We searched Medline, Web of Science, and abstracts from major meetings in 2005 and 2006. We used the medical subject heading (MeSH) terms “inflammatory bowel disease”, “ulcerative colitis”, and “Crohn's disease”.
SeriesInflammatory bowel disease: clinical aspects and established and evolving therapies
Introduction
Following the discussion of the cause and immunobiology in part 1 of this Series,1 we focus here on the clinical aspects of inflammatory bowel disease.
Section snippets
Definition
Ulcerative colitis is a relapsing non-transmural inflammatory disease that is restricted to the colon. Dependent on the anatomic extent of involvement, patients can be classified as having proctitis, left-sided colitis (involving the sigmoid colon with or without involvement of the descending colon), or pancolitis. A few patients also develop ileal inflammation (backwash ileitis), which occasionally complicates differentiation from Crohn's ileocolitis (table 1). Patients typically present with
Definition
Crohn's disease is a relapsing, transmural inflammatory disease of the gastrointestinal mucosa that can affect the entire gastrointestinal tract from the mouth to the anus. Typical presentations include the discontinuous involvement of various portions of the gastrointestinal tract and the development of complications including strictures, abscesses, or fistulas (table 1 and figure 1). The Vienna classification was developed to describe the distinct clinical phenotypes of Crohn's disease with
Extraintestinal manifestations of inflammatory bowel disease
Up to 25% patients with Crohn's disease and ulcerative colitis will develop extraintestinal disease manifestations or complications (figure 5). Extraintestinal manifestations usually respond to treatment of the underlying disease.
Emerging therapies for inflammatory bowel disease
Advances in knowledge of the immunology of inflammatory bowel disease and in bioengineering have led to new therapeutic concepts that target almost every aspect of the inflammatory process.1 Table 5, Table 6 show agents grouped by underlying therapeutic strategy or concept.
Safety and monitoring of medical treatments for inflammatory bowel disease
Many medical therapies inflammatory bowel disease, particularly immunosuppressants and modulators, are associated with important side-effects. Systemic corticosteroid toxicities include moon face, acne, infection (including increase risk of abdominal and pelvic abscess in patients with Crohn's disease), ecchymoses, hypertension, hirsutism, petechial bleeding, striae, diabetes mellitus, osteonecrosis, osteoporosis, myopathy, psychosis, cataracts, and glaucoma.43, 45 Azathioprine and
Neoplastic complications of inflammatory bowel disease
Patients with ulcerative colitis and Crohn's disease have an increased risk of developing malignancies including colon cancer in patients with ulcerative colitis and Crohn's colitis and small-bowel carcinoma in patients with Crohn's enteritis.159 A screening colonoscopy with a minimum of 30 mucosal biopsies should be done in patients with ulcerative colitis to rule out colonic neoplasia, dysplasia, or cancer, 8–10 years after onset of ulcerative colitis symptoms. Patients with extensive colitis
Search strategy and selection criteria
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