What is the management of ileitis (inflammation of the ileum)?

From the Guidelines

Management of ileitis should primarily involve high dose aminosalicylates, such as mesalazine 4g daily, or corticosteroids, like prednisolone 40mg daily, as initial therapy, with consideration of biological agents, like infliximab 5mg/kg, for moderate to severe cases or those unresponsive to initial treatment. When considering treatment options for ileitis, it's essential to weigh the benefits and risks of each approach, taking into account the severity of the disease and the patient's overall health status 1. For mild ileocolonic Crohn's disease, high dose mesalazine (4g daily) may be sufficient as initial therapy, with a grade A recommendation 1. In cases of moderate to severe disease, or mild to moderate disease that has failed to respond to oral mesalazine, oral corticosteroids such as prednisolone 40mg daily are appropriate, with a gradual reduction over 8 weeks to minimize the risk of early relapse 1. Some key points to consider in the management of ileitis include:

• The use of budesonide 9mg daily for patients with isolated ileo-caecal disease and moderate disease activity, although it may be marginally less effective than prednisolone 1
• The role of intravenous steroids, such as hydrocortisone 400mg/day or methylprednisolone 60mg/day, for patients with severe disease, often in combination with intravenous metronidazole 1
• The potential use of elemental or polymeric diets as adjunctive therapy, or as an alternative to corticosteroids in selected patients, although they are less effective than corticosteroids 1
• The consideration of biological agents, such as infliximab 5mg/kg, for patients with moderate to severe disease or those who have failed to respond to initial treatment, with a grade A recommendation 1. It's crucial to individualize treatment approaches based on the specific needs and circumstances of each patient, taking into account factors such as disease severity, medical history, and personal preferences 1.

From the Research

Management of Ileitis

• Ileitis, a type of inflammatory bowel disease, can be managed with various treatments, including mesalamine 2.
• Mesalamine is a 5-aminosalicylic acid compound that is effective in inducing and maintaining clinical remission in patients with mild-to-moderate ulcerative colitis (UC) 3, 4, 5.
• In the treatment of Crohn's ileitis, mesalamine has been shown to be effective, with a microgranular formulation delivering the drug to the terminal ileum 2.

Mesalamine Formulations and Dosage

• Different formulations of mesalamine are available, including oral and topical forms, with varying dosages and delivery methods 3, 4, 5.
• The optimal dose of mesalamine for induction of response and maintenance of remission is still a topic of debate, with some studies suggesting that higher doses (more than 2.4 g/d) may be more effective 5.
• The frequency of administration, such as once-daily versus multiple times a day, may also impact patient adherence and treatment outcomes 3, 4.

Efficacy and Safety of Mesalamine

• Mesalamine has been shown to be effective in inducing and maintaining clinical remission in patients with UC, with a relatively good safety profile 3, 4, 5.
• Serious adverse effects are rare, but nonadherence to treatment is a common issue 5.
• Mesalamine is considered safe in pregnancy, excluding formulations with dibutyl phthalate 5.

Comparison with Other Treatments

• Mesalamine has been compared to other treatments, such as steroids, in the management of ileitis and UC 2.
• In some studies, mesalamine has been shown to be equally effective as steroids in inducing remission in patients with mild to moderate Crohn's ileitis 2.