title: Inflammatory Bowel Disease.
abstract: BACKGROUND
  Inflammatory bowel diseases are common in Europe, with prevalences as high as 1 in 198 persons (ulcerative colitis) and 1 in 310 persons (Crohn's disease).
  
  
  METHODS
  This review is based on pertinent articles retrieved by a search in PubMed and in German and European guidelines and Cochrane reviews of controlled trials.
  
  
  RESULTS
  Typically, the main clinical features of inflammatory bowel diseases are diarrhea, abdominal pain, and, in the case of ulcerative colitis, peranal bleeding. These diseases are due to a complex immunological disturbance with both genetic and environmental causes. A defective mucosal barrier against commensal bowel flora plays a major role in their pathogenesis. The diagnosis is based on laboratory testing, ultrasonography, imaging studies, and, above all, gastrointestinal endoscopy. Most patients with Crohn's disease respond to budesonide or systemic steroids; aminosalicylates are less effective. Refractory exacerbations may be treated with antibodies against tumor necrosis factor (TNF) or, more recently, antibodies against integrin, a protein of the cell membrane. In ulcerative colitis, aminosalicylates are given first; if necessary, steroids or antibodies against TNF-α or integrin are added. Maintenance therapy to prevent further relapses often involves immunosuppression with thiopurines and/or antibodies. Once all conservative treatment options have been exhausted, surgery may be necessary.
  
  
  CONCLUSIONS
  The treatment of chronic inflammatory bowel diseases requires individually designed therapeutic strategies and the close interdisciplinary collaboration of internists and surgeons.
authors.affiliation: Department of Internal Medicine I - Gastroenterology, Hepatology, Infectiology, University Hospital of Tübingen, Asklepios Klinik Nord - Heidberg, Hamburg, Department of Internal Medicine I (Gastroenterology, Hepatology and Endocrinology), Robert-Bosch-Krankenhaus, Stuttgart.
authors.forename: Jan
authors.initials: J
authors.lastname: Wehkamp
authors.forename: Martin
authors.initials: M
authors.lastname: Götz
authors.forename: Klaus
authors.initials: K
authors.lastname: Herrlinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Steurer
authors.forename: Eduard F
authors.initials: EF
authors.lastname: Stange
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents