Dr Henry WeiGastroenterology & Endoscopy
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Treating IBD: settling inflammation and keeping it controlled

Treatment for Crohn's disease or ulcerative colitis depends on where the inflammation is, how severe it is and what treatment you have already tried. We aim to settle active inflammation and keep it controlled. I check your symptoms and test results, and discuss side effects and which options fit your life.

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Choosing a treatment in New Zealand

I consider previous treatment, complications, other health conditions, pregnancy plans and whether tablets, injections or infusions fit your life. Overseas recommendations and NZ funded access are separate. PHARMAC's October 2026 Schedule includes eligibility and renewal conditions for advanced IBD medicines. A medicine appearing on an overseas list does not guarantee local availability or funding for you.

A funded option is not automatically the best option for every person

Clinical suitability, safety, supply and funding criteria all need checking. Some patients need advanced treatment early because of the disease pattern or risk, rather than trying every milder medicine first. I explain the reason for the proposed choice and the available alternatives.

Guidance behind this advice
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What are we aiming for with treatment?

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Explanatory diagram
Induction and maintenance have different purposesTwo treatment purposes are compared, not two disease states or a mandatory drug sequence. Induction aims to control active inflammation and symptoms. Maintenance aims to sustain control and reduce relapse. Some medicines can serve both purposes, with individual regimens. Corticosteroids are generally used for induction rather than long-term maintenance. The diagram does not select a medicine, dose, duration or funding pathway for a person.Calm a flareInduction treatmentReduce active inflammationand improve symptoms.The choice depends on thecondition, severity andprevious treatment.Keep it controlledMaintenance treatmentKeep inflammation controlledand reduce further flares.Treatment often continueswhen you feel well.Review before stopping it.Steroids are short-term treatment for a flare.They are not maintenance treatment for IBD.The same medicine may have both roles. This is not a dose or treatment schedule.

Calm a flare and keep it controlled

Treatment has two linked aims: settle active inflammation, then keep it controlled. Some medicines do both. Steroids can help control a flare but are not maintenance treatment.

Simplified illustrations, not to scale. These show an example, not your own anatomy or test result.

Read every diagram explanation

Calm a flare and keep it controlled

Treatment has two linked aims: settle active inflammation, then keep it controlled. Some medicines do both. Steroids can help control a flare but are not maintenance treatment.

Symptoms and inflammation

Feeling better is important. I also check whether inflammation is controlled, because the two do not always match. Conversely, ongoing symptoms do not always arise from inflammation, and an alternative approach may be better than escalating treatment aimed at inflammation.

Why rectal treatment can help UC

For some UC, medicine placed into the rectum treats the affected lining directly. Suppositories act in the rectum; foam or enemas can reach further, with variable reach. Oral and rectal medicines may be combined. The formulation and location guide the choice.

Checking response and safety

Follow-up checks how well treatment is working and whether it remains suitable. Blood tests, stool tests, endoscopy or imaging are selected for your condition and medicine. The schedule is individual.

Treatment during a flare and between flares

Induction means bringing active inflammation under control. Maintenance means keeping it controlled and reducing further flares. Some medicines do both; others are suitable only for a short course. Feeling better is a useful sign, but it does not always show that inflammation has healed.

Before changing treatment, I check the symptoms, test results, how the medicine has been taken and whether infection or another problem could explain a change. Persistent diarrhoea does not by itself mean the next step is more immune suppression.

Mesalazine is mainly a UC treatment

Mesalazine belongs to the 5-ASA group. It treats inflammation in the bowel lining and is commonly used to settle and maintain control of mild or moderate ulcerative colitis. It is not a reliable general treatment for Crohn's disease, which usually needs a different strategy.

The preparation and route are chosen for the area involved. Tablets or granules release medicine within the bowel. Suppositories act mainly in the rectum; enemas can reach further into the lower colon. Oral and rectal treatment may be combined. Products are not automatically interchangeable, and blood tests may include kidney monitoring.

Steroids are for short-term control

Steroids can reduce inflammation during a flare. Depending on the disease and severity, they may be given by mouth, rectally or into a vein in hospital. Different preparations act in different areas and are not equivalent treatments.

Steroids are not intended to keep IBD controlled indefinitely. Repeated courses or symptoms returning during dose reduction should prompt review of the longer-term plan.

Follow the prescribed course and any dose-reduction instructions. Do not stop suddenly or restart leftover tablets without advice. Tell your treating team if side effects or vomiting prevent you taking the prescribed course.

Other medicines target the immune response

Immunomodulators alter immune activity and may help maintain control or support another treatment. They can take time to work and are not a quick rescue for a severe flare.

Biologics are targeted protein medicines given as injections or infusions. Small-molecule medicines are tablets that affect particular inflammatory pathways. A tablet is not necessarily milder or safer than an injection.

I consider the type of IBD, previous treatment, complications and your other health conditions when choosing a medicine. Sometimes a combination works best.

We discuss the expected benefit, side effects and the tests we will use to check your response. Other medicines may be available in New Zealand through a clinical trial, but are not routine funded treatment options through public or private care.

Examples of medicines used in New Zealand. The sequence is individual, and Pharmac funding criteria may apply.
FeatureExamplesHow they may fit into treatment
Immune-modifying tabletsAzathioprine, mercaptopurine (6-MP) and thioguanineSelected people may use these medicines for maintenance or alongside another treatment. They require regular blood-test monitoring.
Common first biologic optionsAdalimumab or infliximab (anti-TNF medicines); vedolizumab may also be consideredThese may be used when disease activity or complications justify advanced treatment. The choice depends on the IBD type, severity and your circumstances.
Later-line or alternative targeted optionsVedolizumab, ustekinumab or upadacitinib, depending on what has already been triedThese may be used after a previous biologic has not worked, stopped working or was not suitable, or when another mechanism is preferred.

Safety checks start before treatment

Before certain immune-targeting treatments, checks include previous infections, tuberculosis and hepatitis risk, vaccination history and blood tests. Additional tests depend on the medicine. These checks help reduce preventable complications; the exact list is individual.

Keep vaccinations up to date with your GP and treating team. Some live vaccines are unsuitable during significant immune suppression, so ask before vaccination or travel.

Monitoring may include blood counts, liver or kidney tests and, for selected medicines, other checks. Tell every prescriber about your IBD medicines, including supplements and any new antibiotics.

If treatment seems to stop working

Contact the treating team rather than stopping or doubling a medicine yourself. We may use blood tests, calprotectin, endoscopy or imaging to check for inflammation. Stool testing may identify infection. Symptoms can also have causes such as IBS-type sensitivity, bile acid diarrhoea or a narrowing, which need a different response.

For some biologic medicines, a blood test can measure the drug level or antibodies against it. This may help decide whether to adjust the dose or change medicine. I interpret it alongside your symptoms and inflammation tests. Surgery may be needed if medicines cannot control the disease or there is a complication.

Taking treatment, planning pregnancy and eating well

Keep maintenance treatment going as prescribed even when you feel well. Tell me about cost, missed doses, injection difficulties or appointments you cannot manage. A pharmacist or treating team can help clarify the schedule and monitoring. Ask which symptoms need a call before the next dose.

Discuss pregnancy and breastfeeding early. Many IBD medicines can be continued, while others require a planned change. Uncontrolled disease also carries risks, so do not stop treatment automatically.

Nutrition supports recovery; dietitian-led nutritional treatment has a specific role for selected people, especially with Crohn's disease. No diet or supplement is a universal cure or a reason to abandon effective treatment.

Worsening symptoms or infection need advice

Contact the team looking after your IBD or your GP promptly for increasing blood, diarrhoea, fever or suspected medicine side effects. If you are significantly unwell or have an infection around a scheduled dose, seek advice about that dose rather than making a blanket decision to stop all medicines.

Severe pain, a swollen abdomen, repeated vomiting, heavy bleeding, dehydration or frequent bloody diarrhoea with fever need urgent assessment. A severe flare should not be self-treated with loperamide.

Call 111 for collapse, severe breathing difficulty, a severe allergic reaction, or if you are too unwell to travel safely. Do not wait for an email reply.

Three things to remember

  • Know which treatment settles a flare and which keeps inflammation controlled.
  • I discuss the benefits, side effects, monitoring and NZ funding requirements when choosing a medicine with you.
  • Seek advice before changing treatment, including during infection or pregnancy planning.

Related information

Sources and further reading

English clinical master checked 16 October 2026.

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