1.5 Chronic bowel disorders

General Guidance

For NICE Guidance on Irritable Bowel Syndrome in Adults click here

• Once malignancy has been ruled out individual conditions require specific treatments including dietary manipulation, as well as drug therapies and the maintenance of adequate fluid intake.
• The mainstay of treatment for ulcerative colitis and Crohn’s colitis remain the aminosalicylates.
• Inflammatory flare up: the use of short courses of low dose oral corticosteroids or preferably local corticosteroid application by enema or foam products can be helpful whilst waiting for hospital appointment.
• Mesalazine is available in several different formulations which differ in their release profiles, it is therefore important to ensure that patients remain on the formulation their symptoms are best controlled on, this is most easily achieved by writing these prescriptions by brand name NOT generically. This group of drugs has been associated with an increased risk of interstitial nephritis and regular urine and plasma creatinine tests must be carried out at the interval recommended by the manufacturer.
• Balsalazide should only be prescribed by general practitioners in the context of a shared care arrangement with the consultant.
• Mesalazine foam has been shown to be superior to local steroids.
• Other treatments such as methotrexate, cyclosporin, thalidomide and other immunomodulatory drugs should only be prescribed by a consultant gastroenterologist.
• NICE approved treatment with Infliximab is available for consultant prescribing in patients who have not responded to full and adequate courses of alternative treatments such as corticosteroids and immunosupressants.

Recommended drugs

Sulfasalazine (prescribe by brand) ££

Mesalazine (prescribe by brand - Octasa brand of choice) £££

Balsalazide Sodium ££

Prednisolone enema ££££

Prednisolone foam ££

Hydrocortisone foam ££

Mesalazine foam £££

Not recommended

Olsalazine Sodium £££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low