Modern therapy for inflammatory bowel disease

Modern therapy for inflammatory bowel disease implies that therapy should be disease modifying rather than merely symptomatic. To achieve this goal, induction and maintenance of bowel healing are mandatory. Long-term bowel healing results in fewer hospitalizations and less surgery. Only immunosuppression therapy and biological approaches, or a combination of both, result in long-term healing of the bowel mucosa. Unsolved issues are when these drugs should be initiated and whether we should aim at eradicating the bowel inflammation from the onset of therapeutic intervention immediately following diagnosis. Identification of genetic and serologic parameters which allow prediction of the course of the disease would be useful for identifying patients who need aggressive treatment early in the disease. Once total control of the disease is achieved, long-term maintenance of a healed bowel is important. We hypothesize that changing the gut flora, e.g. using probiotics, may allow maintenance of bowel healing after induction with biologicals and immunosuppression.