[Crohn disease and ulcerative colitis--newer therapeutic approaches]

Most of the progress in the treatment of chronic inflammatory bowel diseases (IBD) is derived from the long known basic treatment drugs: aminosalicylates and glucocorticoids. 5-aminosalicylic acid (5-ASA) was prevented from being absorbed by coupling it to less toxic molecules than sulfapyridine especially to another 5-ASA molecule or by coating it with acid fast resins of different solubility. From these properties special indications may be derived for the different preparations according to the localisation of the IBD. New topical highly active glucocorticoids with high first pass effect in the liver are intensively investigated at present. It is hoped that the local steroid effect in the bowel can be achieved without systemic side effects. The cascade of inflammation in IBD comprises different phases, it's immunological basis is under intense scrutiny. New forms of treating IBD are based upon the attempt to inhibit specifically isolated factors of inflammation such as cytokines and mediators of inflammation (f.i. inhibition of PAF, LTB4, CD4-T-cells or scavenging O2-radicals) Whether the specific inhibition of a single factor in the inflammatory cascade will finally abolish the whole inflammatory process has to be proven in the future.