Standard and innovative therapy of inflammatory bowel diseases

During last years, treatment of IBD evolved from a non-specific suppression of the mucosal immunological response to a more specific intervention in the immunocascade. While corticosteroids and aminosalicylates remain the mainstay of treatment, more potent immunosuppressors like azathioprine, methotrexate and cyclosporine are used in corticodependent or resistant patients. Safety profiles of these drugs become better established. The successful introduction of biological therapies such as a chimeric monoclonal antibody against TNFalpha, opened a new field of research and possibilities. New humanized agents interfering at several levels in the production of cytokines are in development. Moreover, other pathways are focused like signal transduction, adhesion of cells to tissue, modulation of tissue architecture, bacterial flora .... Challenges for the next future remain the development of more effective and safe drugs, the identification of target populations for every drug, the study of the influence of biological therapies on natural history of the disease and finally the definite cure of the patient. An updated review from current and future treatment modalities is given.