Medication for Inflammatory Bowel Disease

Corticosteroid medications are powerful anti-inflammatory agents and are often used short-term to relieve symptoms quickly. They are also helpful when used as a “bridge” to long-term treatment, since some IBD medications are more effective if they are used after symptoms are under control. 

Corticosteroids can be taken by mouth, as an enema, or through a vein with intravenous (IV) infusion. 

Doctors may prescribe 5-aminosalicylic acid medications, known as 5-ASAs, for people with mild to moderate IBD. 5-ASAs are more effective for ulcerative colitis, but occasionally they may be prescribed for someone with Crohn’s disease.

These medications reduce inflammation in the lining of the intestines, relieving abdominal pain, diarrhea, and other symptoms. They are available as pills, enemas, or suppositories. Your doctor recommends the form that is right for you based on the area of the gastrointestinal tract that is affected. 

5-ASAs may help achieve and keep IBD in remission, so your doctor may recommend taking them daily as part of a long-term treatment plan. 

Immunomodulator medications suppress or regulate certain aspects of the immune system, counteracting the body’s abnormal response to food and bacteria in the digestive tract. They can alleviate symptoms and sometimes achieve remission by decreasing intestinal inflammation. Doctors may prescribe these medications for long-term use in people with mild to moderate IBD. 

Often, immunomodulators are prescribed after you have taken a course of corticosteroid medications and symptoms are under control. They may be taken by mouth or injection. Your gastroenterologist determines the most appropriate method for you and can teach you how to give yourself biweekly injections at home. 

Your doctor monitors how well this therapy is working in periodic follow-up visits. During these visits, imaging tests or endoscopic procedures can indicate whether the digestive tract is responding to medication. If these medications improve your health and relieve symptoms, therapy may continue for years.

Some immunomodulators work better for Crohn’s disease and others are more effective for ulcerative colitis. Your doctor can determine the best medication for you. 

Biologic therapies, sometimes called biologics, are a class of medications that reduce intestinal inflammation by targeting specific immune system responses. There are two classes of biologic agents used to control symptoms of IBD: anti-TNF agents and anti-integrin medications. These medications are often given long-term, sometimes along with immunomodulators.

Anti-TNF Agents 

Gastroenterologists may prescribe anti-TNF medications—which block proteins that cause inflammation in the digestive tract—if IBD is moderate to severe at the time of diagnosis or if your symptoms have not responded to other medical treatments. Anti-TNFs may also be given if symptoms such as a fistula, a hole that forms between the intestines and another organ, present an immediate risk to your health.

Anti-TNF medications are injected using a syringe or given through a vein with IV infusion. If your doctor prescribes the injectable type, he or she shows you how to give yourself the medication at home.

If IV infusion is right for you, specialists help you set up appointments at one of NYU Langone’s infusion centers, which are located in Manhattan and Brooklyn. Doctors administer IV infusion by inserting a slim, flexible tube, called a catheter, into a vein in the arm. After it is in place, doctors inject medication into the catheter. Anti-TNF infusion takes about two hours.

Your gastroenterologist determines the frequency of IV infusions based on several factors, including the severity of the disease.

Anti-Integrin Therapy

Anti-integrin therapy may be prescribed for people with severe IBD whose symptoms have not responded to other medications. This therapy prevents inflammation-causing white blood cells, called lymphocytes, from binding to the lining of the gastrointestinal tract.

Anti-integrin medications are administered through IV infusion. The duration of infusion therapy can vary from 30 minutes to 2 hours, depending on which medication is given.

The appropriate frequency of anti-integrin IV infusions is different for everyone. Your gastroenterologist recommends the most effective schedule for you based on certain factors, including the severity of the disease.

As part of a comprehensive, personalized medical treatment plan, your gastroenterologist may prescribe or recommend medication that is not intended to address the cause of IBD. Instead, it may be used to resolve complications, relieve pain, or address a nutritional deficiency. These medications are recommended in addition to those that reduce inflammation. 

Antibiotics 

If a bacterial infection occurs as a complication of IBD, your doctor may prescribe antibiotics, which are taken by mouth or administered via IV infusion. Your gastroenterologist recommends the appropriate length of time you should take antibiotics based on the severity of the infection.

Antispasmodic Agents

For abdominal pain that does not respond to other IBD medications, gastroenterologists may recommend a prescription antispasmodic medication, which suppresses muscle spasms in the bowel, easing pain and discomfort.

Pain Relievers

Gastroenterologists at NYU Langone understand that IBD symptoms can be painful. Ideally, medication that addresses the cause of abdominal discomfort also alleviates the painful symptoms. If IBD medications don’t relieve discomfort, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen. 

Doctors do not recommend over-the-counter or prescription nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, naproxen, and aspirin. This is because NSAIDs may increase the risk of stomach ulcers and gastrointestinal bleeding.

Vitamin and Mineral Supplements

People with IBD often have vitamin or mineral deficiencies because digestive dysfunction prevents the body from absorbing important nutrients. These include iron, folate, vitamin D, and vitamin B12. As part of treatment at NYU Langone's Inflammatory Bowel Disease Center, nutritionists may recommend dietary changes. They may also advise supplementing your diet with vitamins and minerals to boost your digestive health.