Symptom management

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In people with inflammatory bowel disease (IBD) like Crohn’s disease (CD) and ulcerative colitis (UC), inflammation in the digestive tract can cause many different types of symptoms and complications. The most important part of any patient’s IBD treatment plan is medications that are used to directly treat the underlying disease and thus reduce the symptoms it causes; these medicines include aminosalicylates, immunomodulators, corticosteroids, antibiotics, and biologic therapies.

As a secondary part of the treatment strategy, some patients may also use other types of medications or supplements in order to provide some degree of additional symptom relief. Some of the most common types of medications or supplements for symptom management include:

  • Anti-diarrheals
  • Pain relievers
  • Iron supplements
  • Vitamin B12 supplements
  • Calcium and vitamin D supplements

However, it is very important to note that these forms of symptom management should not be used instead of the patient’s primary IBD medications; they are two completely different categories of treatments. Some people with IBD may get quick, short-term symptom relief from over-the-counter medications such as anti-diarrheals, but such medications are not doing anything to treat the underlying cause of the symptoms, which is inflammation due to IBD. This is why it is so important for patients to continue taking their IBD medications regularly to help treat the cause of symptoms over the longer term.

What are anti-diarrheals?

Diarrhea is one of the most frequent symptoms experienced by people with IBD. Depending upon the type of diarrhea (acute or chronic) and its underlying cause, healthcare providers may advise patients to take anti-diarrheal medications to help treat this symptom. The most common type of over-the-counter anti-diarrheal drug is called loperamide (Imodium). It works by slowing down the digestive process to decrease the frequency of bowel movements. It is important to treat diarrhea to improve the patient’s quality of life and to make sure that the patient’s body is absorbing enough nutrients during the process of digestion.1

What are pain relievers?

Many people with IBD experience pain caused by their symptoms or complications. Pain related to IBD can have many different sources. It may or may not be caused by inflammation that the disease causes, and it can arise from within or outside of the digestive tract. The first step in trying to manage a patient’s pain that is due to active IBD is usually to adjust their IBD medications. Reducing the symptoms can often help to reduce the pain. Patients who continue to experience pain despite the adjustment, or who have pain that is not caused by active IBD, may be advised to try pain relievers such as acetaminophen (Tylenol). However, many over-the-counter pain relievers, such as ibuprofen and aspirin (also known as non-steroidal anti-inflammatory drugs, or NSAIDS), are generally not recommended for people with IBD because they can potentially cause bleeding and inflammation in the digestive tract, which can be very harmful for people with CD or UC who already have damage in those areas due to inflammation caused by the disease.2

What are iron supplements?

Anemia is a condition in which a person does not have enough iron for the bloodstream to carry oxygen throughout the body. It is a common complication for many people with IBD, caused by inflammation in their digestive tracts. To treat anemia, healthcare providers will often recommend that patients take an iron supplements to help boost the levels of iron in their bodies.3

What are vitamin B12 supplements?

Vitamins are nutrients that are absorbed into the body in through the small intestine. In people with CD, inflammation in the small intestine can reduce its ability to absorb these nutrients from food during the process of digestion. If blood tests indicate that a patient with CD is not receiving enough B12 from food, then the patient may be advised by healthcare providers to start taking a vitamin B12 supplement. Having a deficiency of vitamin B12 is a common complication of CD.4

What are calcium and vitamin D supplements?

Calcium and vitamin D are two other important nutrients in which people with CD are often deficient. Inflammation in the small intestine can affect the body’s ability to absorb vitamin D, and vitamin D is necessary for absorbing calcium. Taking corticosteroids to relieve CD symptoms or flares can also affect the body’s ability to absorb calcium. If healthcare providers detect that a patient with CD has a calcium and/or vitamin D deficiency, they may recommend increasing the intake of both nutrients through food and/or supplements. It is important to treat calcium and vitamin D deficiencies, because they can lead to serious conditions related to bone strength.5

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view references
  1. Diarrheal diseases - acute and chronic. American College of Gastroenterology. Available at http://patients.gi.org/topics/diarrhea-acute-and-chronic/. Accessed 1/25/18.
  2. Docherty M, Jones RCQ, Wallace, M. Managing pain in inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2011 Sep; 7(9): 592-601.
  3. Stein J, Dignass AU. Management of iron deficiency anemia in inflammatory bowel disease - a practical approach. Annals of Gastroenterology 2013;26:104-113.
  4. Vitamin B12. Mayo Clinic. Available at http://www.mayoclinic.org/drugs-supplements/vitamin-b12/background/hrb-20060243. Accessed 1/25/18.
  5. Bone Loss. Crohn's and Colitis Foundation of America. Available at http://www.crohnscolitisfoundation.org/resources/bone-loss.html. Accessed 1/25/18.
View Written By | Review Date
Written by: Anna Nicholson and Emily Downward | Last Reviewed: January 2018.
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