From the Guidelines
Granulomatous ileocolitis, commonly known as Crohn's disease, should be treated with a combination of medications to control inflammation and manage symptoms, with the goal of achieving complete mucosal healing and improving quality of life, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for granulomatous ileocolitis typically involves a step-up approach, starting with mild disease and progressing to more severe disease.
- For mild disease, 5-aminosalicylates like mesalamine (2-4g daily) may be used.
- For moderate to severe flares, corticosteroids such as prednisone (40-60mg daily with tapering over 8-12 weeks) may be used.
- For maintenance therapy, immunomodulators like azathioprine (2-2.5mg/kg/day) or 6-mercaptopurine (1-1.5mg/kg/day) may be used.
Biologic Agents
For moderate to severe disease or those not responding to conventional therapy, biologic agents are recommended, including:
- Anti-TNF medications (infliximab 5mg/kg IV at weeks 0,2, and 6, then every 8 weeks; adalimumab 160mg initially, 80mg at week 2, then 40mg every other week) 1.
- Anti-integrins (vedolizumab).
- IL-12/23 inhibitors (ustekinumab).
Antibiotics and Nutritional Support
Antibiotics like metronidazole (10-20mg/kg/day) or ciprofloxacin (500mg twice daily) may help with perianal disease or bacterial overgrowth, as recommended by the WSES-AAST guidelines 1. Nutritional support is crucial, and patients should avoid trigger foods.
Surgery
Surgery may be necessary for complications like strictures, fistulas, or abscesses, as recommended by the British Society of Gastroenterology consensus guidelines 1. The disease involves an abnormal immune response in genetically susceptible individuals, leading to granuloma formation and transmural inflammation throughout the gastrointestinal tract, causing symptoms like abdominal pain, diarrhea, weight loss, and fatigue, as described in the ACR appropriateness criteria 1.
From the FDA Drug Label
INDICATIONS AND USAGE HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: ... Crohn’s Disease (CD) (1.5): treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older. The answer to Granulomatous Ileocolitis is that it is related to Crohn's Disease (CD), which is one of the indications for adalimumab 2. Granulomatous Ileocolitis is a characteristic feature of Crohn's disease.
From the Research
Definition and Causes of Granulomatous Ileocolitis
- Granulomatous ileocolitis is a condition characterized by inflammation of the ileum and colon with the presence of granulomas, which are clusters of immune cells attempting to wall off substances perceived as foreign [ 3 ].
- The exact causes of granulomatous ileocolitis can vary, but it is often associated with Crohn's disease, a type of inflammatory bowel disease (IBD) [ 4, 5, 6, 7 ].
Treatment Options for Granulomatous Ileocolitis
- Treatment for granulomatous ileocolitis often involves the use of aminosalicylates, such as sulfasalazine and mesalamine, which have anti-inflammatory properties [ 4, 5, 6 ].
- However, the effectiveness of these treatments can vary, with some studies suggesting that sulfasalazine may be more effective than placebo in inducing remission, but less effective than corticosteroids [ 4, 5 ].
- Other treatment options may include corticosteroids, immunomodulators, biologics, and antibiotics, depending on the underlying cause and severity of the condition [ 7 ].
Association with Coeliac Disease
- There is a reported association between granulomatous ileocolitis and coeliac disease, although this is not common [ 3 ].
- The pathological mechanisms leading to this association are not fully understood, but may involve immune system dysregulation and inflammation [ 3 ].
Current Research and Recommendations
- Further research is needed to fully understand the causes and effective treatments for granulomatous ileocolitis [ 4, 5, 7 ].
- Current recommendations for treatment are based on the underlying cause and severity of the condition, as well as the presence of any associated conditions, such as coeliac disease [ 7, 3 ].