[Local or systemic treatment of inflammatory bowel diseases?]

Standard therapy of inflammatory bowel disease is based on the treatment with corticosteroids, sulfasalazine and 5-aminosalicylic acid. Depending on localization, extent and activity of the bowel inflammation, these drugs are administered topically, systemically or in combination. The advantage of the topical therapy is the lack of non allergic side effects. Ulcerative proctitis and left-sided colitis should, in the first approach, be treated topically with suppositories or enemas. In severe colitis, a combined systemic and topical therapy is useful. In Crohn's disease topical agents are of minor importance. 5-aminosalicylic acid is efficient in mildly active Crohn's disease and prevents relapse for some patients in remission. In severely active Crohn's disease, systemic corticosteroids have to be administered. Azathioprine, cyclosporin A and metronidazole are considered to be reserve drugs because of significant side effects. The clinical usefulness of new topical corticosteroids showing both high antiinflammatory effect and no systemic side effects is presently investigated.