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IBD: Medical Management

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Abstract

Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory conditions characterized by periods of symptomatic relapse and remission. The cause of inflammatory bowel disease (IBD) is unknown but it is believed to be caused by a combination of environmental, genetic, and immunological factors in which an uncontrolled immune response within the intestinal mucosa leads to inflammation in genetically predisposed individuals. Multifactorial evidence suggests that a defect of innate immune response to microbial agents, as well as abnormalities in adaptive immunity and epithelial barrier function are involved in IBD.1

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References

  1. Torres MI, Rios A. Current view of the immunopathogenesis in inflammatory bowel disease and its implications for therapy. World J Gastroenterol. 2008;14(13):1972–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Summers RW, Switz DM, Sessions Jr JT, et al. National Cooperative Crohn’s Disease Study: results of drug treatment. Gastroenterology. 1979;77(4 Pt 2):847–69.

    Article  CAS  PubMed  Google Scholar 

  3. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn’s Disease Study (ECCDS): results of drug treatment. Gastroenterology. 1984;86(2):249–66.

    Article  CAS  PubMed  Google Scholar 

  4. Van Hees PA, Van Lier HJ, Van Elteren PH, et al. Effect of sulphasalazine in patients with active Crohn’s disease: a controlled double-blind study. Gut. 1981;22(5):404–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Anthonisen P, Barany F, Folkenborg O, et al. The clinical effect of salazosulphapyridine (Salazopyrin r) in Crohn’s disease. A controlled double-blind study. Scand J Gastroenterol. 1974;9(6):549–54.

    Article  CAS  PubMed  Google Scholar 

  6. Feagan BG. Aminosalicylates for active disease and in the maintenance of remission in Crohn’s disease. Eur J Surg. 1998;164(12):903–9.

    Article  CAS  PubMed  Google Scholar 

  7. Das KM, Eastwood MA, McManus JP, Sircus W. Adverse reactions during salicylazosulfapyridine therapy and the relation with drug metabolism and acetylator phenotype. N Engl J Med. 1973;289(10):491–5.

    Article  CAS  PubMed  Google Scholar 

  8. Sutherland L, Singleton J, Sessions J, et al. Double blind, placebo controlled trial of metronidazole in Crohn’s disease. Gut. 1991;32(9):1071–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ursing B, Alm T, Barany F, et al. A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: the cooperative Crohn’s disease study in Sweden. II. Result. Gastroenterology. 1982;83(3):550–62.

    Article  CAS  PubMed  Google Scholar 

  10. Greenbloom SL, Steinhart AH, Greenberg GR. Combination ciprofloxacin and metronidazole for active Crohn’s disease. Can J Gastroenterol. 1998;12(1):53–6.

    Article  CAS  PubMed  Google Scholar 

  11. Steinhart AH, Feagan BG, Wong CJ, et al. Combined budesonide and antibiotic therapy for active Crohn’s disease: a randomized controlled trial. Gastroenterology. 2002;123(1): 33–40.

    Article  CAS  PubMed  Google Scholar 

  12. Colombel JF, Lemann M, Cassagnou M, et al. A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn’s disease. Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives (GETAID). Am J Gastroenterol. 1999;94(3):674–8.

    Article  CAS  PubMed  Google Scholar 

  13. Prantera C, Zannoni F, Scribano ML, et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol. 1996;91(2):328–32.

    CAS  PubMed  Google Scholar 

  14. Shafran I, Johnson LK. An open-label evaluation of rifaximin in the treatment of active Crohn’s disease. Curr Med Res Opin. 2005;21(8):1165–9.

    Article  CAS  PubMed  Google Scholar 

  15. Otley A, Steinhart AH. Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2005;4:CD000296.

    Google Scholar 

  16. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn’s disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med. 1994;331(13):836–41.

    Article  CAS  PubMed  Google Scholar 

  17. Tremaine WJ, Hanauer SB, Katz S, et al. Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn’s disease: a randomized placebo-controlled study in the United States. Am J Gastroenterol. 2002;97(7):1748–54.

    Article  CAS  PubMed  Google Scholar 

  18. Thomsen OO, Cortot A, Jewell D, et al. A comparison of budesonide and mesalamine for active Crohn’s disease. International Budesonide-Mesalamine Study Group. N Engl J Med. 1998;339(6):370–4.

    Article  CAS  PubMed  Google Scholar 

  19. Gross V, Andus T, Caesar I, et al. Oral pH-modified release budesonide versus 6-methylprednisolone in active Crohn’s disease. German/Austrian Budesonide Study Group. Eur J Gastroenterol Hepatol. 1996;8(9):905–9.

    CAS  PubMed  Google Scholar 

  20. Rutgeerts P, Lofberg R, Malchow H, et al. A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med. 1994;331(13):842–5.

    Article  CAS  PubMed  Google Scholar 

  21. Bar-Meir S, Chowers Y, Lavy A, et al. Budesonide versus prednisone in the treatment of active Crohn’s disease. The Israeli Budesonide Study Group. Gastroenterology. 1998;115(4):835–40.

    Article  CAS  PubMed  Google Scholar 

  22. Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn’s disease. The Global Budesonide Study Group. Gut. 1997;41(2):209–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide as maintenance treatment for Crohn’s disease: a placebo-controlled, dose-ranging study. Canadian Inflammatory Bowel Disease Study Group. Gastroenterology. 1996;110(1):45–51.

    Article  CAS  PubMed  Google Scholar 

  24. Ferguson A, Campieri M, Doe W, Persson T, Nygard G. Oral budesonide as maintenance therapy in Crohn’s disease – results of a 12-month study. Global Budesonide Study Group. Aliment Pharmacol Ther. 1998;12(2):175–83.

    Article  CAS  PubMed  Google Scholar 

  25. Lofberg R, Rutgeerts P, Malchow H, et al. Budesonide prolongs time to relapse in ileal and ileocaecal Crohn’s disease. A placebo controlled one year study. Gut. 1996;39(1):82–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hanauer S, Sandborn WJ, Persson A, Persson T. Budesonide as maintenance treatment in Crohn’s disease: a placebo-controlled trial. Aliment Pharmacol Ther. 2005;21(4):363–71.

    Article  CAS  PubMed  Google Scholar 

  27. Simms L, Steinhart AH. Budesonide for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2001;1:CD002913.

    Google Scholar 

  28. Faubion Jr WA, Loftus Jr EV, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–60.

    Article  CAS  PubMed  Google Scholar 

  29. Munkholm P, Langholz E, Davidsen M, Binder V. Frequency of glucocorticoid resistance and dependency in Crohn’s disease. Gut. 1994;35(3):360–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Franchimont DP, Louis E, Croes F, Belaiche J. Clinical pattern of corticosteroid dependent Crohn’s disease. Eur J Gastroenterol Hepatol. 1998;10(10):821–5.

    Article  CAS  PubMed  Google Scholar 

  31. Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995;123(2):132–42.

    Article  CAS  PubMed  Google Scholar 

  32. Candy S, Wright J, Gerber M, Adams G, Gerig M, Goodman R. A controlled double blind study of azathioprine in the management of Crohn’s disease. Gut. 1995;37(5):674–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005;54(8):1121–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet. 2009;374(9701):1617–25.

    Article  CAS  PubMed  Google Scholar 

  35. Aberra FN, Lichtenstein GR. Review article: monitoring of immunomodulators in inflammatory bowel disease. Aliment Pharmacol Ther. 2005;21(4):307–19.

    Article  CAS  PubMed  Google Scholar 

  36. Hayee BH, Harris AW. Methotrexate for Crohn’s disease: experience in a district general hospital. Eur J Gastroenterol Hepatol. 2005;17(9):893–8.

    Article  CAS  PubMed  Google Scholar 

  37. Alfadhli AA, McDonald JW, Feagan BG. Methotrexate for induction of remission in refractory Crohn’s disease. Cochrane Database Syst Rev. 2005;1:CD003459.

    Google Scholar 

  38. Feagan BG, Rochon J, Fedorak RN, et al. Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med. 1995;332(5):292–7.

    Article  CAS  PubMed  Google Scholar 

  39. Chong RY, Hanauer SB, Cohen RD. Efficacy of parenteral methotrexate in refractory Crohn’s disease. Aliment Pharmacol Ther. 2001;15(1):35–44.

    Article  CAS  PubMed  Google Scholar 

  40. Lemann M, Chamiot-Prieur C, Mesnard B, et al. Methotrexate for the treatment of refractory Crohn’s disease. Aliment Pharmacol Ther. 1996;10(3):309–14.

    Article  CAS  PubMed  Google Scholar 

  41. Lemann M, Zenjari T, Bouhnik Y, et al. Methotrexate in Crohn’s disease: long-term efficacy and toxicity. Am J Gastroenterol. 2000;95(7):1730–4.

    CAS  PubMed  Google Scholar 

  42. Feagan BG, Fedorak RN, Irvine EJ, et al. A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. North American Crohn’s Study Group Investigators. N Engl J Med. 2000;342(22):1627–32.

    Article  CAS  PubMed  Google Scholar 

  43. Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337(15):1029–35.

    Article  CAS  PubMed  Google Scholar 

  44. Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–9.

    Article  CAS  PubMed  Google Scholar 

  45. Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med. 1999;340(18):1398–405.

    Article  CAS  PubMed  Google Scholar 

  46. Lichtenstein GR, Yan S, Bala M, Blank M, Sands BE. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology. 2005;128(4):862–9.

    Article  CAS  PubMed  Google Scholar 

  47. Generini S, Giacomelli R, Fedi R, et al. Infliximab in spondyloarthropathy associated with Crohn’s disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations. Ann Rheum Dis. 2004;63(12):1664–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Brooklyn TN, Dunnill MG, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006;55(4):505–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Herfarth H, Obermeier F, Andus T, et al. Improvement of arthritis and arthralgia after treatment with infliximab (Remicade) in a German prospective, open-label, multicenter trial in refractory Crohn’s disease. Am J Gastroenterol. 2002;97(10): 2688–90.

    Article  PubMed  Google Scholar 

  50. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350(9):876–85.

    Article  CAS  PubMed  Google Scholar 

  51. Colombel JF, Sandborn WJ, Rutgeerts P, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology. 2007;132(1):52–65.

    Article  CAS  PubMed  Google Scholar 

  52. Rutgeerts P, Van Assche G, Vermeire S. Review article: Infliximab therapy for inflammatory bowel disease – seven years on. Aliment Pharmacol Ther. 2006;23(4):451–63.

    Article  CAS  PubMed  Google Scholar 

  53. Schroder O, Blumenstein I, Stein J. Combining infliximab with methotrexate for the induction and maintenance of remission in refractory Crohn’s disease: a controlled pilot study. Eur J Gastroenterol Hepatol. 2006;18(1):11–6.

    Article  PubMed  Google Scholar 

  54. Sandborn WJ, Feagan BG, Stoinov S, et al. Certolizumab pegol for the treatment of Crohn’s disease. N Engl J Med. 2007;357(3):228–38.

    Article  CAS  PubMed  Google Scholar 

  55. Rutgeerts PJ, Mellili LE, Li J, Pollack PF. Adalimumab maintains improvement in IBDQ scores over 1 year following the initial attainment of remission in patients with moderately severely active Crohn’s disease: results of the Classic II study. Gastroenterology. 2006;130:A479.

    Google Scholar 

  56. Sandborn WJ, Hanauer S, Loftus Jr EV, et al. An open-label study of the human anti-TNF monoclonal antibody adalimumab in subjects with prior loss of response or intolerance to infliximab for Crohn’s disease. Am J Gastroenterol. 2004;99(10):1984–9.

    Article  CAS  PubMed  Google Scholar 

  57. Papadakis KA, Shaye OA, Vasiliauskas EA, et al. Safety and efficacy of adalimumab (D2E7) in Crohn’s disease patients with an attenuated response to infliximab. Am J Gastroenterol. 2005;100(1):75–9.

    Article  CAS  PubMed  Google Scholar 

  58. Hanauer SB, Sandborn WJ, Rutgeerts P, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130(2):323–33. quiz 591.

    Article  CAS  PubMed  Google Scholar 

  59. Sandborn W, Rutgeerts P, Enns RA, Hanauer SB, ­Colombel JF, Panaccione R, et al. Adalimumab rapidly induces clinical remission and response in patients with moderate to severe Crohn’s disease who had secondary failure to infliximab therapy: results of the GAIN study. Am J Gastroenterol. 2006;101(Abstract):S448.

    Article  Google Scholar 

  60. Schreiber S, Rutgeerts P, Fedorak RN, et al. A randomized, placebo-controlled trial of certolizumab pegol (CDP870) for treatment of Crohn’s disease. Gastroenterology. 2005;129(3): 807–18.

    Article  CAS  PubMed  Google Scholar 

  61. Schreiber S, Khaliq-Kareemi M, Lawrence I, Hanauer SB, McColm J, Bloomfield R, et al. Certolizumab pegol, a humanized anti-TNF pegylated FAb fragment is safe and effective in the maintenance of response and remission following induction in active Crohn’s disease: a phase III study (PRECiSE II). Gut. 2005;54(Abstract):A82.

    Google Scholar 

  62. Winter TA, Wright J, Ghosh S, Jahnsen J, Innes A, Round P. Intravenous CDP870, a PEGylated Fab′ fragment of a humanized antitumour necrosis factor antibody, in patients with moderate-to-severe Crohn’s disease: an exploratory study. Aliment Pharmacol Ther. 2004;20(11–12):1337–46.

    Article  CAS  PubMed  Google Scholar 

  63. Sandborn W, Feagan BG, Stoinov S, Honiball PJ, Rutgeerts P, McColm JA, et al. Certolizumab pegol administered subcutaneously is effective and well tolerated in patients with active Crohn’s disease: results from a 26 week, placebo controlled phase II study (PRECiSE 1). Gastroenterology. 2006;130(Abstract):A107.

    Google Scholar 

  64. Rutgeerts P, D’Haens GR, Van Assche GA, et al. Adalimumab induces and maintains mucosal healing in patients with moderate to severe ileocolonic Crohn’s disease – first results of the EXTEND trial. Program and abstracts from Digestive Disease Week, 30 May–4 June 2009, Chicago, IL. Abstract 751e.

    Google Scholar 

  65. Colombel JF, Schwartz DA, Sandborn WJ, et al. Adalimumab for the treatment of fistulas in patients with Crohn’s disease. Gut. 2009;58(7):940–8.

    Article  CAS  PubMed  Google Scholar 

  66. Lofberg R, Louis E, Reinisch W, et al. Adalimumab induces sustained fistula healing in both anti-TNF-Naïve and anti-TNF-experienced patients with Crohn’s disease: The Care Trial. Program and abstracts from Digestive Disease Week, 30 May–4 June 2009, Chicago, IL. Abstract S1144.

    Google Scholar 

  67. Schreiber S, Khaliq-Kareemi M, Lawrance IC, et al. Maintenance therapy with certolizumab pegol for Crohn’s disease. N Engl J Med. 2007;357(3):239–50.

    Article  CAS  PubMed  Google Scholar 

  68. D’Haens G, Baert F, van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008;371(9613):660–7.

    Article  PubMed  CAS  Google Scholar 

  69. Sandborn W, Rutgeerts P, Reinisch W, et al. SONIC: A randomized double-blind, controlled trial comparing infliximab and infliximab and azathioprine to azathioprine in patients with Crohn’s disease naive to immunomodulators and biologic therapy. Am J Gastroenterol. 2008;103:1117. Abstract 29.

    Google Scholar 

  70. Schreiber S, Reinisch W, Colombel JF, Sandborn WJ, Hommes DW, Li J, et al. Early Crohn’s disease shows high levels of remission to therapy with adalimumab: sub-analysis of Charm. Gastroenterology. 2007;132(4 Suppl 2):A-147.

    Google Scholar 

  71. Panaccione RCJ, Enns R, Feagan B, Hanauer S, Lawrence I, Rutgeerts P, et al. Natalizumab maintains remission in patients with moderately to severely active Crohn’s disease for up to 2 years: results from an open-label extension study. Gastroenterology. 2006;130(Abstract):A111.

    Google Scholar 

  72. Ghosh S, Goldin E, Gordon FH, et al. Natalizumab for active Crohn’s disease. N Engl J Med. 2003;348(1):24–32.

    Article  CAS  PubMed  Google Scholar 

  73. Sandborn WJ, Colombel JF, Enns R, et al. Natalizumab induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2005;353(18):1912–25.

    Article  CAS  PubMed  Google Scholar 

  74. Targan S, Feagan B, Fedorak R, Lashner B, Panacionne R, Present D, et al. Natalizumab induces sustained response and remission in patients with active Crohn’s disease: results from the ENCORE trial. Gastroenterology. 2006;130(Abstract):A108.

    Google Scholar 

  75. Baert F, Noman M, Vermeire S, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med. 2003;348(7):601–8.

    Article  CAS  PubMed  Google Scholar 

  76. Afif W, Loftus EV Jr, Faubion W et al. Clinical utility of measuring infliximab and human anti-chimeric antibody ­concentrations in patients with inflammatory bowel ­disease. Am J Gastroenterol. 2010;105(5):1133–9.

    Google Scholar 

  77. Sandborn WJ, Rutgeerts P, Enns R, et al. Adalimumab induction therapy for Crohn disease previously treated with infliximab: a randomized trial. Ann Intern Med. 2007;146(12):829–38.

    Article  PubMed  Google Scholar 

  78. Hanauer SB, Wagner CL, Bala M, et al. Incidence and importance of antibody responses to infliximab after maintenance or episodic treatment in Crohn’s disease. Clin Gastroenterol Hepatol. 2004;2(7):542–53.

    Article  CAS  PubMed  Google Scholar 

  79. FDA Consumer Resources Page. Food and Drug Administration Web site. http://www.fda.gov/Forconsumers/ConsumersUpdates/ucm107878.htm (2008). Accessed 12 Nov 2009.

  80. Clark M, Colombel JF, Feagan BC, et al. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21–23, 2006. Gastroenterology. 2007;133(1):312–39.

    Article  PubMed  Google Scholar 

  81. Siegel CA, Marden SM, Persing SM, Larson RJ, Sands BE. Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn’s disease: a meta-analysis. Clin Gastroenterol Hepatol. 2009;7(8):874–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Yousry TA, Major EO, Ryschkewitsch C, et al. Evaluation of patients treated with natalizumab for progressive multifocal leukoencephalopathy. N Engl J Med. 2006;354(9):924–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. FDA Drug Safety Page. Food and Drug Administration Web site. http://www.fda.gov/Drugs/DrugSafety/DrugSafetyNewsletter/ucm120064.htm (2008). Accessed 15 Nov 2009.

  84. van Dieren JM, Kuipers EJ, Samsom JN, Nieuwenhuis EE, van der Woude CJ. Revisiting the immunomodulators tacrolimus, methotrexate, and mycophenolate mofetil: their mechanisms of action and role in the treatment of IBD. Inflamm Bowel Dis. 2006;12(4):311–27.

    Article  PubMed  Google Scholar 

  85. Baumgart DC, Wiedenmann B, Dignass AU. Rescue therapy with tacrolimus is effective in patients with severe and refractory inflammatory bowel disease. Aliment Pharmacol Ther. 2003;17(10):1273–81.

    Article  CAS  PubMed  Google Scholar 

  86. Ierardi E, Principi M, Francavilla R, et al. Oral tacrolimus long-term therapy in patients with Crohn’s disease and steroid resistance. Aliment Pharmacol Ther. 2001;15(3):371–7.

    Article  CAS  PubMed  Google Scholar 

  87. Lowry PW, Weaver AL, Tremaine WJ, Sandborn WJ. Combination therapy with oral tacrolimus (FK506) and azathioprine or 6-mercaptopurine for treatment-refractory Crohn’s disease perianal fistulae. Inflamm Bowel Dis. 1999;5(4):239–45.

    Article  CAS  PubMed  Google Scholar 

  88. Sandborn WJ, Present DH, Isaacs KL, et al. Tacrolimus for the treatment of fistulas in patients with Crohn’s disease: a randomized, placebo-controlled trial. Gastroenterology. 2003;125(2):380–8.

    Article  CAS  PubMed  Google Scholar 

  89. de Oca J, Vilar L, Castellote J, et al. Immunodulation with tacrolimus (FK506): results of a prospective, open-label, non-controlled trial in patients with inflammatory bowel disease. Rev Esp Enferm Dig. 2003;95(7):465–70. 459–64.

    PubMed  Google Scholar 

  90. Casson DH, Eltumi M, Tomlin S, Walker-Smith JA, Murch SH. Topical tacrolimus may be effective in the treatment of oral and perineal Crohn’s disease. Gut. 2000;47(3):436–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Lukas M. What is the time for surgery in severe Crohn’s disease? Inflamm Bowel Dis. 2008;14:S271–2.

    Article  PubMed  Google Scholar 

  92. Akobeng AK, Gardener E. Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s disease. Cochrane Database Syst Rev. 2005;(1):CD003715.

    Google Scholar 

  93. Modigliani R, Colombel JF, Dupas JL, et al. Mesalamine in Crohn’s disease with steroid-induced remission: effect on steroid withdrawal and remission maintenance, Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives. Gastroenterology. 1996;110(3):688–93.

    Article  CAS  PubMed  Google Scholar 

  94. Blum E, Katz JA. Postoperative therapy for Crohn’s disease. Inflamm Bowel Dis. 2009;15(3):463–72.

    Article  PubMed  Google Scholar 

  95. Achkar JP, Hanauer SB. Medical therapy to reduce postoperative Crohn’s disease recurrence. Am J Gastroenterol. 2000;95(5):1139–46.

    Article  CAS  PubMed  Google Scholar 

  96. Camma C, Giunta M, Rosselli M, Cottone M. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology. 1997;113(5):1465–73.

    Article  CAS  PubMed  Google Scholar 

  97. Lochs H, Mayer M, Fleig WE, et al. Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s Disease Study VI. Gastroenterology. 2000;118(2):264–73.

    Article  CAS  PubMed  Google Scholar 

  98. Hanauer SB, Korelitz BI, Rutgeerts P, et al. Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial. Gastroenterology. 2004;127(3):723–9.

    Article  CAS  PubMed  Google Scholar 

  99. Ardizzone S, Maconi G, Russo A, Imbesi V, Colombo E, Bianchi Porro G. Randomised controlled trial of azathioprine and 5-aminosalicylic acid for treatment of steroid dependent ulcerative colitis. Gut. 2006;55(1):47–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Ardizzone S, Maconi G, Sampietro GM, et al. Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease. Gastroenterology. 2004;127(3):730–40.

    Article  CAS  PubMed  Google Scholar 

  101. Sorrentino D, Terrosu G, Avellini C, Beltrami CA, Bresadola V, Toso F. Prevention of postoperative recurrence of Crohn’s disease by infliximab. Eur J Gastroenterol Hepatol. 2006;18(4):457–9.

    Article  PubMed  Google Scholar 

  102. Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136(2):441–50.e1. quiz 716.

    Article  CAS  PubMed  Google Scholar 

  103. Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108(6):1617–21.

    Article  CAS  PubMed  Google Scholar 

  104. Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001;135(10):906–18.

    Article  CAS  PubMed  Google Scholar 

  105. Bernstein LH, Frank MS, Brandt LJ, Boley SJ. Healing of perineal Crohn’s disease with metronidazole. ­Gastroenterology. 1980;79(2):357–65.

    Article  CAS  PubMed  Google Scholar 

  106. Brandt LJ, Bernstein LH, Boley SJ, Frank MS. Metronidazole therapy for perineal Crohn’s disease: a follow-up study. Gastroenterology. 1982;83(2):383–7.

    Article  CAS  PubMed  Google Scholar 

  107. Jakobovits J, Schuster MM. Metronidazole therapy for Crohn’s disease and associated fistulae. Am J Gastroenterol. 1984;79(7):533–40.

    CAS  PubMed  Google Scholar 

  108. Mahadevan U, Marion JF, Present DH. Fistula response to methotrexate in Crohn’s disease: a case series. Aliment Pharmacol Ther. 2003;18(10):1003–8.

    Article  CAS  PubMed  Google Scholar 

  109. Gionchetti P, Rizzello F, Venturi A, et al. Comparison of oral with rectal mesalazine in the treatment of ulcerative proctitis. Dis Colon Rectum. 1998;41(1):93–7.

    Article  CAS  PubMed  Google Scholar 

  110. Cohen RD, Woseth DM, Thisted RA, Hanauer SB. A meta-analysis and overview of the literature on treatment options for left-sided ulcerative colitis and ulcerative proctitis. Am J Gastroenterol. 2000;95(5):1263–76.

    Article  CAS  PubMed  Google Scholar 

  111. Mulder CJ, Fockens P, Meijer JW, van der Heide H, Wiltink EH, Tytgat GN. Beclomethasone dipropionate (3 mg) versus 5-aminosalicylic acid (2 g) versus the combination of both (3 mg/2 g) as retention enemas in active ulcerative proctitis. Eur J Gastroenterol Hepatol. 1996;8(6):549–53.

    Article  CAS  PubMed  Google Scholar 

  112. Safdi M, DeMicco M, Sninsky C, et al. A double-blind comparison of oral versus rectal mesalamine versus combination therapy in the treatment of distal ulcerative colitis. Am J Gastroenterol. 1997;92(10):1867–71.

    CAS  PubMed  Google Scholar 

  113. Lee FI, Jewell DP, Mani V, et al. A randomised trial comparing mesalazine and prednisolone foam enemas in patients with acute distal ulcerative colitis. Gut. 1996;38(2):229–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Nielsen OH. Sulfasalazine intolerance. A retrospective survey of the reasons for discontinuing treatment with sulfasalazine in patients with chronic inflammatory bowel disease. Scand J Gastroenterol. 1982;17(3):389–93.

    Article  CAS  PubMed  Google Scholar 

  115. Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006;(2):CD000543.

    Google Scholar 

  116. Marteau P, Probert CS, Lindgren S, et al. Combined oral and enema treatment with Pentasa (mesalazine) is superior to oral therapy alone in patients with extensive mild/moderate active ulcerative colitis: a randomised, double blind, placebo controlled study. Gut. 2005;54(7):960–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Sands BE. Fulminant colitis. J Gastrointest Surg. 2008;12(12): 2157–9.

    Article  PubMed  Google Scholar 

  118. George J, Present DH, Pou R, Bodian C, Rubin PH. The long-term outcome of ulcerative colitis treated with 6-mercaptopurine. Am J Gastroenterol. 1996;91(9):1711–4.

    CAS  PubMed  Google Scholar 

  119. Adler DJ, Korelitz BI. The therapeutic efficacy of 6-mercaptopurine in refractory ulcerative colitis. Am J Gastroenterol. 1990;85(6):717–22.

    CAS  PubMed  Google Scholar 

  120. Fraser AG, Orchard TR, Jewell DP. The efficacy of azathioprine for the treatment of inflammatory bowel disease: a 30 year review. Gut. 2002;50(4):485–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  121. Naftali T, Novis B, Pomeranz I, et al. Cyclosporine for severe ulcerative colitis. Isr Med Assoc J. 2000;2(8):588–91.

    CAS  PubMed  Google Scholar 

  122. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330(26):1841–5.

    Article  CAS  PubMed  Google Scholar 

  123. Svavoni F, Bonassi U, Bonassi F. Effectiveness of cyclosporine in the treatment of refractory ulcerative colitis. Gastroenterology. 1998;114:A1096.

    Article  Google Scholar 

  124. Hogenauer C, Wenzl HH, Hinterleitner TA, Petritsch W. Effect of oral tacrolimus (FK 506) on steroid-refractory moderate/severe ulcerative colitis. Aliment Pharmacol Ther. 2003;18(4):415–23.

    Article  CAS  PubMed  Google Scholar 

  125. Ogata H, Matsui T, Nakamura M, et al. A randomised dose finding study of oral tacrolimus (FK506) therapy in refractory ulcerative colitis. Gut. 2006;55(9):1255–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  126. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353(23):2462–76.

    Article  CAS  PubMed  Google Scholar 

  127. Sandborn WJ, Rutgeerts P, Feagan BG, et al. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. 2009;137(4):1250–60. quiz 1520.

    Article  CAS  PubMed  Google Scholar 

  128. Hanauer S, Good LI, Goodman MW, et al. Long-term use of mesalamine (Rowasa) suppositories in remission maintenance of ulcerative proctitis. Am J Gastroenterol. 2000;95(7):1749–54.

    Article  CAS  PubMed  Google Scholar 

  129. Mantzaris GJ, Hatzis A, Petraki K, Spiliadi C, Triantaphyllou G. Intermittent therapy with high-dose 5-aminosalicylic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis. Dis Colon Rectum. 1994;37(1):58–62.

    Article  CAS  PubMed  Google Scholar 

  130. Dignass A, Veerman H. Once versus twice daily mesalazine (Pentasa) for the maintenance of remission in ulcerative colitis: the result from a multinational study. Gut. 2008;57 Suppl 1:A1.

    Google Scholar 

  131. Kruis W, Gorelov A, Kiudelis G. Once daily dosing of 3g mesalamine is therapeutic equivalent to a three times daily dosing of 1g mesalamine for the treatment of active ulcerative colitis. Gastroenterology. 2007;132:A130.

    Google Scholar 

  132. Ardizzone S, Molteni P, Imbesi V, Bollani S, Bianchi Porro G. Azathioprine in steroid-resistant and steroid-dependent ulcerative colitis. J Clin Gastroenterol. 1997;25(1):330–3.

    Article  CAS  PubMed  Google Scholar 

  133. Timmer A, McDonald JW, Macdonald JK. Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(1):CD000478.

    Google Scholar 

  134. Sutherland L, MacDonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2003;(3):CD000543.

    Google Scholar 

  135. Hawthorne AB, Logan RF, Hawkey CJ, et al. Randomised controlled trial of azathioprine withdrawal in ulcerative colitis. BMJ. 1992;305(6844):20–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  136. Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology. 2003;125(2):320–7.

    Article  CAS  PubMed  Google Scholar 

  137. Mahadevan U, Loftus Jr EV, Tremaine WJ, et al. Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications. Inflamm Bowel Dis. 2002;8(5):311–6.

    Article  PubMed  Google Scholar 

  138. Reding R, Michel LA, Donckier J, de Canniere L, Jamart J. Surgery in patients on long-term steroid therapy: a tentative model for risk assessment. Br J Surg. 1990;77(10):1175–8.

    Article  CAS  PubMed  Google Scholar 

  139. Stein RB, Hanauer SB. Comparative tolerability of treatments for inflammatory bowel disease. Drug Saf. 2000;23(5):429–48.

    Article  CAS  PubMed  Google Scholar 

  140. Subramanian V, Saxena S, Kang JY, Pollok RC. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008;103(9):2373–81.

    Article  PubMed  Google Scholar 

  141. Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954–63.

    Article  CAS  PubMed  Google Scholar 

  142. Colombel JF, Loftus Jr EV, Tremaine WJ, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99(5):878–83.

    Article  CAS  PubMed  Google Scholar 

  143. Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg. 2008;12(10):1730–6. discussion 1736–7.

    Article  PubMed  Google Scholar 

  144. Appau KA, Fazio VW, Shen B, et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn’s patients. J Gastrointest Surg. 2008;12(10):1738–44.

    Article  PubMed  Google Scholar 

  145. Selvasekar CR, Cima RR, Larson DW, et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204(5):956–62. discussion 962–3.

    Article  PubMed  Google Scholar 

  146. Madden MV, McIntyre AS, Nicholls RJ. Double-blind crossover trial of metronidazole versus placebo in chronic unremitting pouchitis. Dig Dis Sci. 1994;39(6):1193–6.

    Article  CAS  PubMed  Google Scholar 

  147. Maser EA, Present DH. Pouch-ouch. Curr Opin Gastroenterol. 2008;24(1):70–4.

    Article  PubMed  Google Scholar 

  148. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119(2):305–9.

    Article  CAS  PubMed  Google Scholar 

  149. Gionchetti P, Rizzello F, Venturi A, et al. Antibiotic combination therapy in patients with chronic, treatment-resistant pouchitis. Aliment Pharmacol Ther. 1999;13(6):713–8.

    Article  CAS  PubMed  Google Scholar 

  150. Isaacs KL, Sandler RS, Abreu M, et al. Rifaximin for the treatment of active pouchitis: a randomized, double-blind, placebo-controlled pilot study. Inflamm Bowel Dis. 2007;13(10):1250–5.

    Article  PubMed  Google Scholar 

  151. Baidoo L, Kundu R, Su C. Rifaximin is an effective antibiotic for the treatment of pouchitis. Gastroenterology. 2005;128:A797.

    Article  Google Scholar 

  152. Gionchetti P, Rizzello F, Poggioli G, et al. Oral budesonide in the treatment of chronic refractory pouchitis. Aliment Pharmacol Ther. 2007;25(10):1231–6.

    Article  CAS  PubMed  Google Scholar 

  153. Gionchetti P, Morselli C, Rizzello F, et al. Infliximab in the treatment of refractory pouchitis. Gastroenterology. 2005; 128:A578.

    Google Scholar 

  154. Gionchetti P, Rizzello F, Helwig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003;124(5):1202–9.

    Article  PubMed  Google Scholar 

  155. Colombel JF, Ricart E, Loftus Jr EV, et al. Management of Crohn’s disease of the ileoanal pouch with infliximab. Am J Gastroenterol. 2003;98(10):2239–44.

    Article  CAS  PubMed  Google Scholar 

  156. Shen B, Remzi FH, Shen L. Efficacy and safety of adalimumab in the treatment of Crohn’s disease of the ileal pouch. The annual meeting of the American College of Gastroenterology, Orlando, FL; 2008. Abstract:620.

    Google Scholar 

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Acknowledgments.

This chapter was written by Stephen B. Hanauer, Wee-Chian Lim, and Miles Sparrow in the ­previous version of this textbook. The author wishes to thank Stacey Grabert, Pharm.D., MS, for editorial assistance in preparing this manuscript.

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Sands, B.E. (2011). IBD: Medical Management. In: Beck, D.E., Roberts, P.L., Saclarides, T.J., Senagore, A.J., Stamos, M.J., Wexner, S.D. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1584-9_28

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