Table of Contents
The two major inflammatory bowel diseases, Crohn disease and ulcerative colitis, tend to have serious, even deadly, long-term consequences.
Crohn disease is a condition that tends to "come and go." Sometimes symptoms are worse, sometimes symptoms are better, but crisis is inevitable. By the time people have had Crohn disease for 15 years, there is a 70 percent chance they will have gone through a crisis requiring surgical removal of part of the colon.
Crohn disease can cause ulcers that "skip" along the entire digestive tract, but ulcerative colitis is focused in the bowel. Ulcerative colitis is also a disease with a dismal long-term prognosis. From 40 to 60 percent of people diagnosed with ulcerative colitis eventually develop a condition called pouchitis, characterized by diarrhea, incontinence, chronic fatigue, and fever, 18 percent in the first year after diagnosis. If the condition is not handled properly, it can, in about 2 percent of cases, there can be toxic megacolon, which causes abdominal bloating, intense pain, rapid heartbeat with lower blood pressure, and general symptoms of toxic shock. Usually megacolon occurs after a trigger, such as taking opiate pain killers, receiving a barium enema, or low potassium levels, which can be induced by inappropriately prescribed blood pressure medications. Sometimes the only treatment for toxic megacolon is a colectomy, surgical removal of the colon. There is also a 1/2 to 1 percent annual risk of developing colon cancer even when the disease is well-controlled.
Treatment of Inflammatory Bowel Disease Usually Focuses on Symptoms
Because Crohn disease and ulcerative colitis are extremely unpleasant, patients demand and doctors provide short-term relief. Nearly everyone who has either form of inflammatory bowel disease gets graduated, "step-wise" treatment.
- Step I involves treatment with anti-inflammatory drugs in the aminosalicylate class. Chemically similar to Aspirin, these medications balsalazide (Colazal), Mesalamine (Apriso, Asacol, Lialda, Pentasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine) are taken as oral medications, enemas, or suppositories. Also at this stage the doctor usually prescribes a high-potency probiotic formula.
- Step IA is treatment with selected antibiotics, usually Ciprofloxacin and metronizadole. These treatments tend to be more helpful in Crohn disease than in ulcerative colitis. The downside of antibiotic treatment is that it can kill the "good bugs" and allow a serious infection such as Clostridium dificile to start. The benefits of antibiotic therapy often do not outweigh its side effects.
- Step II is treatment with steroid drugs. Medications such as prednisone, dexamethasone, and Hydrocortisone relieve inflammation of the bowel, but weaken the immune system. They can cause death of bone, peptic ulcers, cataracts, and psychiatric symptoms. Usually the doctor reduces dosage once bowel inflammation is under control.
- Step III involves weakening the immune system to limit inflammation. One of the most popular medications in the United States are adalimumab (Humira) or infliximab (Remicade), which are biologically engineered antibodies that bind to TNF-alpha, which causes the inflammation of the bowel. One serious downside to treatment with Humira or Remicade is that every dose costs between $1300 and $2500. Another serious downside is that combining Remicade with other treatments used at this stage (azathioprine or 6-mercaptopurine) greatly increases the risk of lymphoma.
If these treatments don't work, then doctors may try nicotine patches, enemas with a natural anti-inflammatory called butyric acid, or the anticoagulant heparin. The problem is that patients and doctors alike become focused on treating symptoms without treating the underlying cause.