Recognition and management of inflammatory bowel disease

Inflammatory bowel disease comprising of ulcerative colitis and Crohn's disease can no longer be considered to be diseases confined to the West. Genetic susceptibility, mucosal immune dysregulation and intestinal bacterial flora contribute to the pathogenesis, but the exact causes remain uncertain. The identification of Nod2 gene mutations associated with Crohn's disease points to defects in innate immune system that alter interaction with microbial agents. Early recognition is important to prevent morbidity and complications. This poses special challenge in countries where the incidence is lower than that in the West and infective diseases involving the intestinal tract is common. Management requires a multidisciplinary medical-surgical team effort and is focussed on disease modifying therapy rather than simply management of acute relapses. Corticosteroid therapy, though valuable, is not disease modifying and is associated with considerable side effects and morbidity. Specific targeted therapy using monoclonal antibodies has been a most important advance in recent years, but the cost of such therapy continues to be prohibitive.