From the Guidelines
The recommended treatment for an inflammatory bowel disease (IBD) flare-up with frequent loose stools typically involves a combination of anti-inflammatory medications and supportive care, with the most recent guidelines suggesting the use of biologics such as infliximab or vedolizumab for moderate to severe cases, as supported by 1.
Treatment Approach
For mild to moderate flares, 5-aminosalicylates like mesalamine (1-4g daily) are often used as first-line therapy.
- For more severe flares, corticosteroids such as prednisone (40-60mg daily, tapered over 8-12 weeks) or budesonide (9mg daily for 8 weeks) may be necessary.
- Immunomodulators like azathioprine (2-3mg/kg/day) or biologics such as infliximab (5mg/kg at weeks 0,2, and 6, then every 8 weeks) might be required for steroid-dependent or refractory cases.
Supportive Care
During flares, patients should:
- Maintain hydration
- Consider a low-residue diet to reduce bowel irritation
- Avoid NSAIDs and high-fiber foods that may worsen symptoms
- Antidiarrheal medications like loperamide should be used cautiously and only if infection has been ruled out, as noted in 1 and 1.
Individualized Treatment
Treatment should be individualized based on disease type (Crohn's disease or ulcerative colitis), location, severity, and previous medication response, with consideration of the latest guidance on therapeutics in Crohn's disease and ulcerative colitis, as discussed in 1 and 1.
From the Research
Management of Inflammatory Bowel Disease Flare-Up
The management of inflammatory bowel disease (IBD) flare-ups, characterized by frequent loose stools, involves a multi-faceted approach.
- The treatment strategy depends on the severity of the disease and the specific symptoms presented by the patient 2.
- First-line therapies for IBD include 5-aminosalicylates, budesonide, systemic steroids, azathioprine, 6-mercaptopurine, methotrexate, infliximab, adalimumab, and certolizumab pegol 2.
- For patients with severe ulcerative colitis (UC), steroid dosing has been clarified, and a mega-analysis of steroid outcomes and toxicities has been reported 3.
- The pharmacological management of IBD has evolved over the years, with three distinct eras:
- The first era (1943-1951) relied on antibiotics such as sulfonamides and chloramphenicol 4.
- The second era (1955-1975) introduced the use of adrenocorticotropic hormone or corticosteroids and 5-aminosalicylate 4.
- The third era, which commenced in 1979, has seen the expansion of pharmacological interventions to include 5 main drug classes: 5-aminosalicylates, corticosteroids, immunomodulators, biologics, and antibiotics 4.
Treatment Options
- The choice of treatment depends on the severity of the disease, with mild cases often managed with aminosalicylates and moderate to severe cases requiring corticosteroids, immunomodulators, or biologics 4, 3.
- Patients with severe UC may require hospitalization and treatment with intravenous corticosteroids or cyclosporine 3.
- Surgical intervention may be necessary in cases where conservative treatment is ineffective, or in the presence of complications such as abscesses, peritonitis, or fistula formation 5.
Patient Education and Communication
- Patient understanding of IBD flare-ups and remission is largely symptom-based, with limited knowledge of the underlying inflammation and tissue damage 6.
- Effective communication between patients and healthcare providers is crucial to ensure a shared understanding of symptoms and treatment goals 6.
- Patient education on emerging expectations of IBD care should be prioritized to improve treatment outcomes and patient satisfaction 6.