Advertisement

Medical Management 2: Conventional

  • Torsten KucharzikEmail author
  • Anil Kumar Asthana
Chapter

Abstract

Treatment algorithms of Crohn’s disease (CD) and ulcerative colitis (UC) share a lot of similarities. However, despite a variety of common therapeutic pathways, there are a few differences between both diseases that require different treatment approaches. There is no standardized definition on conventional therapy in IBD. In the following chapter steroids and mesalamine are defined as conventional therapy in IBD. The gold standard in the treatment of mild to moderate active ulcerative colitis is mesalamine. Mesalamine also plays an important role in maintenance treatment of UC. Topical application should always be considered as with topical application, much higher concentration of mesalamine could be obtained within the mucosa compared to the oral application. Mesalamine is less frequently used in patients with Crohn’s disease. Budesonide is used as standard treatment for mild to moderate Crohn’s disease with ileocecal involvement. Budesonide MMX exerts a continuous release within the whole colon and can be used in UC patients refractory to mesalamine. Conventional steroids are the method of choice in severe UC and CD. Long term steroid use should be avoided in patients with IBD. Mesalamine and steroids have no role in maintenance therapy of CD. If maintenance therapy appears to be useful in CD patients, immunosuppressive drugs or biologicals should be used. In the following chapter, we will present a therapeutic algorithm on how to use conventional drugs in patients with ulcerative colitis and Crohn’s disease.

Keywords

Conventional therapy Corticosteroids Glucocorticosteroids Mesalamine Budesonide IBD Ulcerative colitis Crohn’s disease 

References

  1. Andus T, Kocjan A, Muser M, Baranovsky A, Mikhailova TL, Zvyagintseva TD et al (2010) Clinical trial: a novel high-dose 1 g mesalamine suppository (Salofalk) once daily is as efficacious as a 500-mg suppository thrice daily in active ulcerative proctitis. Inflamm Bowel Dis 16(11):1947–1956CrossRefGoogle Scholar
  2. Barnes PJ (2011) Glucocorticosteroids: current and future directions. Br J Pharmacol 163(1):29–43CrossRefGoogle Scholar
  3. Becker DE (2013) Basic and clinical pharmacology of glucocorticosteroids. Anesth Prog 60(1):25–31; quiz 2CrossRefGoogle Scholar
  4. Benchimol EI, Seow CH, Steinhart AH, Griffiths AM (2008) Traditional corticosteroids for induction of remission in Crohn’s disease. Cochrane Database Syst Rev (2):CD006792.  https://doi.org/10.1002/14651858.CD006792.pub2
  5. Cohen RD, Woseth DM, Thisted RA, Hanauer SB (2000) A meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis. Am J Gastroenterol 95(5):1263–1276CrossRefGoogle Scholar
  6. Doherty G, Bennett G, Patil S, Cheifetz A, Moss AC (2009) Interventions for prevention of post-operative recurrence of Crohn’s disease. Cochrane Database Syst Rev (4):CD006873.  https://doi.org/10.1002/14651858.CD006873.pub2
  7. Duricova D, Pedersen N, Elkjaer M, Jensen JK, Munkholm P (2010) 5-aminosalicylic acid dependency in Crohn’s disease: a Danish Crohn Colitis Database study. J Crohns Colitis 4(5):575–581CrossRefGoogle Scholar
  8. Ford AC, Kane SV, Khan KJ, Achkar JP, Talley NJ, Marshall JK et al (2011) Efficacy of 5-aminosalicylates in Crohn’s disease: systematic review and meta-analysis. Am J Gastroenterol 106(4):617–629CrossRefGoogle Scholar
  9. Gomollon F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO et al (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25CrossRefGoogle Scholar
  10. Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U et al (2017) Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis 11(7):769–784CrossRefGoogle Scholar
  11. Kruis W, Fric P, Pokrotnieks J, Lukas M, Fixa B, Kascak M et al (2004) Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 53(11):1617–1623CrossRefGoogle Scholar
  12. Lim WC, Wang Y, MacDonald JK, Hanauer S (2016) Aminosalicylates for induction of remission or response in Crohn’s disease. Cochrane Database Syst Rev 7:CD008870Google Scholar
  13. Marshall JK, Thabane M, Steinhart AH, Newman JR, Anand A, Irvine EJ (2010) Rectal 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev (1):CD004115.  https://doi.org/10.1002/14651858.CD004115.pub2
  14. Nielsen OH, Munck LK (2007) Drug insight: aminosalicylates for the treatment of IBD. Nat Clin Pract Gastroenterol Hepatol 4(3):160–170CrossRefGoogle Scholar
  15. Safdi M, DeMicco M, Sninsky C, Banks P, Wruble L, Deren J et al (1997) A double-blind comparison of oral versus rectal mesalamine versus combination therapy in the treatment of distal ulcerative colitis. Am J Gastroenterol 92(10):1867–1871PubMedGoogle Scholar
  16. Seow CH, Benchimol EI, Griffiths AM, Otley AR, Steinhart AH (2008) Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev (3):CD000296.  https://doi.org/10.1002/14651858.CD000296.pub3
  17. Travis SP, Danese S, Kupcinskas L, Alexeeva O, D’Haens G, Gibson PR et al (2014) Once-daily budesonide MMX in active, mild-to-moderate ulcerative colitis: results from the randomised CORE II study. Gut 63(3):433–441CrossRefGoogle Scholar
  18. Tromm A, Bunganic I, Tomsova E, Tulassay Z, Lukas M, Kykal J et al (2011) Budesonide 9 mg is at least as effective as mesalamine 4.5 g in patients with mildly to moderately active Crohn’s disease. Gastroenterology 140(2):425–434.e1; quiz e13–4CrossRefGoogle Scholar
  19. Wang Y, Parker CE, Bhanji T, Feagan BG, MacDonald JK (2016a) Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 4:CD000543PubMedGoogle Scholar
  20. Wang Y, Parker CE, Feagan BG, MacDonald JK (2016b) Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev (5):CD000544.  https://doi.org/10.1002/14651858.CD000544.pub4

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyUniversity of Hamburg, Lüneburg HospitalLüneburgGermany
  2. 2.Department of Gastroenterology and HepatologyThe Royal Melbourne HospitalMelbourneAustralia

Personalised recommendations