Living with Inflammatory Bowel Disease: Modern Science, Therapies, and the Path to a Better Daily Life

 This article summarizes the most important information that every patient with inflammatory bowel disease (IBD)—including ulcerative colitis and Crohn’s disease—should know about their condition and its treatment. All answers are entirely based on the scientific review “Treatment of Inflammatory Bowel Disease: A Comprehensive Review,” published in December 2021 in the journal Frontiers in Medicine. The authors of the review are Zhaobei Cai (Department of General Surgery, Second Hospital of Jilin University, China, and Department of Gastroenterology and Hepatology, General Hospital of the Chinese People’s Liberation Army, Beijing), Shu Wang (Department of Radiation Therapy, Second Hospital of Jilin University, China), and Jiannan Li (Department of General Surgery, Second Hospital of Jilin University, China). These authors are established physicians and researchers working in the fields of gastroenterology, surgery, and chronic inflammatory disease therapy, lending this information a high degree of scientific reliability and practical value.

"The modern goal of IBD treatment is not just symptom suppression, but true healing of the intestinal lining and a longer life without relapse."

Expert Insights

1. What are the most important modern goals in IBD treatment? "

Recent advances in the management of IBD have led to a paradigm shift in the treatment goals, from targeting symptom-free daily life to shooting for mucosal healing... Multiple studies are emerging to show that mucosal healing may be associated with reduced rates of clinical recurrence, hospitalization, surgery and disability, and a good long-term prognosis."

Explanation: Today’s therapeutic strategies aim not merely to suppress symptoms, but to achieve actual healing of the intestinal lining. Reaching “mucosal healing” is considered an important predictor of longer remission periods and improved quality of life.

2. Why do some patients not respond to standard therapies, and what happens next? 

"A considerable fraction of patients do not respond to available treatments or lose response, which calls for new therapeutic strategies. Diverse therapeutic options are emerging, involving small molecules, apheresis therapy, improved intestinal microecology, cell therapy, and exosome therapy."

Explanation: Around 40% of IBD patients do not respond to or lose response to biological therapies (such as TNF-alpha inhibitors). In such cases, new classes of medications (small molecules, JAK inhibitors), microbiota-targeted therapies, cell therapy, and others are being considered, offering hope for difficult-to-treat cases.

3. What are the benefits and risks of traditional medications—5-ASA, corticosteroids, and immunosuppressants? 

"Oral 5-ASA has better efficacy in UC treatment than placebo... Regular 5-ASA therapy reduced colorectal cancer risk by 75% in UC patients... CSs have no proven efficacy in maintaining remission in IBD and should not be used for this purpose... TPs, including azathioprine, have a favorable and similar therapeutic effect on CD and UC, which helps reduce hospitalization and surgery rates of IBD patients."

Explanation: 5-ASA (aminosalicylates) are a mainstay treatment for ulcerative colitis and offer added protection against colon cancer. Corticosteroids are effective during flare-ups but are not suitable for long-term maintenance due to serious side effects. Immunosuppressants (thiopurines) are effective in maintaining remission but carry risks such as bone marrow suppression and liver damage.

4. What are the major innovations in biologic drugs, and when are they recommended? 

"The introduction of specific inhibitors of tumor necrosis factor (TNF) is a groundbreaking achievement... Anti-TNF treatment is not all-encompassing despite its vital role in IBD treatment. Up to 40% of patients do not respond to TNF inhibitors, and nearly 23–46% of patients experience secondary loss-of-response 1 year after anti-TNF-α treatment."

Explanation: Biologic therapies (TNF inhibitors, IL-12/23 antagonists, anti-integrins) are highly effective for severe or treatment-resistant cases, but not all patients respond equally well. After failure with one class, switching to another or considering combination therapy is often discussed.

5. What is the role of the microbiota, probiotics, and fecal transplantation? 

"On the theoretical basis of intestinal microbiota disorder, researchers have found potentially effective treatment methods for IBD by improving intestinal microecology with progressive achievements in recent years, including antibiotics, probiotics, prebiotics, postbiotics, synbiotics, and fecal microbiota transplantation (FMT)... FMT has been shown to be effective in the treatment of recurrent and refractory CDI with a high success rate of 90%... The potential of FMT in the treatment of IBD has been further unleashed. The Australian consensus on the clinical use of FMT acknowledged for the first time the efficacy of FMT in inducing remission in patients with mild to moderate UC."

Explanation: Modern therapies increasingly focus on restoring gut microbial balance using probiotics, prebiotics, and especially fecal microbiota transplantation (FMT). FMT shows particular promise in difficult cases and in recurrent Clostridioides difficile infections.

Summary: Modern IBD treatment relies on an individualized approach, based on disease severity, previous treatment response, and patient-specific factors. Patients and their loved ones should discuss options with a gastroenterologist, understanding the risks, benefits, and emerging therapies available.

Questions and Answers

1. What side effects can I expect from different IBD medications? 

Answer: Side effects vary depending on the type of medication:

• 5-ASA (aminosalicylates): usually have mild side effects like bloating, nausea, abdominal pain, diarrhea, and headache. Rarer effects include kidney toxicity and reactions to sulfasalazine (infertility, anemia, photosensitivity).

• Corticosteroids: may cause infections, diabetes, high blood pressure, eye problems, osteoporosis, and mental health issues. Long-term use carries a risk of dependency and serious side effects.

• Immunosuppressants (thiopurines, methotrexate): possible bone marrow suppression, liver damage, and gastrointestinal intolerance. Up to 39% of patients discontinue due to side effects.

• Biologic therapies: generally considered safer, but some patients may experience loss of effectiveness over time or adverse effects like infections.

“There were numerous adverse events of CSs, particularly at high doses and prolonged treatment... Side effects associated with 5-ASA, including flatulence, nausea, abdominal pain, diarrhea, and headache, are generally mild.”

2. What are the advantages and disadvantages of surgical treatment? 

Answer: Surgery remains a key option for patients who do not respond to medications or develop complications like massive bleeding, perforation, or suspected cancer. Surgery can be life-saving but does not fully cure the disease—especially in Crohn’s disease, where relapses are possible. The surgery rate has declined in recent years due to better medications, but mortality in certain groups (especially ulcerative colitis) remains significant.

“Surgery is still an important means for IBD treatment... the rate of surgery for CD has decreased... One study showed that the symptomatic recurrence rate of CD patients was 20% at 1 year and 34% at 3 years after ileocolectomy.”

3. What is the role of diet and mental health in IBD treatment? 

Answer: Patient education regarding diet and mental health contributes to better disease management. The article emphasizes the importance of addressing not just medical treatment, but also overall lifestyle care.

“In addition, patient education on diet and psychology appears to benefit IBD treatment.”

4. What are the options for new, alternative therapies if standard drugs don’t work? 

Answer: If standard medications are not effective, new therapies are being explored, including apheresis therapy (removing inflammatory cells from the blood), cell therapies, exosome-based treatments, and microbiota-targeted approaches like probiotics and FMT. Results are promising, but some of these treatments are still in clinical trials.

“Diverse therapeutic options are emerging, involving small molecules, apheresis therapy, improved intestinal microecology, cell therapy, and exosome therapy.”

5. How important is regular monitoring and follow-up of the disease? 

Answer: Regular endoscopic evaluations and use of biomarkers are now standard for disease monitoring. Relying solely on symptoms is no longer sufficient—objective tests help detect relapses early and allow for timely treatment adjustments.

“Nowadays, the disease activity can also be assessed by objective indicators such as endoscopic findings and biomarkers... The goals are not only to induce and maintain remission in symptom, to prevent and treat complications but also to achieve mucosal healing.”

Conclusion: 

The information presented in this article reflects the most current scientific knowledge and clinical experience in managing inflammatory bowel disease. As emphasized by the authors of the cited review, effective IBD treatment and monitoring require a personalized, flexible approach, with attention to side effects, mental health, emerging therapies, and strong doctor-patient communication. Patients and their families have both the right and the responsibility to be well-informed, and this article aims to help them make the best possible decisions for their health based on current science and expert practice.

Source: Cai Z, Wang S, Li J. Treatment of Inflammatory Bowel Disease: A Comprehensive Review. Frontiers in Medicine. 2021;8:765474. doi: 10.3389/fmed.2021.765474