Traditional treatments for inflammatory bowel disease depend on the disease’s location and severity, complications, and response to prior treatments. The goals of therapy are to control inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding. Therapy may include drugs, nutritional supplementation, surgery, or a combination of approaches.

The following drugs are used to treat inflammatory bowel disease:
 

• Aminosalicylates. Aminosalicylates are drugs that contain 5-aminosalicyclic acid (5-ASA) and help control inflammation. These drugs are primarily used to treat mild to moderate inflammatory bowel disease, as well as to help with remission maintenance (Bebb JR et al 2004). Adverse effects include nausea, vomiting, heartburn, diarrhea, and headache. 5-ASA agents such as olsalazine, mesalamine, and balsalazide have a different carrier and fewer adverse effects and may be used by people who cannot take sulfasalazine. Balsalazide is one of the newest drug therapies and has the advantage of slow release. It is converted in the body to mesalamine and has been shown to reduce bowel inflammation, diarrhea, rectal bleeding, and stomach pain (Muijsers RB et al 2002). 5-ASA agents are given orally or rectally (through an enema or in a suppository), depending on the location of the inflammation.
• Corticosteroids. Corticosteroids (such as prednisone and hydrocortisone) reduce inflammation. They are used to treat more severe cases of inflammatory bowel disease and to induce remission. Corticosteroids can be given orally, intravenously, or rectally (through an enema or in a suppository), depending on the location of the inflammation. These drugs can cause serious adverse effects, including increased risk of infection, high blood pressure, bone loss, kidney suppression, and ulcers. Less serious adverse effects include weight gain, acne, facial hair, and mood swings. They are not recommended for long-term use and are typically replaced with 5-ASA drugs once remission has been induced.
• Antimetabolites. Antimetabolites (such as azathioprine and mercaptopurine) reduce inflammation by preventing replication of inflammatory cell lines. They are used to treat people with inflammatory bowel disease who have not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids. However, antimetabolites are slow acting; it may take up to 6 months before their full benefit is seen. Anyone taking these drugs should be monitored for complications such as pancreatitis, hepatitis, a reduced white blood cell count, and an increased risk of infection.
• Methotrexate. The cancer chemotherapy drug methotrexate can promote remission in approximately 50 percent of patients with inflammatory bowel disease but it is less effective in maintaining remission (Harrell LE et al 2004, Xu CT et al 2004). Methotrexate has been effective in treating patients who have moderate to severe ulcerative colitis and in patients with Crohn’s disease who are not responding to corticosteroids, mercaptopurine, or azathioprine. It can be given orally or by weekly injections under the skin or into the muscles (Xu CT et al 2004). Methotrexate is most reliably absorbed by injection.
• Infliximab. During flare-ups, levels of the inflammatory cytokine TNF-alpha become elevated. This has led to interest in drugs such as infliximab that suppress TNF-alpha. In early experiments, infliximab has shown clinical promise in treating inflammatory bowel disease and offers a good, although very expensive, therapy option. Its use is generally limited to severe cases of Crohn’s disease.
• Cyclosporine. This drug inhibits T cell-mediated immune responses, thus reducing the immune reaction that underlies inflammation. It blocks a number of inflammatory cytokines, including TNF-alpha and various interleukins. Because cyclosporine is associated with significant risk of toxicity, its use is limited to severe ulcerative colitis or Crohn’s disease.
• Pentoxifylline. Pentoxifylline is an inexpensive prescription drug that has been shown to lower TNF-alpha. This drug was approved to reduce blood viscosity and treat occlusive arterial disease, but a beneficial side effect is its ability to down-regulate the release of TNF-alpha, IL-1b, and IL-6. Pentoxifylline is well tolerated. It has very low toxicity and minimal adverse effects associated with chronic use. This makes it a very desirable drug for treatment of chronic conditions. The suggested dose of pentoxifylline to reduce these inflammatory cytokines is 400 milligrams (mg) twice a day.
  Other drugs that may be considered include immunosuppressive agents such as tacrolimus, mycophenolate mofetil and thalidomide. Each of these drugs acts to reduce the immune response.