Primary Care Considerations in the
Management of Inflammatory Bowel
Jesse A. Green
Multiple pharmacologic interactions are noted between current Inflammatory Bowel Disease (IBD)
medications and drugs used to treat more common diseases. In an effort to evaluate these important,
clinically significant side-effects, the Lexi-Comp and Epocrates databases were used to analyze
interactions between IBD medications and those of several common conditions (hypertension,
diabetes, asthma, dyslipidemia, and chronic pain). Additionally, Pub Med Searches were performed
to evaluate recent literature discussing the relationship between IBD and these co-morbidities.
Managing Inflammatory Bowel Disease (IBD) in the primary care setting can often be difficult because of the potential for interactions
between IBD medications and medications commonly
utilized to manage more prevalent disease processes.
The incidence of IBD in the North American continent
ranges from 2. 2 to 14. 3 cases per 100,000 person-years
for UC and 3. 1 to 14. 6 cases per 100,000 person-year
for CD ( 1). In contrast, hypertension (HTN) affects
approximately 30% of the population ( 2); currently
it is estimated that there is a 33-39% lifetime risk for
developing diabetes in the United States ( 3). One or
more of these common medical disease processes may
occur in patients with concomitant IBD. Current IBD
treatment regimens may include corticosteroids, 5-ASA
Emory Manten, MD, Gastroenterology Fellow
Jesse A. Green, MD, Associate Professor of Medicine
Catherine Bartholomew, MD, Associate Professor
of Medicine, Division Chief of Gastroenterology,
Albany Medical College, Albany, N.Y.
drugs, immunomodulators, methotrexate and biologic
agents, all of which may interact with medications
commonly encountered in the primary care setting.
The Lexi-Comp and Epocrates databases were used
to analyze possible interactions between various
medication classes. Additionally, Pub Med Searches
were performed to evaluate recent literature pertaining
to IBD management with these medical conditions.
IBD typically is managed with medications in several
drug classes including corticosteroids, 5-ASA agents,
biologic agents, methotrexate and immunomodulators.
Each of these agents works by a different mechanism
in altering disease processes. Corticosteroids act by
decreasing inflammatory cytokines; side effects may
occur secondary to altered immune status and adrenal
suppression. 5-ASA medications work through an
unclear anti-inflammatory mechanism which directly
acts upon on the colonic mucosa. This medication
class is commonly utilized in maintenance therapy