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Management of inflammatory bowel disease
V A Botoman1, G F Bonner, D A Botoman
1Cleveland Clinic Florida, Ft. Lauderdale, USA.
American Family Physician
|February 3, 1998
Summary
Effective inflammatory bowel disease (IBD) management involves patient education and tailored treatments. Therapies range from dietary changes and 5-aminosalicylic acid compounds to corticosteroids and immunosuppressants for severe or refractory cases.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Therapeutics
Background:
- Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, presents with recurrent, morbid symptoms.
- Effective management necessitates active patient involvement and comprehensive education.
Purpose of the Study:
- To outline current therapeutic strategies for managing inflammatory bowel disease.
- To address the spectrum of IBD severity, from mild to refractory cases.
- To highlight specific considerations for IBD during pregnancy and long-term surveillance.
Main Methods:
- Review of established treatment protocols for ulcerative colitis and Crohn's disease.
- Categorization of therapies based on disease severity and specific manifestations.
- Inclusion of guidelines for managing IBD in pregnancy and cancer risk surveillance.
Main Results:
- Mild IBD requires symptomatic relief and dietary adjustments.
- Mild to moderate IBD is managed with 5-aminosalicylic acid (5-ASA) compounds (e.g., olsalazine, mesalamine).
- Mesalamine suppositories/enemas are effective for proctosigmoiditis; antibiotics (e.g., metronidazole) may be needed for Crohn's disease.
- Corticosteroids are used for severe symptoms but have limitations for chronic use due to side effects.
- Immunosuppressants are options for refractory disease.
- 5-ASA compounds and corticosteroids are suitable for IBD in pregnancy.
- Periodic colonoscopy is recommended for patients with long-standing IBD, particularly ulcerative colitis, due to colon cancer risk.
Conclusions:
- Treatment for inflammatory bowel disease is stratified according to disease severity and type.
- A multimodal approach combining medication, lifestyle, and monitoring is crucial for optimal patient outcomes.
- Long-term surveillance is essential to mitigate complications like colon cancer in ulcerative colitis patients.