[Treatment strategies for inflammatory bowel disease]

In patients with active inflammatory bowel disease (IBD), the objective is to achieve clinical remission. For ulcerative colitis (UC), oral or rectal aminosalycilates are widely used, and in more severe flares, corticoids and occasionally ciclosporine. In active Crohn's disease, corticosteroids represent the main treatment; budesonide must be preferred, as this steroid is better tolerated than prednisone. In patients refractory or intolerant to steroids, infliximab or artificial nutrition can be considered. Maintenance treatment is indicated in most of IBD patients. 5-ASA derivates are preferred in UC; in case of failure, azathioprine can be used. In Crohn's disease, azathioprine or methotrexate are more widely used; maintenance with infliximab is an option in case of failure. Surgery is mainly indicated for complications or in patients resistant to medical treatment.