Treatment Guideline Chart
Inflammatory bowel disease consists of ulcerative colitis and Crohn's disease.
Ulcerative colitis is a diffuse mucosal inflammation limited to the colon while Crohn's disease is a patchy, transmural inflammation that occurs in any part of the gastrointestinal tract.
The ileum and colon are the most frequently affected sites.

Inflammatory%20bowel%20disease Treatment

Supportive Therapy

Severe Ulcerative Colitis

  • IV fluid and electrolyte replacement to correct and prevent dehydration or electrolyte imbalance, with blood transfusion to maintain a hemoglobin of >10 g/dL
  • Withdrawal of anticholinergics, antidiarrheal agents, NSAIDs and opioid drugs which can precipitate colonic dilatation
  • Controlled trials failed to demonstrate therapeutic benefit of administering antibiotics especially in the absence of infections; however, there are protocols that recommend administration of broad-spectrum antibiotics in patients with severe UC who have signs of toxicity or with worsening condition despite maximal medical therapy
  • SC Heparin may be given to reduce the risk of thromboembolism
  • Total parenteral nutrition is needed if patient is significantly malnourished

Severe to Fulminant Crohn's Disease 

  • If patient is unable to maintain nutritional requirements for 5-7 days, nutritional support via elemental feeding or parenteral hyperalimentation is indicated
  • Dehydrated patients should receive fluid and electrolytes as necessary
  • Transfusions may be necessary for anemia and active hemorrhage
  • Use of opiates and anticholinergics should be limited and antidiarrheal agents avoided 
  • Prophylaxis for venous thromboembolism is recommended 
  • Oral feeding should continue as tolerated in patients without evidence of intestinal obstruction
  • Severely ill patients or those with obstruction should have bowel rest and parenteral support
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