Update on the Treatment of Inflammatory Bowel Disease

Abstract

Inflammatory bowel diseases, including Crohn’s disease and Ulcerative Colitis, are chronic, progressive, immune-medi-ated diseases that have no cure until now. Inflammatory bowel disease can cause significant morbidity and lead to complications such as strictures, fistulas, surgery, infections, and cancer. Inflammatory bowel disease is highly heteroge-neous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Early diagnosis and prompt institution of treatment are the cornerstones for maximizing outcomes and improving quality of life. In the last decade, several new therapies with different mech-anisms of action have been approved for the management of inflammatory bowel disease. Although the therapeutic arsenal is growing, a significant percentage of patients do not respond to the established treatments. Decisions about optimal drug therapy in inflammatory bowel disease are complex, with limited guidance on comparative efficacy and safety of different treatments, leading to considerable practice variability. Risk stratification of disease severi-ty, based on prognostic factors, can help guide selection of first-line therapy. After starting appropriate therapy, it is important to confirm remission using objective end points (treat to target) with continued control of inflammation with adjustment of therapy (tight control). In this review we provide a physician-oriented overview of clinical management of ulcerative colitis and Crohn’s disease in adults.