Drug Therapy of Inflammatory Bowel Disease

Abstract

Drug therapy in inflammatory bowel disease is of widespread interest for several reasons. First, because no definitive medical therapy exists for either Crohn’s disease or ulcerative colitis, patients and their physicians remain ultimately frustrated with all available medical therapy. But drug therapy claims attention and controversy beyond that frustration because every clinician is an experimenter who makes first hand experimental observations of the course of every patient. Inevitably clinicians develop strong opinions from the success or failure of treatments for which they bear the responsibility. Rueful experience has repeatedly proven however that there are so many variables acting upon the course of ulcerative colitis or Crohn’s disease in addition to the variables of drug choice and dose, that observations from single cases or even ten or fifteen cases may be grossly misleading. Realizing this, our English colleagues, notably Drs. Truelove, Avery Jones, and Lennard-Jones, beginning almost thirty years ago,^l took advantage of their uniquely large and cooperative groups of patients to study in statistically valid controlled trials the effect of drugs in inflammatory bowel disease. Largely due to their efforts, the results of properly controlled clinical trials have come to be accepted as the best guide to drug therapy. Despite their expense, difficulty and complexity such studies remain essential for the ultimate evaluation of medical, and perhaps also surgical, therapies.