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Medical Therapy of Inflammatory Bowel Disease

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Inflammatory Bowel Disease

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Inflammatory bowel disease (IBD) comprises a family of idiopathic autoimmune disorders that affect multiple organ systems, particularly the gastrointestinal (GI) tract. Roughly half of all IBD patients have ulcerative colitis (UC), whereas the remainder have Crohn’s disease (CD). These diseases afflict people of all age groups, ethnicities, and socioeconomic levels, with only a slight predominance in women as opposed to men. The purpose of this chapter is to explore the medical therapy of these challenging disorders.

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References

  1. Stein RB, Hanauer SB. Medical therapy for inflammatory bowel disease. Gastroenterol Clin North Am 1999; 28 (3): 297–321.

    Article  PubMed  CAS  Google Scholar 

  2. Azad Khan AK, Piris J, Truelove SC. An experiment to determine the active therapeutic moiety sulphasalazine. Lancet 1977; 2 (8044): 892–895.

    Article  PubMed  CAS  Google Scholar 

  3. Hanauer SB, Meyers S, Sachar DB. The pharmacology of antiinflammatory drugs in inflammatory bowel disease. In: Kirsner JB and Shorter RG, eds. Inflammatory Bowel Disease, 4th Edition. Williams & Wilkins, Baltimore, MD, 1995, pp. 643–663.

    Google Scholar 

  4. Malchow H, Ewe K, Brandes JW, et al. European cooperative Crohn’s disease study (ECCDS): results of drug treatment. Gastroenterology 1984; 86 (2): 249–266.

    PubMed  CAS  Google Scholar 

  5. Summers RW, Switz DM, Sessions JT Jr, et al. National Cooperative Crohn’s Disease Study (NCCDS): results of drug treatment. Gastroenterology 1979; 77 (4 Pt 2): 847–869.

    PubMed  CAS  Google Scholar 

  6. Singleton JW, Hanauer SB, Gitnick GL, et al. Mesalamine capsules for the treatment of active Crohn’s disease: results of a 16-wk trial. The Pentasa Crohn’s Disease Study Group. Gastroenterology 1993; 104 (5): 1293–1301.

    PubMed  CAS  Google Scholar 

  7. Tremaine WJ, Schroeder KW, Harrison JM, et al. A randomized, double-blind, placebo-controlled trial of the oral mesalamine (5-ASA) preparation, Asacol, in the treatment of symptomatic Crohn’s colitis and ileocolitis. J Clin Gastroenterol 1994; 19 (4): 278–282.

    Article  PubMed  CAS  Google Scholar 

  8. Prantera C, Cottone M, Pallone F, et al. Mesalamine in the treatment of mild to moderate active Crohn’s ileitis: results of a randomized, multicenter trial. Gastroenterology 1999; 116 (3): 521–526.

    Article  PubMed  CAS  Google Scholar 

  9. Camma C, Giunta M, Rosselli M, et al. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology 1997; 113 (5): 1465–1473.

    Article  PubMed  CAS  Google Scholar 

  10. 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 (GETAID). Gastroenterology 1996; 110 (3): 688–693.

    Article  PubMed  CAS  Google Scholar 

  11. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn’s disease. The Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994; 331 (13): 836–841.

    Article  PubMed  CAS  Google Scholar 

  12. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults. Am J Gastroenterol 1997; 92 (2): 204–211.

    PubMed  CAS  Google Scholar 

  13. Danielsson A, Lofberg R, Persson T, et al. A steroid enema, budesonide, lacking systemic effects for the treatment of distal ulcerative colitis or proctitis. Scand J Gastroenterol 1992; 27 (1): 9–12.

    Article  PubMed  CAS  Google Scholar 

  14. Hanauer SB, Meyers S. Management of Crohn’s disease in adults. Am J Gastroenterol 1997; 92 (4): 559–566.

    PubMed  CAS  Google Scholar 

  15. 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): 370–374.

    Article  PubMed  CAS  Google Scholar 

  16. Sandborn WJ. Pouchitis following ileal pouch-anal anastomosis: definition, pathogenesis, and treatment. Gastroenterology 1994; 107 (6): 1856–1860.

    PubMed  CAS  Google Scholar 

  17. Turunen UM, Farkkila MA, Hakala K, et al. Long-term treatment of ulcerative colitis with ciprofloxacin: a prospective, double-blind, placebo-controlled study. Gastroenterology 1998; 115 (5): 1072–1078.

    Article  PubMed  CAS  Google Scholar 

  18. Bernstein LH, Frank MS, Brandt LJ, et al. Healing of perineal Crohn’s disease with metronidazole. Gastroenterology 1980; 79 (2): 357–365.

    PubMed  CAS  Google Scholar 

  19. 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): 1617–1621.

    Article  PubMed  CAS  Google Scholar 

  20. 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). Ame J Gastroenterol 1999; 94 (3): 674–678.

    Article  CAS  Google Scholar 

  21. Michetti P, Peppercorn MA. Medical therapy of specific clinical presentations. Gastroenterol Clin North Am 1999; 28 (3): 353–370.

    Article  PubMed  CAS  Google Scholar 

  22. Pearson DC, May GR, Fick GH, et al. Azathioprine and 6-mercaptopurine in Crohn’s disease. A meta-analysis. Ann Intern Med 1995; 123 (2): 132–142.

    PubMed  CAS  Google Scholar 

  23. Present DH, Korelitz BI, Wisch N, et al. Treatment of Crohn’s disease with 6- mercaptopurine: a long-term, randomized, double-blind study. N Engl J Med 1980; 302 (18): 981–987.

    Article  PubMed  CAS  Google Scholar 

  24. Hawthorne AB, Logan RFA, Hawkey CJ, et al. Randomized controlled trial of azathioprine withdrawal in ulcerative colitis. Br Med J 1992; 305 (6844): 20–22.

    Article  CAS  Google Scholar 

  25. George J, Present DH, Pou R, et al. The long-term outcome of ulcerative colitis treated with 6-mercaptopurine. Am J Gastroenterol 1996; 91 (9): 1711–1714.

    PubMed  CAS  Google Scholar 

  26. Sandborn WJ, Tremaine WJ, Wolf DC, et al. Lack of effect of intravenous azathioprine on time to respond to azathioprine for steroid treated Crohn’s disease. North American Azathioprine Study Group. Gastroenterology 1999; 117 (3): 527–535.

    Article  PubMed  CAS  Google Scholar 

  27. Lewis JD, Schwartz JS, Lichtenstein GR. Azathioprine for maintenance of remission in Crohn’s disease: benefits outweigh the risk of lymphoma. Gastroenterology 2000; 118 (6): 1018–1024.

    Article  PubMed  CAS  Google Scholar 

  28. Su CG, Stein RB, Lewis JD, Lichtenstein GR. Azathioprine or 6-mercaptopurine for inflammatory bowel disease: Do risks outweigh benefits? Dig Liver Dis 2000; 32: 518–531.

    Article  PubMed  CAS  Google Scholar 

  29. 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): 292–297.

    Article  PubMed  CAS  Google Scholar 

  30. 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): 1627–1632.

    Article  PubMed  CAS  Google Scholar 

  31. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994; 330 (26): 1841–1845.

    Article  PubMed  CAS  Google Scholar 

  32. Egan LJ, Sandborn WJ, Tremaine WJ. Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn’s disease with intravenous cyclosporine. Am J Gastroenterol 1998; 93 (3): 442–448.

    Article  PubMed  CAS  Google Scholar 

  33. Brynskov J, Freund L, Rasmussen SN, et al. A placebo-controlled, double-blind, randomized trial of cyclosporine therapy in active chronic Crohn’s disease. N Engl J Med 1989; 321 (13): 845–850.

    Article  PubMed  CAS  Google Scholar 

  34. Feagan BG, McDonald JW, Rochon J, et al. Low-dose cyclosporine for the treatment of Crohn’s disease. The Canadian Crohn’s Relapse Prevention Trial. N Engl J Med 1994; 330 (26): 1846–1851.

    Article  PubMed  CAS  Google Scholar 

  35. Jewell DP, Lennard-Jones JE, et al. Oral cyclosporine for chronic active Crohn’s disease: a multicentre controlled trial. Eur J Gastroenterol Hepatol 1994; 6: 499–505.

    Article  Google Scholar 

  36. Stange EF, Modigliani R, Pena AS, et al. European trial of cyclosporine in chronic active Crohn’s disease: a 12-mo study. Gastroenterol 1995; 109 (3): 774–782.

    Article  CAS  Google Scholar 

  37. Targan SR, Hanauer SB, van Deventer SJ, et al. A short-term study of chimeric monoclonal antibody CA2 to tumor necrosis factor (a) for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 1997; 337 (15): 1029–1035.

    Article  PubMed  CAS  Google Scholar 

  38. Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet 2002; 359 (9317): 1541–49.

    Article  PubMed  CAS  Google Scholar 

  39. D’Haens G, van Deventer SJH, van Hogezand R, et al. Endoscopic and histological healing with infliximab anti-tumor necrosis factor antibodies in Crohn’s disease: A European multicenter trial. Gastroenterology 1999; 116 (5): 1029–1034.

    Article  PubMed  Google Scholar 

  40. 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): 1398–1405.

    Article  PubMed  CAS  Google Scholar 

  41. Bickston SJ, Lichtenstein GR, Arseneau et al. The relationship between infliximab treatment and lymphoma in Crohn’s disease. Gastroenterology 1999; 117 (6): 1433–1437.

    Article  PubMed  CAS  Google Scholar 

  42. Feagon BG, Sandborn WJ, Baker JP, et al. A randomized, double-blind, placebo, controlled multi-center trial of the engineered human antibody to TNF (CDP571) for steroid sparing and maintenance of remission in patients with steroid-dependent Crohn’s disease [abstract]. Gastroenterology 2000; 118: A665.

    Google Scholar 

  43. Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Gastro 2001; 121 (5): 1088–94.

    Article  CAS  Google Scholar 

  44. Ehrenpreis ED, Kane SV, Cohen LB, et al. Thalidomide therapy for patients with refractory Crohn’s disease: an open-label trial. Gastroenterology 1999; 117 (6): 1271–1277.

    Article  PubMed  CAS  Google Scholar 

  45. Vasiliauskas EA, Kam LY, Abreu-Martin MT, et al. An open-label pilot study of low-dose thalidomide in chronically active, steroid-dependent Crohn’s disease. Gastroenterology 1999; 117 (6): 1278–1287.

    Article  PubMed  CAS  Google Scholar 

  46. Yacyshyn BR, Bowen-Yacyshyn MB, Jewell L, et al. A placebo-controlled trial of ICAM-1 antisense oligonucleotide in the treatment of Crohn’s disease. Gastroenterology 1998; 114 (6): 1133–1142.

    Article  PubMed  CAS  Google Scholar 

  47. Slonim AE, Bulone L, Damore MB, et al. A preliminary study of growth hormone therapy for Crohn’s disease. N Engl J Med 2000; 342 (22): 1633–1637.

    Article  PubMed  CAS  Google Scholar 

  48. Lewis JD, Lichtenstein GR, Stein RB, et al. An open-label trial of the PPARgamma igand rosiglitazone for active ulcerative colitis. Am J Gastroenterol. 2001; 96: 3323–3328.

    PubMed  CAS  Google Scholar 

  49. McLeod RS, Wolff BG, Steinhart AH. Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease. Gastroenterology 1995; 109 (2): 404–413.

    Article  PubMed  CAS  Google Scholar 

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Hecht, T.E.H., Su, C.G., Lichtenstein, G.R. (2003). Medical Therapy of Inflammatory Bowel Disease. In: Cohen, R.D. (eds) Inflammatory Bowel Disease. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-311-8_8

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  • DOI: https://doi.org/10.1007/978-1-59259-311-8_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-5465-0

  • Online ISBN: 978-1-59259-311-8

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