What are some ivy (English ivy) treatments used to treat symptoms of a Crohn's disease flare-up?

IV Treatments for Crohn's Disease Flare-Up

I believe you may be asking about IV (intravenous) treatments rather than "ivy treatments" for managing a Crohn's disease flare-up, as there are no established ivy (English ivy plant) therapies for this condition.

Intravenous Corticosteroids for Acute Flares

For patients with Crohn's disease requiring hospitalization due to severe disease activity, intravenous methylprednisolone at 40-60 mg/day (typically administered as 40 mg every 8 hours) should be initiated immediately to induce symptomatic remission. 1, 2

Initial Assessment Before IV Therapy

Before starting IV corticosteroids, you must rule out complications that require different interventions 2:

• Intra-abdominal abscess (requires drainage, not steroids)
• Intestinal stricture with obstruction (may require surgery)
• Superimposed infection, particularly Clostridium difficile (requires antibiotics)
• Confirm active inflammation using C-reactive protein (CRP) and fecal calprotectin to distinguish true inflammatory flares from functional symptoms 2

Response Evaluation and Next Steps

• Evaluate clinical response within 1 week to determine whether therapy modification is needed 1, 2
• Patients who fail to respond to IV corticosteroids within this timeframe require escalation to biologic therapy 2
• For patients who respond to IV therapy, transition to oral prednisone 40-60 mg/day and taper over 8-12 weeks 1, 2

Intravenous Biologic Therapy

For patients with moderate-to-severe disease and risk factors for poor prognosis (young age at diagnosis, extensive disease, perianal involvement, deep ulcerations, prior surgery), consider initiating anti-TNF therapy during hospitalization rather than waiting for corticosteroid response. 2

Infliximab Administration

• Infliximab is preferred in the hospital setting due to its intravenous administration and rapid onset of action 2
• Dosed at 5 mg/kg at weeks 0,2, and 6 2
• Combination therapy with infliximab plus a thiopurine (azathioprine or 6-mercaptopurine) is more effective than monotherapy for inducing and maintaining remission 2

Critical Maintenance Strategy

Corticosteroids must never be used for maintenance therapy—initiate maintenance therapy before discharge to prevent relapse after corticosteroid taper. 1, 2

Maintenance Options After IV Induction

• Anti-TNF biologics (infliximab or adalimumab) with or without thiopurine combination therapy 2
• Ustekinumab for patients with inadequate response to or contraindications to anti-TNF therapy 3, 2
• Vedolizumab for patients who fail corticosteroids, thiopurines, methotrexate, or anti-TNF therapy 3
• Thiopurines (azathioprine 2-2.5 mg/kg/day or 6-mercaptopurine 1-1.5 mg/kg/day) for selected patients who achieved remission on corticosteroids 2
• Parenteral methotrexate (15-25 mg subcutaneously weekly) as an alternative immunosuppressant 2

Common Pitfalls to Avoid

• Never use corticosteroids for long-term maintenance—they are completely ineffective for maintaining remission and cause significant toxicity 1, 4
• Do not delay biologic therapy in high-risk patients—waiting for steroid response in patients with poor prognostic factors leads to worse outcomes 2
• Assess for steroid dependency—patients requiring repeated courses or unable to taper below 10 mg/day require escalation to biologic or immunomodulator therapy 2
• Evaluate response to anti-TNF induction between 8-12 weeks—if no response by week 14, discontinue and switch to alternative biologic 2

Supportive IV Therapy

While managing the inflammatory flare, address fluid and electrolyte depletion that often occurs with diarrhea 5:

• Administer appropriate IV fluids and electrolytes—the use of anti-diarrheal agents does not preclude the need for fluid and electrolyte therapy 5