While most patients with Ulcerative Colitis and Crohn's Disease do well with amino-salicylates that are extremely safe such as Asacol and Pentasa, many need to be treated with drugs that potentially can have significant side effects.
The different classes of second line medications include steroids such as Prednisone and Entocort, Immunosuppressive agents such as 6-mercaptopurine (6-MP) and Imuran, and biologics such as Remicade and Humira. If your physician feels that your disease is not under control, one of these agents will likely be recommended. The side effects of steroids are well defined. The side effects of Prednisone can range from the annoying side effecets such as increased appetite, restlessness and indigestion, to more serious ones such as making one prone to serious life threatening infections, cataracts, gastrointestinal bleeding and avascular necrosis of the hip. Entocort, a steroid as well, isn't released until it reaches the intestines, and therefore has a much safer side effect profile. If you are on Prednisone for inflammatory bowel disease, you should check with your physician to see if you might be a candidate for Entocort.
The next group of drugs used to treat inflammatory bowel disease are the immunosuppressive agents 6-MP and Imuran. Serious side effects associated with these mediactions are fortunately rare, but do occur. They include pancreatitis, bone marrow suppression, allergic reactions and drug-induced hepatitis. Additionally, because of their immunosuppressive effect, they can cause infections, lymphomas and other cancers such as skin and cervical cancer.
In looking at all of these medications, you and your physician must assess the risk-benefit ratio of taking them. Interestingly, patients are now more willing to accept risks of developing lymphoma and even death than has been reported in the literature. This is however, dependent on both the severity of their illness, as well as how much benefit is expected from the treatment. As one would expect, the sicker patients who were promised more treatment benefit had a higher threshold for taking a risk of side effects. Interestingly, parents took more risks for their children, than adults did for themselves, but only if the disease was very severe.
In general, as expected, patients with ulcerative colitis were more likely to proceed to surgery than taking what they perceive to be a dangerous medication. The most likely reason for this is that surgery for ulcerative colitis is curative. In contrast, Crohn's patients, who will not be cured with surgery, and who can end up needing multiple surgeries were more willing to accept risk to avoid surgery.
In summary, the medical therapy of ulcerative colitis and Crohn's disease can be very challenging to both physicians and patients. Typically the decision on how to proceed with treatment is a joint effort between doctor and patient. While you ultimately must have confidence in your physician, it is very important that you understand all options and work with your physician to come up with a treatment regimen that is best for you.