Medication for Colorectal Disease

The medical treatments for colorectal diseases are similar and prescribed based on the location of the disease and its severity; in each patient, the goal of therapy is to control and reduce inflammation, achieving and maintaining remission for the long term. This is because repeated inflammation causes scar tissues that impair or obstruct the function of your bowels, and uncontrolled disease can cause other life threatening complications. 

There are five general categories of medications, each with a few brand name or generic options. Your doctor will determine which one is right for you. The categories are:
  • Aminosalicylates
  • Corticosteroids
  • Antibiotics
  • Immunosuppressives
  • Biologics
Aminosalicylates are medications that were first invented on the battlefields of Europe, sulfa-based drugs that treated infections. Many individuals are not able to tolerate sulfa drugs due to side effects that include nausea, rashes and headaches. However, new formulas of the medications reduce or eliminate these side effects.

The medications, which are available in enemas, pills and suppositories, work by inhibiting the formation of a substance produced by the body called prostaglandins, which control inflammation. They have been found to be more effective for ulcerative colitis than for Crohn’s patients.

Corticosteroid medications are similar to natural hormones produced in the body that help control many necessary functions, including blood sugar and salt (electrolyte) levels, the body's water balance, and immune system function. Corticosteroid medications are often used to treat diseases that cause inflammation, such as Crohn’s disease or ulcerative colitis.

The traditional form of these medications have many side effects, including weight gain, stomach ulcers, sleeping difficulties, increased blood pressure, increased blood sugar (glucose), delayed wound healing, and a reduced ability to fight infection. Other problems associated with long-term corticosteroid use include cataract formation, decreased blood flow to the hip joint that causes deterioration of the joint (aseptic necrosis or avascular necrosis), and osteoporosis. As a result, your doctor may choose to use these medications in the short terms and wean you from them as opposed to using these for long-term maintenance of remission.

A newer form of the medication, budesonide, is commonly used in Crohn’s disease as it is not metabolized in the liver and acts more locally on the last loop of the small intestine and the first segment of the colon.

Antibiotics
such as ciprofoloxacin and metronidazole are used at different times and for different reasons, primarily in Crohn’s disease. Individuals who form abscesses or fistulas or those who have a recurrence of their disease after surgery may be prescribed these medications. The common side effects of metronidazole can be bothersome (metallic taste in the mouth, headaches, nausea, diarrhea, dizziness).

Immunosuppressives were first used in the treatment of leukemia to reduce the production of white cells and later in organ transplant recipients to reduce the production of immune cells that could attack a new organ. As Crohn’s disease and ulcerative colitis are thought to be caused in part by an overactive response of the immune system, these drugs are used to more broadly suppress that immune response by limiting the production of immune response cells.

The drugs may take up to three to six months to take effect and so are often paired in the first few months with faster acting steroids to help bring the disease into remission while the immunosuppressive drugs work to control cell production. As these drugs weaken the immune system, individuals taking them may be more susceptible to viral and bacterial infections. Immunosuppressives are generally monitored through regular blood draws to check for liver, kidney and bone marrow function.

Biologics are the newest category of medications used to treat inflammatory bowel diseases. These medications are made of proteins that bond to cells in the early stage of the inflammatory cycle, thus stopping the cycle from occurring.

For example, most of the drugs target tumor necrosis factor alpha (TNF-alpha), a protein that is found to be secreted in higher levels in patients with Crohn’s or colitis; this protein is found to activate a chain reaction that leads to inflammation in the intestines. The biologic medication is injected or infused into the patient and then binds to TNF-alpha, stopping the chain reaction from ever happening. In this way, these therapies are more targeted than the more broadly acting steroids or immunosuppressives. 

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