IVF
Bowel rest
Analgesia
Electrolyte correction
Consider steroid burst
Methylprednisolone (e.g., 30mg IV bid) or prednisone (e.g., 60 mg day 1, then 40 mg daily x 4 days)
Antidiarrheals are contraindicated
Methylprednisolone (e.g., 30mg IV bid) or prednisone (e.g., 60 mg day 1, then 40 mg daily x 4 days)
Alterations should be discussed with GI
Aminosalicylates (5-ASA) - Mild-to-moderate<unk> . Give with probiotics.
Sulfasalazine 3-5gm/day PO (sulfa drug)
Caution: Can cause folate deficiency so give with folic acid, and can cause hemolytic anemia in G6PD patients
Mesalamine 4gm/day PO
Active moiety of sulfasalazine, and formed from prodrug balsalazide
Balsalazide or Olsalazine - Bypasses small intestine to deliver drug into large intestine (better for UC)
Anti-diarrheal - Use caution in patients with active inflammation as can precipitate toxic megacolon
Loperamide 4-16mg/day
Diphenoxylate 5-20mg/day
Cholestyramine 4g once to six times daily
Glucocorticoids - Symptomatic relief (course not altered)
Prednisone - 40-60mg/day with taper once remission induced
Methylprednisolone 20mg IV q6hr
Hydrocortisone 100mg q8hr
Do not start if any suspicion of infection (ie C. diff colitis)
Double edge sword: Reduction of bone density in addition to underlying disease process(decreased Ca absorption)
Antibiotics - Induce remission
Ciprofloxacin 500mg q8-12hr OR
Metronidazole 500mg q6hr OR
Rifaximin 800mg BID
Immunomodulators - Steroid-sparing agents used in fistulas and patients with surgical contraindication. Slower onset.
6-Mercaptopurine 1-1.5mg/kg/day → Start at 50mg daily
Azathioprine 2-2.5mg/kg/day → Start at 50mg daily
Methotrexate IM
Anti-TNF - Medically resistant moderate-to-severe<unk> 
Infliximab (Remicade) 5mg/kg IV
Adalimumab (Humira), Natalizumab or certolizumab pegol can also be used
Sulfasalazine 3-5gm/day PO (sulfa drug)
Caution: Can cause folate deficiency so give with folic acid, and can cause hemolytic anemia in G6PD patients
Mesalamine 4gm/day PO
Active moiety of sulfasalazine, and formed from prodrug balsalazide
Balsalazide or Olsalazine - Bypasses small intestine to deliver drug into large intestine (better for UC)
Caution: Can cause folate deficiency so give with folic acid, and can cause hemolytic anemia in G6PD patients
Active moiety of sulfasalazine, and formed from prodrug balsalazide
Loperamide 4-16mg/day
Diphenoxylate 5-20mg/day
Cholestyramine 4g once to six times daily
Prednisone - 40-60mg/day with taper once remission induced
Methylprednisolone 20mg IV q6hr
Hydrocortisone 100mg q8hr
Do not start if any suspicion of infection (ie C. diff colitis)
Double edge sword: Reduction of bone density in addition to underlying disease process(decreased Ca absorption)
Do not start if any suspicion of infection (ie C. diff colitis)
Double edge sword: Reduction of bone density in addition to underlying disease process(decreased Ca absorption)
Ciprofloxacin 500mg q8-12hr OR
Metronidazole 500mg q6hr OR
Rifaximin 800mg BID
6-Mercaptopurine 1-1.5mg/kg/day → Start at 50mg daily
Azathioprine 2-2.5mg/kg/day → Start at 50mg daily
Methotrexate IM
Infliximab (Remicade) 5mg/kg IV
Adalimumab (Humira), Natalizumab or certolizumab pegol can also be used
Crohn's disease
Viral gastroenteritis
Irritable bowel syndrome
Bacterial gastroenteritis
Ulcerative colitis
Campylobacter infections
Celiac disease
Clostridium difficile colitis