A 35-year-old man presents with abdominal pain, diarrhea, and weight loss for the past six months. He occasionally notices blood in his stools. A colonoscopy reveals patchy areas of inflammation with ulceration, predominantly in the terminal ileum, and histopathology confirms granulomatous inflammation. He is diagnosed with Crohn’s disease, a subtype of inflammatory bowel disease (IBD).
Which of the following is NOT a recommended treatment for inflammatory bowel disease?
A. Steroids
B. Methotrexate
C. Eradication of Helicobacter pylori
D. Sulphasalazine
E. Infliximab (TNF-alpha antibody)
Correct Answer: C. Eradication of Helicobacter pylori
Detailed Explanation:
Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is treated with a combination of medications aimed at controlling inflammation, maintaining remission, and addressing complications. While many treatments are effective for managing IBD, Helicobacter pylori eradication is not relevant to its management because H. pylori is associated with peptic ulcer disease and gastric cancer, not IBD.
Why H. pylori Eradication Is Not Recommended:
- H. pylori infection primarily affects the stomach, leading to gastritis and ulcers, which are unrelated to the pathophysiology of IBD.
- Treating H. pylori with antibiotics like clarithromycin and amoxicillin has no role in controlling intestinal inflammation caused by IBD.
Why Other Options Are Correct:
A. Steroids
- Corticosteroids, such as prednisone and budesonide, are commonly used in the acute phase of IBD to reduce inflammation and induce remission.
- They are not used for long-term maintenance due to side effects like osteoporosis, hyperglycemia, and adrenal suppression.
B. Methotrexate
- Methotrexate is an immunosuppressant used primarily for Crohn’s disease, particularly in patients who do not respond to thiopurines or cannot tolerate them.
- It works by inhibiting DNA synthesis in rapidly dividing inflammatory cells.
D. Sulphasalazine
- Sulphasalazine and other 5-aminosalicylic acid (5-ASA) derivatives (e.g., mesalamine) are effective in managing mild to moderate ulcerative colitis.
- They act locally in the colon to reduce inflammation. Sulphasalazine is less commonly used for Crohn’s disease but may benefit colonic involvement.
E. Infliximab (TNF-alpha antibody)
- Infliximab is a monoclonal antibody targeting tumor necrosis factor-alpha (TNF-alpha), a key inflammatory cytokine in IBD.
- It is highly effective in moderate to severe cases of Crohn’s disease and ulcerative colitis, especially in steroid-refractory patients or those with fistulizing disease.
Treatment Overview in IBD:
- Induction Therapy (to achieve remission):
- Corticosteroids (e.g., prednisone).
- Biologics like infliximab for severe or refractory cases.
- Maintenance Therapy (to prevent relapses):
- Thiopurines (azathioprine, mercaptopurine).
- Methotrexate (Crohn’s disease).
- 5-ASA agents (ulcerative colitis).
- Advanced Therapy:
- Biologics: TNF inhibitors (infliximab, adalimumab), integrin inhibitors (vedolizumab).
- Surgical Intervention:
- Reserved for complications such as strictures, perforation, or refractory disease.