Inflammatory bowel disease: clinical aspects and established and evolving therapies.
Crohn's disease and ulcerative colitis are two idiopathic inflammatory bowel disorders. In this paper we discuss the current diagnostic approach, their pathology, natural course, and common complications, the assessment of disease activity, extraintestinal manifestations, and medical and surgical management, and provide diagnostic and therapeutic algorithms. We critically review the evidence for established (5-aminosalicylic acid compounds, corticosteroids, immunomodulators, calcineurin inhibitors) and emerging novel therapies--including biological therapies--directed at cytokines (eg, infliximab, adalimumab, certolizumab pegol) and receptors (eg, visilizumab, abatacept) involved in T-cell activation, selective adhesion molecule blockers (eg, natalizumab, MLN-02, alicaforsen), anti-inflammatory cytokines (eg, interleukin 10), modulation of the intestinal flora (eg, antibiotics, prebiotics, probiotics), leucocyte apheresis and many more monoclonal antibodies, small molecules, recombinant growth factors, and MAP kinase inhibitors targeting various inflammatory cells and pathways. Finally, we summarise the practical aspects of standard therapies including dosing, precautions, and side-effects.
Baumgart
Daniel C
DC
Department of Medicine, Division of Gastroenterology and Hepatology, Charité Medical Centre, Virchow Hospital, Medical School of the Humboldt-University of Berlin, 13344 Berlin, Germany. daniel.baumgart@charite.de
Sandborn
William J
WJ
D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D015179:Colorectal Neoplasms / Q000209:etiology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D019804:Mesalamine / Q000009:adverse effects / Q000627:therapeutic use*; D016737:Proctocolectomy, Restorative
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine