General Principles of Medical Therapy

Abstract

In considering the optimal medical therapy of IBD, it is most important to individualize treatment according to the particular needs of each patient. Maintaining a patient's quality of life is the most important goal, whether it is with mesalamine, 6-MP, infliximab, or surgery if indicated. For UC, it is important to remember that topical therapy can be useful in distal disease and that the higher the dose of 5-ASA, the better the response. For CD, activity should be treated according to severity. Budesonide is a promising treatment for mild to moderate ileitis and right-sided colitis and infliximab is an effective therapy for moderate to severe inflammatory and fistulizing CD. For both UC and CD, corticosteroids are effective in inducing remission, but not maintaining it. 6-MP-AZA is effective in maintaining remission in both diseases. There are quick and simple ways to measure disease activity and quality of life and these scales can be used everyday in outpatient practice. Newer advances in medical therapy and diligence by physicians and patients alike should make IBD a more tolerable, albeit chronic disease.