Advances in medical therapy of inflammatory bowel disease

The main advances in the treatment of inflammatory bowel disease concern management of intractable and steroid dependent Crohn's disease and ulcerative colitis. Immunosuppression is now used worldwide with goon efficacy and acceptable short-term safety. IV cyclosporin is an alternative to colectomy in the presence of acute ulcerative colitis not responsive to glucocorticosteroids but is not yet art alternative on the long-term. Azathioprine, 6-mercaptopurine and methotrexate are important drugs for the long-term management of Crohn's disease whereas their role in ulcerative colitis is less well defined. The future seems to lie in therapy with immunomodulating agents including antibodies against TNF alpha and interleukin 10. For the acute treatment of ileocolonic Crohn's disease, budesonide turns out to be a safe alternative to standard glucocorticosteroids. The role of antibiotics in the treatment of attacks of Crohn's disease is important but not well defined. Much research is needed to come to an optimal therapy of these puzzling diseases.