Chapter 18. Recent Advances in the Treatment of Inflammatory Bowel Disease

Abstract

Publisher Summary This chapter discusses the recent advances in the treatment of inflammatory bowel disease. Crohn's disease (CD) and ulcerative colitis (UC) are chronic forms of inflammatory bowel disease (IBD). The etiology of IBD is not known. Active current areas of research into the etiology of IBD are focusing on Mycobacterium paratuberculosis as an initiator in CD and pathogenic E. coli involvement in UC. There has been a major growth in the study and characterization of a number of soluble mediators implicated in the inflammatory response associated with IBD. The role of platelet activating factor (PAF), as a mediator of the inflammatory response in IBD, is currently under investigation. Recent data indicates that kinins and specifically bradykinin may be involved in the inflammation observed in IBD. A more recent theory suggests the etiology of UC involves a defect in mucin synthesis and/or degradation. For most physicians corticosteroids are the first therapeutic approach for IBD. 5-aminosalicylic acid (5-ASA) is clearly effective in UC. But, its mechanism of action is not confirmed. The role of immunosuppressive therapy in IBD has been controversial since its inception. Disodium chromoglycate has been reported to be active clinically in the treatment of UC. The role of inflammatory mediators in IBD has prompted the introduction of a number of new agents designed to control their action. However, it is clear that a need still exists for more therapeutically efficacious agents for the treatment of IBD, including CD and UC.