Ongoing advances in inflammatory bowel diseases, including maintenance therapies, biologic agents, and biology of disease.

Abstract

Inflammatory bowel diseases remain a significant chronic disease affecting children and adolescents. Although corticosteroids remain the standard form of therapy for many patients, an era of biological agents for therapy in inflammatory bowel diseases is upcoming with human trials using these agents now forthcoming. In addition, studies on maintenance of remission are beginning to address the selection of those patients most likely to benefit from aminosalicylate therapies, the risks of relapse from using cyclooxygenase inhibitors, the lack of benefit from lipoxygenase inhibitors, and possible future methodologies to examine the effectiveness of the immuno-suppressive agent 6-mercaptopurine. Further development of the hypothesis that new-onset disease may be different than longstanding disease can be appreciated with reports of cytokine analysis in new-onset inflammation and the high risk of progression of disease in new-onset ulcerative proctitis in children. With more reports on the role of intestinal epithelial cells in intestinal diseases, it is now clear that this cell layer is not a passive bystander with regard to the interactions between the luminal contents and immune system components found within the lamina propria; new studies suggest that novel therapeutic strategies may be possible. This review summarizes recently reported aspects of Crohn's disease and ulcerative colitis, with an emphasis on issues-pertinent for younger patients.