[Current developments in the diagnosis and therapy of Crohn disease and ulcerative colitis]

The etiology and pathogenesis of idiopathic chronic-inflammatory bowel diseases, i.e. Crohn's disease and ulcerative colitis, are still unknown. This has no effect on diagnosis, yet does affect treatment of these diseases, which has thus remained symptomatic. Clinical features, laboratory findings, endoscopy in conjunction with histologic examination and radiologic studies are all of proven value in the diagnosis of these disorders. Microbiologic and, if indicated, serologic studies are employed to search for colitis caused by microorganisms. Other bowel disorders to be considered in differential diagnosis include ischemic, radiation and drug-induced forms of colitis, as well as diverticulitis. More recently introduced techniques for the detection of secondary intra-abdominal processes are CT-scan and MRI (magnetic resonance imaging). Ultrasound examination of the abdomen can be used to search for thickening of the bowel wall. Use of the rather complicated hydrocolon sonography is rarely necessary. Endo-sonography is an established method for exploration of the rectum and is particularly useful for the detection of abscesses. The role of this technique in the diagnosis of colon processes remains to be determined. Studies using radiolabeled leukocytes are of theoretical interest but not usually required in the routine work-up of such patients. The same is true of chemical analyses of the feces and testing for antineutrophil cytoplasmic antibodies. Standard systemic treatment is based on the administration of salicylic acid derivatives and corticosteroids. Azathioprine and 6-mercaptopurine can be used in patients refractory to standard treatment. Metronidazole has been proven quite effective in patients with Crohn's disease of the colon, particularly in the perianal region.(ABSTRACT TRUNCATED AT 250 WORDS)