Inflammatory bowel disease. 1. Origins, presentation, and course

The exact source of interference with the normal protective immune response in patients with inflammatory bowel disease remains unclear. Infectious causes have been proposed, and the increased incidence among family members indicates genetic predisposition. No matter what the pathogenesis may be, the disease is chronic, recurrent, and destructive in many cases. Conventional therapy with 5-ASAs, corticosteroids, immunomodulating agents, methotrexate, and antibiotics often offers relief. However, adverse effects accompany long-term use of many of these agents, so follow-up is important. Much investigation of alternative methods is under way, and anecdotal as well as published experience suggests benefits in at least some patients. Because of the chronic nature of their condition, patients with inflammatory bowel disease often become quite sophisticated in their understanding of treatment methods. Therefore, they should be told of updates regarding new options for disease control. We recommend that patients be seen periodically by a gastroenterologist who has expertise in inflammatory bowel disease, even when the disease is quiescent. Our experience in observing these patients over time strongly supports use of some of the agents discussed in this article for prophylaxis against flares and chronic inflammation.