colon. There are many medications that are approved for use in people with Crohn's disease and ulcerative colitis. Some, however, are only approved for one or the other. Drugs have different ways of working and being given, so patients and gastroenterologists can work together to find an option that not only effectively manages their symptoms, but fits into a patient's lifestyle. Article If You Are Taking A Biologic For IBD, Should You Get Vaccinated? Article What Are the Differences Between These 6 Biologics for IBD? The good news is that if one medication or one type of medication isn't doing the job, there are other drugs in the same class, or in another class, that can be tried next. Even better news is that more medications are being created for treating IBD, and there is greater hope than ever before to find a treatment that works well to manage the symptoms of IBD and the inflammation IBD causes.Surgery is also a way to treat IBD, and for both Crohn's disease and ulcerative colitis, various types of surgery are used as a treatment. However, the type of surgery used will be different based on whether it's done to treat Crohn's disease or ulcerative colitis. This is because of the different ways these diseases affect the digestive system and how surgery improves symptoms and quality of life for patients. While the thought of surgery is daunting, it is used only after other treatments have been tried and are no longer working.Goals of IBD TreatmentThere are several different medications that are used to treat IBD. These medications are typically talked about by classes, and include antibiotics, biologics, corticosteroids, and immunomodulators. Treatment with medications has a two-fold goal: to get a flare-up under control and into remission, and then to keep remission going and prevent more flare-ups. Some drugs are used for either one of those goals or the other, and some are used for both.There isn't one standard of treatment that's used for every person with IBD. There are guidelines offered by medical societies, but treatment is not a one-size-fits-all proposition. Medical treatment will need to be customized to fit the needs of each patient. Article How to Have Less Pain When Injecting Humira Article What You Need To Know Before Taking Flagyl (Metronidazole) That being said, however, decisions about treatment choices are based on evidence from research.Crohn's Disease TreatmentsMedications for Crohn's DiseaseMedications that are used to treat Crohn's disease include:AntibioticsCipro (ciprofloxacin)Flagyl (metronidazole)Immunomodulators6-mercaptopurine (Purinethol, 6-MP)Azathioprine (Imuran and Azasan)Folex, Rheumatrex (methotrexate)Prograf (Tacrolimus)Sandimmune, Neoral (cyclosporine A)CorticosteroidsCortenema (hydrocortisone)Deltasone (prednisone)Entocort (budesonide)Medrol (methylprednisolone)Proctofoam-HC (hydrocortisone acetate, rectal foam)Biologic TherapiesCimzia (certolizumab pegol)Entyvio (vedolizumab)Humira (adalimumab)Inflectra (infliximab-dyyb)Remicade (infliximab)Stelara (ustekinumab)Tysabri (natalizumab)Surgery for Crohn's DiseaseUsually surgery is done after medications aren't helping with inflammation or there are complications. The type of surgery done is going to be based on the location of the inflammation the Crohn's disease is causing and how far it has spread. Surgery will not be a cure for Crohn's disease and, in some people, the Crohn's disease inflammation may return in another location.Surgery for Crohn's disease is always improving, and in some cases might be done with minimally invasive techniques (such as laparoscopic surgery) that cut down on time in hospital and the recovery period. Here are a few of the more common types of surgery done to treat Crohn's disease:Resection: The most common type of surgery done to treat Crohn's disease is a resection. A resection is when a portion of inflamed or disease intestine is removed, and the two ends of healthy tissue are stitched back together again (also called an anastomosis). This can be done in the small intestine or the large intestine.Strictureplasty: Crohn's disease can cause scar tissue that builds up and may cause a narrowing in the intestine. When a portion of the intestine becomes too narrow, it might be opened up again during strictureplasty surgery.Proctocolectomy: In some people with Crohn's disease where there is no disease in the rectum, a restorative proctocolectomy might be done. The large intestine is removed and the end of the small intestine is connected directly to the anus. This means that a stoma isn't needed and stool can be passed out the bottom. This type of surgery is usually only done in a particular group of patients. This surgery is also called an ileoanal anastomosis (straight pull-through). Article The Potential Side Effects of Methotrexate (Rheumatrex) Article Could Telemedicine Be Useful in IBD? Ostomy surgery: Some people with Crohn's disease that affects the colon will have surgery to create an ileostomy. This is when the colon is removed and a stoma is created on the abdomen. Stool passes out of the body through the stoma instead of the bottom, and an ostomy appliance is worn on the abdomen to catch it. Most people with Crohn's disease will not need ostomy surgery.Ulcerative Colitis TreatmentsMedications for Ulcerative ColitisMedications that are used to treat ulcerative colitis include:Aminosalicylates (5-ASA)Azulfidine (sulfasalazine)Asacol, Pentasa, Lialda, Apriso, Delzicol (mesalamine)Canasa (mesalamine suppositories)Colazal (balsalazide)Dipentum (olsazine)Rowasa (mesalamine enemas)Immunomodulators6-mercaptopurine (Purinethol, 6-MP)Azathioprine (Imuran and Azasan)Sandimmune, Neoral (cyclosporine A)Tacrolimus (Prograf)CorticosteroidsCortenema (hydrocortisone enema)Deltasone (prednisone)Entocort (budesonide)Medrol (methylprednisolone)Proctofoam-HC (hydrocortisone acetate, rectal foam)Uceris (budesonide)Biologic TherapiesEntyvio (vedolizumab)Humira (adalimumab)Inflectra (infliximab-dyyb)Remicade (infliximab)Simponi (golimumab)Surgery for Ulcerative ColitisThe Crohn's and Colitis Foundation of America estimates that anywhere between 23 percent and 45 percent of ulcerative colitis patients have surgery. The surgical options for ulcerative colitis always include the removal of the large intestine (colectomy), with the creation of either a stoma or an internal pouch to collect stool. The surgical options for ulcerative colitis include:Protocolectomy with creation of pelvic pouch: After the colon is removed to treat ulcerative colitis, an internal pouch is created out of the last section of the small intestine (the ileum). With this pouch, there is no external ostomy bag or a stoma because the pouch acts like a rectum. Pelvic pouches can be made in a few different shapes, but the one that's most often used is the j-pouch. This surgery is also called ileal pouch-anal anastomosis, or IPAA.Protocolectomy with creation of ileostomy: After the colectomy, some patients with ulcerative colitis have an end ileostomy created. A stoma is created on the abdomen for the passage of stool and an ostomy appliance is worn over the stoma. The idea of having a stoma seems intimidating, but most patients with ulcerative colitis have a higher quality of life after having ileostomy surgery and do very well with their stoma.A Word From VerywellThere are more medical and surgical options available today to treat Crohn's disease and ulcerative colitis than ever before. The treatments that have become available in recent years are more effective, and there are more being studied.The most important part of treating IBD successfully and getting it into remission is in seeing a gastroenterologist regularly and taking medication on time. With the variety of medications available, many patients can bring down the inflammation, prevent complications, and improve the quality of their lives.Sources:Bhandari BM, Kroser JA. "Inflammatory Bowel Disease." American College of Gastroenterology. March 2010, March 2011. Cleveland Clinic Foundation. 26 Sept 2013.Braegger CP, Nicholls S, Murch SH, Stephens S, MacDonald TT. "Tumour necrosis factor alpha in stool as a marker of intestinal inflammation." Lancet. 1992;339:89.Crohns & Colitis Foundation of America. "Surgery for Crohn's Disease & Ulcerative Colitis." CCFA.org. 31 Aug 2010. Terdiman JP, Gruss CB, Heidelbaugh JJ, Sultan S, Falck–Ytter YT, the AGA Institute Clinical Practice and Quality Management Committee. "American Gastroenterological Association Institute Guideline on the Use of Thiopurines, Methotrexate, and Anti–TNF-a Biologic Drugs for the Induction and Maintenance of Remission in Inflammatory Crohn’s Disease." Gastro. 2013;145:1459–1463.