Medical Treatment of Inflammatory Bowel Disease

Jong Beom Park; Hyo Jong Kim

doi:10.5124/jkma.2006.49.12.1164

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Park and Kim: Medical Treatment of Inflammatory Bowel Disease

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2006; 49(12): 1164-1174.

Published online: 31 December 2006

DOI: https://doi.org/10.5124/jkma.2006.49.12.1164

Medical Treatment of Inflammatory Bowel Disease

Jong Beom Park, MD, Hyo Jong Kim, MD

Department of Internal Medicine, Kyung Hee University College of Medicine, Korea. parkjb@khu.ac.kr, hjkim@khmc.or.kr

Abstract

Ulcerative colitis (UC) and Crohn's disease (CD), the primary constituents of inflammatory bowel disease (IBD), are precipitated by a complex interaction of environmental, genetic, and immunoregulatory factors. A growing body of data implicates a dysfunctional mucosal immune response to commensal bacteria in the pathogenesis of IBD, especially CD. Medical management of IBD includes two treatment strategies: induction and maintenance of remission. 5-Aminosalycilates are mostly used for mild active IBD and for maintenance treatment of UC. Glucocorticoids remain, despite their frequent (and occasionally severe) side effects, as the mainstay for induction of remission in moderate to severe active IBD, both UC and CD. However, these agents, although beneficial for many patients with IBD, are not effective for the majority of patients over the long term. Immunomodulators including azathioprine(AZA), 6-mercaptopurine(6-MP), or methotrexate are effective in the treatment of CD or UC. Cyclosporine and infliximab have emerged as the main, rapid-acting, alternatives in steroid-refractory UC and CD, respectively. In addition, infliximb was approved recently in the treatment of UC. The large number of new agents presents a bewildering challenge to practitioners anticipating their use in the clinic. Unfortunately, in spite of recent remarkable advances in medical therapy of IBD, there have been no any curative therapeutic agents for IBD up to now. Therefore, the treatment is should be individualized according to the severity of the disease and clinical course of the patients with IBD. And, it is also very important to prescribe the therapeutic agents correctly and appropriately for the patients with IBD.

Keywords: Ulcerative colitis, Crohn's disease, Inflammatory bowel disease

Figures and Tables

Figure 1

Infliximab treatment algorithm for Crohn's disease

Table 1

Main factors influencing therapeutic decisions in active IBD

Table 2

Oral 5-aminosalicylate formulations

Table 3

Biological compounds in development for inflammatory bowel disease

PCT : Placebo-controlled trial

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