[Therapeutic principles for chronic inflammatory bowel disease].
Whereas the incidence of ulcerative colitis has remained stable at around 8-9/10(5), the incidence of Crohn's disease has increased from below 1 to more than 5/10(5) per year during the last three decades. The new disease entities, collagenous colitis and lymphocytic colitis, are now covered by the term, chronic inflammatory bowel disease. The general principles of treatment of these diseases are to induce remission of outbreaks and to prevent outbreaks during remission. Available pharmaceutical products are 5-aminosalicylic acid preparations, with different delivery profiles in the gastrointestinal tract, glucocorticoids, and other immunosuppressants, especially azathioprine. New immunomodulating agents, with a specific effect on intracellular processes in the inflammatory cascade are now being developed, and infliximab, a TNF-alpha antibody, is now an accepted agent for use in severe, treatment-resistant cases of fistulising Crohn's disease. When medical treatment fails, surgical treatment is an option. In ulcerative colitis, colectomy is, in principle, curative, but it leaves the patient with either a permanent ileostomy or an ileal pouch, which serves as an artificial rectum after ileoanal anastomosis. This latter procedure has the obvious advantage of giving the patient a normal bowel continuity, but complications in the form of intractable "pouchitis" have been experienced in a small number of patients, thus necessitating removal of the pouch. Patients with Crohn's disease, who do not respond to medical treatment or present signs of stenosis in either the small or the large bowel, must be given surgical treatment, although an operation is less curative than in ulcerative colitis. Surgical resections for Crohn's disease must therefore be more conservative, so as to preserve the bowel and only remove macroscopically affected tissue.
Binder
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Medicinsk-gastroenterologisk afdeling C, Amtssygehuset i Herlev.
Munkholm
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D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D003082:Colectomy / Q000379:methods; D003092:Colitis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018849:Controlled Clinical Trials as Topic; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D019804:Mesalamine / Q000008:administration & dosage; D015201:Meta-Analysis as Topic; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
D000276:Adjuvants, Immunologic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D019804:Mesalamine; D001379:Azathioprine