Inflammatory Bowel Disease Management

First-Line Therapies

The European Crohn's and Colitis Organisation recommends aminosalicylates as effective for mild to moderate ulcerative colitis, particularly for inducing and maintaining remission, with less effectiveness in Crohn's disease 3
The American Gastroenterological Association suggests corticosteroids, such as prednisolone 40mg daily, for patients requiring prompt response or those with mild to moderately active disease unresponsive to mesalazine, which should be tapered gradually over 8 weeks to avoid early relapse 3
The Clinical Gastroenterology and Hepatology journal reports that antibiotics like rifaximin have shown benefit in Crohn's disease and steroid-refractory ulcerative colitis, though its exact mechanism in IBD remains unclear 2, 4

The Gut journal recommends immunomodulators, such as azathioprine or mercaptopurine, for chronic active steroid-dependent disease, with regular monitoring of full blood count to detect neutropenia 1
The American College of Gastroenterology suggests biologics, such as infliximab, for moderate to severe Crohn's disease refractory to or intolerant of steroids, mesalazine, azathioprine/mercaptopurine, and methotrexate, when surgery is inappropriate 1
The Gut journal also recommends other biologics, including ustekinumab, vedolizumab, and JAK inhibitors like tofacitinib, for the treatment of Crohn's disease 5

The Clinical Gastroenterology and Hepatology journal suggests loperamide for diarrhea control in Crohn's disease 2
The American Gastroenterological Association recommends bile acid sequestrants for diarrhea in Crohn's disease with malabsorption 2
The Clinical Gastroenterology and Hepatology journal also recommends polyethylene glycol (PEG) and stimulant laxatives for constipation in IBD 2
The Gut journal suggests antispasmodics and tricyclic antidepressants for pain management in IBD 1, 2

The Clinical Gastroenterology and Hepatology journal reports that dietary interventions, such as a low FODMAP diet, show evidence of benefit in Crohn's disease 2, 4
The American Psychological Association suggests cognitive behavioral therapy, hypnotherapy, and mindfulness therapy for abdominal symptoms in IBD 2, 4
The Clinical Gastroenterology and Hepatology journal also recommends probiotics, which have low risk of harm, but further research is needed for functional symptoms in IBD 2, 4
The American College of Sports Medicine suggests physical exercise, which is beneficial in quiescent or mild IBD, and associated with decreased risk of active disease among Crohn's disease patients in remission 2, 4

The Gut journal recommends surgery for ulcerative colitis not responding to intensive medical therapy, with decisions best made jointly by gastroenterologist and colorectal surgeon in consultation with the patient 1
The American Society of Colon and Rectal Surgeons suggests surgery for Crohn's disease only when symptomatic, as it is potentially panenteric and usually recurs following surgery, and resections should be conservative and limited to macroscopic disease 1