Pharmacotherapy of inflammatory bowel disease

The etiology, pharmacotherapy and management of the two major types of inflammatory bowel disease--ulcerative colitis and Crohn's disease--are reviewed. Sulfasalazine and topical corticosteroids (i.e., hydrocortisone, hydrocortisone acetate or methylprednisolone acetate) are effective in many patients with mild distal ulcerative colitis. Maintenance sulfasalazine therapy significantly reduces the relapse rate in ulcerative colitis. Systemic corticosteroids (i.e., prednisone, prednisolone or methylprednisolone) have improved the survival rate of patients with moderate and severe ulcerative colitis. Antacids should be given regularly during high-dose steroid therapy to prevent gastritis. If oral steroids are ineffective, the use of parenteral corticosteroids (hydrocortisone sodium succinate or methylprednisolone sodium succinate) is suggested. Both sulfasalazine and corticosteroids appear to be effective in the treatment of Crohn's disease but require further investigation, however, if patients fail to respond to this therapy, oral corticosteriods, in low dosages, given concomitantly with azathioprine (currently under evaluation) is suggested.