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IBD Treatment: Mesalamine, Corticosteroids, Anti-TNF, and the Role of Enteral Nutrition and Surgery

A middle-aged Hispanic physician in a white coat discusses IBD treatment options, including mesalamine, corticosteroids, and anti-TNF therapies, with a Hispanic female patient in her 30s. A diagram of the digestive system is displayed on his laptop screen, while brochures on aminosalicilates, immunomodulators, and biologicals are visible on the desk. The scene conveys a professional and educational atmosphere.

The inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, presents a significant challenge in clinical practice due to its chronic and complex nature. The treatment of IBD has evolved considerably over the past decades, focusing on achieving clinical and endoscopic remission, as well as improving patients' quality of life. This article reviews current treatments, emphasizing mesalamine, corticosteroids, anti-TNF therapies, and discusses emerging strategies in the management of this disease.

Diving Deeper into IBD Treatment

Aminosalicylates, such as mesalamine, have been the cornerstone in the treatment of mild to moderate ulcerative colitis for over 30 years. These agents are effective in inducing and maintaining remission, and their favorable safety profile makes them an attractive option for long-term treatment [1]. However, their efficacy in Crohn's disease is limited, necessitating the use of other therapies.

In cases of more severe IBD, immunomodulators such as azathioprine and methotrexate are used to maintain remission and reduce dependence on corticosteroids. These agents work by modulating the immune response, but their onset of action is slow and they may be associated with significant side effects [2].

Biologics, such as anti-TNF agents (e.g., infliximab and adalimumab), have revolutionized the treatment of IBD by providing an option for patients who do not respond to conventional therapies. These agents have proven effective in inducing and maintaining remission, as well as reducing the need for surgery [3]. Additionally, new biologics targeting different inflammatory pathways, such as integrin and interleukin inhibitors, are expanding therapeutic options [4].

Conclusions

The management of IBD continues to evolve with the development of new therapies that offer hope for improved quality of life in patients. Treatment selection should be individualized, considering disease severity, previous treatment responses, and patient comorbidities. The combination of conventional and emerging therapies, along with approaches such as enteral nutrition, may provide a more comprehensive strategy for managing this complex disease [5].

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Created 6/1/2025