If you or someone you care for has inflammatory bowel disease (IBD), you probably want straight answers: which treatments work, what side effects matter, and how to stay well between flare-ups. This page cuts through the noise and gives clear, usable steps you can talk about with your doctor.
For mild ulcerative colitis, doctors often start with aminosalicylates (like mesalamine) to calm inflammation in the colon. For moderate to severe disease, short courses of corticosteroids can quickly reduce symptoms, but they aren’t a long-term fix because of side effects.
Immunomodulators such as azathioprine are common next steps. Azathioprine lowers immune activity to prevent flares. It can take several months to work. You’ll need regular blood tests to check liver function and blood counts because it can affect white cells and liver enzymes. If you want a deeper read on azathioprine—how it works, benefits and risks—see our detailed note on the drug.
Biologics changed IBD care for many people. These are targeted injections or infusions that block specific immune signals (for example, anti-TNF drugs). Newer options like vedolizumab and ustekinumab work differently and can help when anti-TNFs don’t. Oral small molecules such as JAK inhibitors are another option for some patients.
Surgery is not a failure. For some people with severe disease, repeated strictures, or complications, removing a problematic segment of bowel can greatly improve quality of life. Your surgeon and gastroenterologist will discuss timing and outcomes so you can make an informed choice.
Medication is only part of the picture. Keep routine follow-ups and lab checks. Stay updated on vaccines—live vaccines aren’t recommended if your immune system is suppressed. Track symptoms so you can spot a flare early: more bowel movements, blood in stool, fever, or unexpected weight loss are red flags.
Diet tweaks can help symptoms even if they don’t cure the disease. Low-residue choices during flares, small frequent meals, and testing lactose or FODMAP sensitivity are useful strategies. Smoking worsens Crohn’s disease but oddly may reduce ulcerative colitis symptoms; quitting is still the healthier long-term choice for most people.
Finally, build a care team: a gastroenterologist, possibly an IBD nurse, a dietitian, and your primary care doctor. Ask about drug side effects, monitoring schedules, and fertility or pregnancy concerns if those matter to you. When you know what to expect, you can make better choices and stay in control of your care.
Entocort (budesonide) helps control Crohn’s disease with fewer side effects than classic steroids. Learn how it works, what to expect, and practical tips.
