The Traditional Approach Explained
The Usual Approach
The following diagram is the standard medical treatment guideline that doctors and especially gastroenterologists use when treating IBD (Crohn's disease and ulcerative colitis), though sometimes the base level is also used for irritable bowel syndrome (IBS):
In general, doctors take a step-up approach in treating IBD, with the patient starting at the base of the treatment pyramid (Level 1) and ascending if the treatment for that respective level fails to improve gut symptoms and reduce disease activity, or if it causes unbearable side effects:
A summary of each of these levels, together with their consequences are discussed. Medical and scientific references for the information spoken of in this section can be found here.
Level 1a: 5-ASAs
5-aminosalicylic acids (5-ASAs) are entry-level anti-inflammatory prescription drugs for IBD. They work by dampening the inflammatory processes in the intestines, so as to allow damaged tissue to heal.
In addition to having a relapse or failure rate of 75% (Bello et al., 2011), this class of drugs also includes the following potential risks and side effects:
Level 1b: Antibiotics
Antibiotics indiscriminately kill bacteria – regardless of whether they are beneficial or pathogenic.
As a result of this, the microbiome undergoes significant changes, and leads to a host of problems including long-lasting gut dysbiosis (Franciano, 2015), as well as the side effects outlined below:
Level 2: Steroids (Corticosteroids)
Corticosteroids suppress the many inflammatory genes that are normally active in patients with ulcerative colitis and Crohn’s disease.
Because of the severity of the side effects with this class of drug, it is universally seen as only a temporary option by doctors. Some of the serious side effects include the following:
Level 3: Immunosuppressants
As the name suggests, these medications act to directly weaken the immune system, so as to keep inflammation at bay.
As one would expect, turning off the body’s defenses against infectious diseases cannot come without a number of severe, severe, and even fatal risks and side effects:
Level 4: Biologic Therapy
Biologic therapy utilizes 'biologics' which act by interrupting immune system signals involved in the inflammation of tissue. It is usually the last resort option for those that would rather not have their intestines surgically removed (Level 5).
In addition to being extremely costly, costing over $20,000 every year, this treatment type is extremely dangerous. Even the FDA has issued warnings regarding its potentially fatal risks and side effects:
Level 5: Surgery
At the top of the treatment pyramid for IBD is surgery. One of the possible outcomes of these surgical procedures is an ostomy, or a surgery to create an opening from the intestines to the stomach, where an external bag is attached to collect waste:
Unfortunately, the pain doesn't end here. Pouchitis is the inflammation that occurs in the lining of a pouch created during surgery to treat ulcerative colitis and has a massive incidence rate of 50%.
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