Treatment Of Inflammatory Bowel Disease

Inflammatory bowel disease mainly refers to ulcerative colitis and Crohn's disease. Ulcerative colitis is characterized by a relapsing inflammatory condition involving the mucosa of variable lengths of the colon resulting in bleeding, urgency, diarrhea, and tenesmus. The endo-scopic and radiographic appearance may demonstrate multiple diffuse erosions or ulcerations. Biopsy reveals distorted crypt abscesses and diminished goblet cells. When involvement is limited to the rectum, it is termed ulcerative proctitis. Crohn's disease may involve the gut from esophagus to anus; however, the small bowel or colon or both are the major areas of involvement. Inflammation is transmural. If the colon is predominantly involved, the symptoms and presentation are quite similar to those of ulcerative colitis. Small bowel involvement may result in large-volume bloodless diarrhea or obstruction. Normal areas of gut may be found between areas of inflamed mucosa. Fistulas, strictures, and abscess formation are fairly common in Crohn's disease.

The present primary mode of therapy for these diseases involves the use 5-amino-salicylate (5-ASA) products. Often patients require additional medications, including corticosteroids, to help induce remission and various immune modulators, such as azathioprine, 6-mercaptopurine or methotrexate, to maintain remission. In Crohn's disease certain antibiotics, such as metronidazole and ciprofloxacin, and infliximab (Remi-cade), an anti-tumor necrosis factor-a(TNFa) antibody, also have been used. The pharmacology of antibiotics, immunosuppressive drugs, and corticosteroids is discussed in Chapters 43,57, and 60, respectively.

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