Conventional Medical Management of Inflammatory Bowel Disease

Gastroenterology, 05/03/2011

Burger D et al. – Conventional drugs are the mainstay of current therapy for inflammatory bowel diseases, but drug type, timing, and context must be optimized to manage individual patients effectively.

  • When patients are diagnosed with Crohn's disease(CD) or ulcerative colitis, physicians should consider the probable pattern of disease progression so that effective therapy is not delayed.
  • This can be achieved by setting arbitrary time limits for administration of biological therapies, changing therapy from mesalamine in patients with active ulcerative colitis, or using rescue therapy for acute severe colitis.
  • Algorithms with a time-structured approach for guidance of therapy is provided in this review.
  • Common mistakes in conventional therapy include overprescription of mesalamine for CD; inappropriate use of steroids (for perianal CD, when there is sepsis, or for maintenance); delayed introduction or underdosing with azathioprine, 6-mercaptopurine, or methotrexate; and failure to consider timely surgery.

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