Abstract
Inflammatory bowel disease (IBD) comprises a group of idiopathic diseases of the intestine characterized by chronic inflammation of the bowel with periods of exacerbation and remission. The two major categories of IBD are ulcerative colitis and Crohn's disease, and each disease is distinct both clinically and histologically. The exact cause of IBD remains unknown, but several theories have been proposed. Primary care physicians are frequently confronted with the initial diagnosis and management of patients with IBD, and medical treatment options have rapidly expanded in recent years. This article reviews clinical presentations that are essential to establish a diagnosis in this complex disease and the treatment options available.
References
6. Peeters M, Joossens S, Vermeire S, Vlietinck R, Bossuyt X, Rutgeerts P. Diagnostic value of anti-Saccharomyces cerevisiae and antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol. 2001. 96:730–734.
7. Chutkan RK, Scherl E, Waye JD. Colonoscopy in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002. 12:463–483.
9. Cohen R, Woseth DM, Thisted RA, Hanauer SB. A Meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis. Am J Gastroenterol. 2000. 95:1263–1276.
10. Sandborn WJ. Rational selection of oral 5-aminosalicylate formulations and prodrugs for the treatment of ulcerative colitis. Am J Gastroenterol. 2002. 97:2939–2941.
12. Faubion WA Jr, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease : a population-based study. Gastroenterology. 2001. 121:255–260.
13. Danielsson A, Lofberg R, Persson T. A steroid enema, budesonide, lacking systemic effects for the treatment of distal ulcerative colitis or proctitis. Scand J Gastroenterol. 1992. 27:9–12.
14. Greenberg GR, Feagan BG, Martin F, Sutherland LR, Thomson AB, Persson T, et al. Canadian Inflammatory Bowel Disease Study Group. Oral budesonide as maintenance treatment for Crohn's disease : a placebo-controlled, dose-ranging study. Gastroenterology. 1996. 110:45–51.
17. Fraser AG, Orchard TR, Jewel DP. The efficacy of azathioprine for the treatment of inflammatory bowel disease. Gut. 2002. 50:485–489.
18. Present DH, Melzer SJ, Krumholz MP, Wolke A, Korelitz BI. 6-Mercaptopurine in the management of inflammatory bowel disease : short and long-term toxicity. Ann Intern Med. 1989. 111:641–649.
19. Seidman EG. 6-Mercaptopurine in maintaining remission in Crohns disease : An old friend becomes a new hero. Gastroenterology. 2000. 119:1158–1160.
21. van Dullemen HM, van Deventer SJ, Hommes DW, Bijl HA, Jansen J, Woody J, et al. Treatment of Crohn's disease with anti-tumor necrosis factor chimeric monoclonal antibody (cA2). Gastroenterology. 1995. 109:129–135.
22. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Rutgeerts PJ, et al. Crohn's Disease cA2 Study Group. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn's disease. N Engl J Med. 1997. 337:1029–1023.
23. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Deventer SJ, et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999. 340:1398–1405.
24. Sutherland L, Singleton J, Sessions J, Hanauer S, Krawitt E, Kelly M, et al. Double blind, placebo controlled trial of metronidazole in Crohn's disease. Gut. 1991. 32:1071–1075.