salicylates and Crohn-Disease

Since the introduction of biological therapy, endoscopic and histological remission, i.e. mucosal healing, has become an important therapeutic goal in Crohn's Disease and Ulcerative Colitis. Mucosal healing is associated with lower rates of hospitalization and surgery, although its role in preventing progression and changing the natural history of the disease has not been clearly demonstrated. A precise definition of mucosal healing has not yet been established, although the concept used in clinical trials is the "complete absence of all inflammatory and ulcerative lesions in all segments of gut" at endoscopy. This definition does not include mucosal improvement and does not distinguish among grades of mucosal healing. In both Crohn's Disease and Ulcerative Colitis trials, several qualitative and quantitative numeric endoscopic indices have been proposed to measure and distinguish endoscopic changes. In addition, the microscopic features associated with inflammatory bowel diseases are considerably modified by the course of the disease and the treatments adopted. However, it is not yet clear whether microscopic healing should be a primary endpoint in clinical trials. In this paper we discuss endoscopic and histological findings and the limitations of the endoscopic and histological indices as a basis for a standardised diagnosis of mucosal healing.

Topics: Adrenal Cortex Hormones; Biological Therapy; Colitis, Ulcerative; Crohn Disease; Endoscopy, Gastrointestinal; Humans; Immunologic Factors; Intestinal Mucosa; Salicylates; Severity of Illness Index; Terminology as Topic; Wound Healing

Many trials focused on the treatment of active luminal Crohn's disease (CD) have been published in literature. A critical reevaluation of the main trials regarding the use of 5-ASA derivates has shown a not significant benefit of such molecules in treating CD and, as a consequence, the European Crohn's and Colitis Organization's (ECCO) therapeutic statements highlight that 5-ASA should be considered clinically no more effective than placebo for active disease. The main evidence regarding the efficacy of conventional steroids as inductive therapy in active CD is still based on the old but fundamental Cooperative studies which can be considered at low risk for biases in spite of the date of publication. Most probably these RCTs will remain unsurpassed. Current data do not support the use of antibiotics for active luminal CD as primary therapeutic strategy in view of very conflicting results. In accordance with these conclusions current guidelines dot not suggest this kind of treatment in active CD. Even if frequently used, data about the role of conventional immunosuppressors for the therapy of active luminal CD ara scanty. Azathioprine/6-MP should be no more considered as remission-inductive agents for active CD while methotrexate could be considered an effective therapeutic option in inducing remission in this setting particular setting. A number of clinical trials are available about the use of anti-TNF alpha agents (infliximab, adalimumab) in active luminal CD. Both drugs are surely effective in inducing remission even if safety and economic concerns should be better considered and investigated.

Topics: Anti-Bacterial Agents; Budesonide; Crohn Disease; Glucocorticoids; Humans; Immunosuppressive Agents; Randomized Controlled Trials as Topic; Salicylates

Maintenance of medically induced remission is a clinical challenge in Crohn's disease (CD), since it is a chronic disease and that often occurs in young people. The introduction of immunosuppressors and biologics has significantly improved the management of these patients, however efficacy and safety of these treatments in the very long term still needs clarification. Furthermore, scientific research is driven more into new drugs to induce remission rather then maintenance.

Topics: Adalimumab; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Budesonide; Crohn Disease; Humans; Immunosuppressive Agents; Infliximab; Methotrexate; Randomized Controlled Trials as Topic; Remission Induction; Salicylates

Diarrhoea is a common manifestation of Crohn's disease (CD). We advocate an evidence-based approach to treat the underlying disease and reduce symptoms. This article reviews disease grading systems, current concepts in medical therapy, and other treatments that may become available in the future. While some drug classes (e.g. salicylates, immunomodulators) have been studied for many decades, newer approaches including anti-TNF monoclonal antibodies (biologics), and gut selective agents are changing the paradigm we use to treat this debilitating condition.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal; Crohn Disease; Gastrointestinal Agents; Humans; Immunologic Factors; Salicylates; Steroids

Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract that affects up to 480,000 persons in the United States. Symptoms include abdominal pain, diarrhea, fever, malaise, and arthralgias, and cause considerable morbidity. Speculation about genetic, environmental, dietary, infectious, and immunologic etiologies has led to treatment modalities directed at each theoretic cause, but therapy guidelines are determined by the severity of disease. Use of salicylates and/or antibiotics can be effective in mild to moderate disease, while steroids are the accepted therapy for more severe active disease. Azathioprine and other immunosuppresant drugs can be used as adjunctive therapy for active Crohn's disease and may help to maintain remission. Infliximab, an antibody to human tumor necrosis factor alpha, has proved successful in the treatment of severe refractory disease and generally causes only mild side effects. Therapy for Crohn's disease must involve treating comorbid conditions to improve the quality of life of patients.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibodies, Monoclonal; Azathioprine; Crohn Disease; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Salicylates

Although new salicylates are now available for the treatment of ulcerative colitis, sulphasazaline still has an important therapeutic role. The role of salicylates in Crohn's disease is limited to the mild activity phase; further data are required to clarify its role in maintenance on remission. New steroids are a real alternative to traditional steroids in active ulcerative colitis and Crohn's disease.

Topics: Acute Disease; Aspirin; Beclomethasone; Budesonide; Colitis, Ulcerative; Crohn Disease; Drug Therapy, Combination; Glucocorticoids; Humans; Inflammatory Bowel Diseases; Prednisolone; Randomized Controlled Trials as Topic; Salicylates; Sulfasalazine

CD and UC represent a spectrum of chronic IBD that present in protean ways and are accompanied by a variety of systemic sequelae. Sulfasalazine and the newer 5-aminosalicylates are important in the management of mild-to-moderate disease, whereas corticosteroids remain the primary therapy for most patients with moderate-to-severe disease (Tables 2-5). The toxicities associated with long-term steroid therapy, combined with their ineffectiveness as maintenance medications, have led to increased use of immunomodulators, such as azathioprine and 6-MP, for the treatment of steroid-dependent and steroid-resistant IBD. Infliximab is a novel therapeutic adjunct for chronically active and fistulizing CD that will herald a new era of biologic therapy for IBD. Meanwhile, CSA remains an alternative to urgent colectomy in severe UC unresponsive to corticosteroids and also for CD patients with severe disease or refractory fistulas. Finally, continued insights into the etiopathogenic pathways in IBD will provide evolving and innovative approaches until the eventual causes and cures are elucidated. In the meantime, clinicians should remain optimistic regarding current ability to reduce the morbidity and maintain the quality of life for patients suffering with these frustrating diseases.

Topics: Acute Disease; Adrenal Cortex Hormones; Anti-Bacterial Agents; Anti-Inflammatory Agents; Colitis, Ulcerative; Crohn Disease; Cyclosporine; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Methotrexate; Recurrence; Salicylates; Severity of Illness Index; Steroids

Topics: Adrenal Cortex Hormones; Adult; Colitis, Ulcerative; Colostomy; Crohn Disease; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Male; Proctocolectomy, Restorative; Salicylates

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Salicylates

Chronic inflammatory bowel diseases are probably due to stimulation of the intestinal immune system by multiple, so far unknown antigens. Chronic inflammatory bowel diseases can be contained but not healed by corticosteroids, sulfasalazine (SASP), azathioprin and metronidazol. Healing may be expected by direct pharmacological intervention in the intestinal immune system, but these are not yet available. -5-aminosalicylic acid may replace SASP in the treatment of ulcerative colitis. When administered locally 5-ASA may be effective in cases of corticosteroid-resistant distal colitis. Controlled studies are needed before the perspectives for 5-ASA in the treatment of Crohn's disease can be assessed.

Topics: Administration, Oral; Aminosalicylic Acids; Anti-Inflammatory Agents; Colitis, Ulcerative; Crohn Disease; Humans; Mesalamine; Pharmaceutical Vehicles; Salicylates

Salicylate intolerance is defined as a nonspecific antigen-induced pseudo-allergic hypersensitivity reaction which can occur upon contact of an organism with salicylic acid, its derivatives or other related organic or inorganic acids of similar chemical structure. Since the effects of nonsteroidal anti-inflammatory drugs (NSAID) intolerance are by no means always severe or life-endangering but may just as well present as oligosymptomatic or local disorders (e.g. abdominal pain, diarrhea, we decided to evaluate the characteristics of patients with salicylate intolerance on the basis of gastroenterological case material of Medical Department I of Erlangen University. On the basis of the findings from the Erlangen interdisciplinary data register of chronic inflammatory gastrointestinal disease, the signs and symptoms of NSAID intolerance were found to constitute a diagnosis of great practical import to clinical medicine (allergology, dermatology, immunology, other disorders etc.) including gastroenterology. For approx. 2-7% of all patients with inflammatory bowel syndrome and food allergies this poses a new diagnostic and therapeutic challenge which may concern physicians from any of the disciplines involved. When presented with patients with chronic active disease who are suffering from these symptoms one should, therefore, in future give greater thought to the possibility of salicylate intolerance, all the more as there are meaningful dietetic, diagnostic and therapeutic options available for these persons.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Colitis, Ulcerative; Crohn Disease; Diet; Drug Hypersensitivity; Food Hypersensitivity; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Lower Gastrointestinal Tract; Malabsorption Syndromes; Mesalamine; Salicylates

Cigarette smoking is associated with a more severe course of Crohn's disease, but individual factors determining this effect are poorly known and it is not clear whether smoking cessation is associated with an improvement in the disease activity.. To assess the factors determining the harmful effect of smoking in individuals with Crohn's disease.. A total of 622 consecutive patients with Crohn's disease and Crohn's disease activity index <200 were enrolled in a prospective 12-18 month cohort study. Patients were classified as current smokers, former smokers, or non-smokers. Alcohol consumption, oral contraceptive use, body mass index, and blood lipid levels were also recorded. The main outcome measure was the rate of flare-up.. A total of 139 current smokers (46%) developed a flare-up, vs. 79 non-smokers (30%) and 13 former smokers (23%). The relative risk of flare-up adjusted for confounding factors was 1.35 (1.03-1.76) in current smokers. This risk was increased in patients with previously inactive disease and in those who had no colonic lesions. It became significant above a threshold of 15 cigarettes per day. Former smokers behaved like non-smokers. Obesity, dyslipidaemia, and alcohol consumption had no significant effect.. Current smoking, particularly heavy smoking, markedly increases the risk of flare-up in Crohn's disease. Former smokers have a risk similar to that of non-smokers.

Topics: Adult; Alcohol Drinking; Crohn Disease; Female; Gastrointestinal Agents; Humans; Life Tables; Longitudinal Studies; Male; Middle Aged; Prospective Studies; Risk Factors; Salicylates; Smoking; Smoking Cessation; Treatment Outcome

Topics: Crohn Disease; Humans; Mesalamine; Salicylates

Recommendations are advice that is given and considered to be beneficial; however, they are still suggestions and are therefore open to different interpretations. In this sense, the final objective of the review has been to try to homogenize, with the evidence available, the approach to the diagnosis and medical/surgical treatment of one of the most complex manifestations of Crohn's disease, such as simple and complex perianal fistulas.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibodies, Monoclonal; Antirheumatic Agents; Crohn Disease; Endoscopy; Female; Fissure in Ano; Humans; Hyperbaric Oxygenation; Immunosuppressive Agents; Magnetic Resonance Imaging; Mesenchymal Stem Cell Transplantation; Proctitis; Rectal Fistula; Rectovaginal Fistula; Salicylates; Surgical Flaps; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged, 80 and over; Anemia; Antidiarrheals; Betacoronavirus; Bismuth; Blood Sedimentation; C-Reactive Protein; Coronavirus Infections; Cough; COVID-19; Crohn Disease; Diarrhea; Humans; Lymphopenia; Male; Organometallic Compounds; Pandemics; Pneumonia, Viral; Salicylates; SARS-CoV-2; Treatment Outcome

The study is carried out to identify the expression pattern of indoleamine 2,3-dioxygenase (IDO) in human Crohn's disease and ulcerative colitis and to investigate the effect of different therapies (salicylates, steroids, and antitumor necrosis factor antibody) on the intestinal expression of IDO.. Immunohistochemistry was used. A total of 10 high power fields were counted for each patient.. IDO was expressed in the both lamina propria and epithelium. IDO expression increased in the lesions from ulcerative colitis and Crohn's disease and was positively related to the severity of inflammation. IDO-positive mononuclear cells also expressed CD11c, CD68, and TLR4. IDO expression decreased significantly after treatment with steroids and salicylates, but remained unchanged after infliximab therapy.. IDO was over-expressed in human inflammatory bowel disease. It may be a bridge between innate immunity and adaptive immunity. Steroids and salicylates may act through the inhibition of IDO expression. IDO upregulation may be a promising therapy to achieve inflammatory bowel disease remission.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Antigens, CD; Antigens, Differentiation, Myelomonocytic; CD11c Antigen; Colitis, Ulcerative; Crohn Disease; Epithelial Cells; Female; Gastrointestinal Agents; Glucocorticoids; Humans; Immunoenzyme Techniques; Indoleamine-Pyrrole 2,3,-Dioxygenase; Inflammatory Bowel Diseases; Infliximab; Intestinal Mucosa; Male; Middle Aged; Salicylates; Toll-Like Receptor 4; Tumor Necrosis Factor-alpha

Topics: Adalimumab; Adrenal Cortex Hormones; Antibodies, Monoclonal, Humanized; Anus Diseases; Colonoscopy; Crohn Disease; Diagnosis, Differential; Drug Resistance; Edema; Female; Fissure in Ano; Follow-Up Studies; Giant Cells; Granuloma; Humans; Immunosuppressive Agents; Middle Aged; Recurrence; Salicylates; Skin Ulcer; Vulvar Diseases

Topics: Antidiarrheals; Bismuth; Colitis; Colitis, Collagenous; Crohn Disease; Drug Therapy, Combination; Female; Humans; Loperamide; Middle Aged; Organometallic Compounds; Psychoses, Substance-Induced; Rectal Fistula; Salicylates; Steroids

Na+/H+ exchanger isoform 3 (NHE-3) is responsible for net uptake of NaCl and water from the gastrointestinal (GI) tract. However, its status in human inflammatory bowel diseases (IBDs) such as ulcerative colitis(UC) and Crohn's disease (CD) remains poorly understood. The aim of this study was to investigate the underlying mechanism of NHE-3 isoform expression and its modulation by 5'-aminosalicylate in human CD and UC.. Subjects were divided into three groups: 1) controls; 2) untreated/new IBD cases (n = 13) and 3) 5'-aminosalicylate-treated IBD patients (n = 13). Subjects presenting with abdominal pain but with endoscopically normal colons served as normal controls. Inflammation was confirmed by the level of myeloperoxidase (MPO) activity, malondialdehyde (MDA) concentrations and by histologic evaluation. Expressions of NHE-3 protein and mRNA, sodium pump activity and IL-1beta and TNF-alpha mRNA were estimated in the colonic biopsies using ECL-Western blot analysis,reverse transcription-polymerase chain reaction (RT-PCR) and enzyme assays.. The level of NHE-3 protein and sodium pump activity was reduced (p < 0.05) in both the untreated and treated CD and UC patients. NHE-3 mRNA was reduced only in CD patients but not in those with UC. The treatment reversed the symptoms, but levels of MPO activity, MDA concentration, IL-1beta, TNF-alpha and infiltration of inflammatory cells remained high with the exception of IL-1beta mRNA in the treated patients.. NHE-3 suppression is regulated differentially in CD and UC, which together with suppression of sodium pump activity will reduce NaCl and water uptake from the colonic lumen. These findings suggest a role of TNF-a in the regulation of NHE-3 expression in IBD.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Blotting, Western; Case-Control Studies; Colitis, Ulcerative; Colon; Crohn Disease; Female; Humans; Inflammatory Bowel Diseases; Interleukin-1beta; Male; Malondialdehyde; Middle Aged; Peroxidase; Protein Isoforms; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Salicylates; Sodium Chloride; Sodium-Hydrogen Exchanger 3; Sodium-Hydrogen Exchangers; Sodium-Potassium-Exchanging ATPase; Tumor Necrosis Factor-alpha; Water

It is well established that Crohn's disease (CD) is associated with an increased risk of small bowel adenocarcinoma (SBA). The data concerning SBA risk factors in CD are scanty. The aim of this study was to identify them.. In 11 French centers affiliated with the GETAID (Groupe d'Etude Thérapeutique des Affections Inflammatoires du Tube Digestif), we identified 29 patients with CD and SBA. Eighty-seven CD controls without SBA recruited in a single center were matched to the cases for sex, age, duration, and CD site. A conditional logistic regression, taking into account the matching between cases and controls, was performed.. In univariate analysis, the cases had had significantly less small bowel resection and received prolonged treatment with salicylates (more than 2 yr), less often than the controls (odds ratio, OR [95% confidence interval, CI] 0.07 [0.01-0.32] and 0.29 [0.10-0.82], respectively). In multivariate analysis, both associations remained significant (OR 0.04 [0.01-0.28], P= 0.001; OR 0.16 [0.03-0.79], P= 0.02, respectively).. This study suggests that small bowel resection and prolonged salicylates use may protect against SBA in CD patients.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Child; Crohn Disease; Female; Humans; Intestinal Neoplasms; Intestine, Small; Logistic Models; Male; Middle Aged; Risk Factors; Salicylates

UR-1505 is a novel pentafluoropropoxy derivative of salicylic acid, selected from a series of salicylate derivatives, according to their activity as inhibitors of T-lymphocyte activation. This study describes the anti-inflammatory activity of UR-1505 on trinitrobenzenesulphonic acid-induced colitis in rat, an experimental model that resembles to Crohn's disease (CD), as well as its in vitro effects on T-cells and bone marrow-derived macrophages (BMDM) activation. UR-1505 showed intestinal anti-inflammatory effect, associated with reduced colonic levels of TNFalpha and LTB(4), inhibition of the expression of IFNgamma and iNOS, and lower colonic leukocyte infiltration. The in vitro assays revealed that UR-1505 also inhibited T-lymphocyte proliferation and IL-12/IFNgamma production, two of the main pro-inflammatory cytokines involved in the pathogenesis of CD. However, UR-1505 did not modify LPS- nor IFNgamma-induced activation in BMDM. Thus, UR-1505 specifically affects T-cells without modifying the activation of BMDM. In conclusion, the intestinal anti-inflammatory activity of UR-1505 seems to be mediated by a reduction in the recruitment of immune cells to the inflammatory foci, together with the inhibition of T-cell activation. These results suggest that UR-1505 may be an interesting candidate to be explored for the treatment of CD.

Topics: Animals; Anti-Inflammatory Agents; Cells, Cultured; Colitis; Colon; Crohn Disease; Disease Models, Animal; Female; Glutathione; Interferon-gamma; Leukotriene B4; Macrophages; Mice; Mice, Inbred BALB C; Nitric Oxide Synthase Type II; Rats; Rats, Wistar; Salicylates; Spleen; T-Lymphocytes; Trinitrobenzenesulfonic Acid; Tumor Necrosis Factor-alpha

Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease.. To assess the effect of oral contraceptive use on the clinical course of Crohn's disease.. 331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index <200, were enrolled consecutively during a one year period. Patients were classified at inclusion as oral contraceptive users or non-users and smokers or non-smokers.. A prospective 12-18 month cohort study was used. The main outcome measures were flare up rate and time to flare up.. In total, 134 women used oral contraceptives, in most cases low oestrogen formulations. During the study period, 61 oral contraceptive users (46%) developed a flare up, compared with 85 non-users (43%). The hazard ratio for oral contraceptive use was 1.11 (95% confidence interval 0.80 to 1.55). Variables associated with flare up were smoking status, recently active disease, baseline Crohn's disease activity index, and presence of anoperineal lesions. The same results were obtained when the analysis was restricted to patients eligible for a relapse prevention trial.. Unlike smoking, oral contraceptives have no effect on Crohn's disease activity.

Topics: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal; Cohort Studies; Contraceptives, Oral; Crohn Disease; Female; Humans; Middle Aged; Prospective Studies; Recurrence; Salicylates; Treatment Outcome

The conservative treatment of ano-rectal fistulae in Crohn's disease is selected according to the clinical activity and chronicity of the underlying disease. While in the acute phase metronidazole is indicated in addition to the standard therapy, an immuno-suppressive treatment with azathrioprine is recommended for the chronic-active course. The long latency of the therapeutic response can be bridged by an intravenous therapy with either cyclosporine ot with high-dose azathropine. The treatment is initiated only after consultation with the surgeon. For the prophylaxis of a post-surgical recurrence, only salicylates are established. Further inter-discipline therapy intended to induce a pre-surgical remission or to maintain a post-surgical remission.

Topics: Crohn Disease; Humans; Immunosuppressive Agents; Metronidazole; Postoperative Complications; Prognosis; Rectal Fistula; Recurrence; Salicylates

Colonic mucin is heavily sulphated and it has been shown that enzymatic desulphation by faecal bacterial sulphatases greatly increases its susceptibility to degradation by faecal glycosidases. A possible role for faecal mucin sulphatase in the pathogenesis of inflammatory bowel disease has therefore been explored. Faecal mucin sulphatase activity assayed using 35S mucin as substrate was increased in ulcerative colitis (median 80.2 units/g pellet weight (range 6.9-1063; 95% confidence intervals (CI): 45.2 to 293.8, n = 22) compared with 11.3 units/g (range 3.0-53.5; 95% CI: 8.7 to 29.8, n = 17) in healthy controls (p < 0.01), where one unit released 1000 dpm free sulphate/hour from 35S mucin (1680 dpm/microgram). Patients with active ulcerative colitis had higher sulphatase activity (median 146; 95% CI: 98 to 253 units/g, n = 10) than those with inactive ulcerative colitis (median 42.2; CI: 22.5 to 81.6 units/g, n = 12) (p < 0.05). Longitudinal studies in patients with ulcerative colitis show fluctuations of faecal mucin sulphatase activity corresponding to clinical disease activity in six of seven patients. Faecal mucin sulphatase activity was not significantly increased in Crohn's disease (median 36.6, range 5.7-106.6; 95% CI: 22.9 to 65.3 units/g, n = 14). The bismuth salts, bismuth subcitrate and bismuth subsalicylate were found to inhibit faecal mucin sulphatase activity at concentrations achievable therapeutically. The increased faecal mucin sulphatase activity in ulcerative colitis could be the result of greater intraluminal substrate (mucin) availability leading to bacterial enzyme induction, but would probably result in more rapid degradation of secreted mucin and represents a potential target for treatment.

Topics: Adult; Aged; alpha-Glucosidases; Bismuth; Colitis, Ulcerative; Crohn Disease; Feces; Female; Humans; Longitudinal Studies; Male; Middle Aged; Organometallic Compounds; Salicylates; Sulfatases

Topics: Adrenal Cortex Hormones; Colitis, Ulcerative; Crohn Disease; Cyclosporins; Humans; Salicylates

Topics: Combined Modality Therapy; Crohn Disease; Food, Formulated; Humans; Immunosuppressive Agents; Intestinal Mucosa; Metronidazole; Prednisolone; Salicylates; Sulfasalazine

In addition to proctocolectomy, new surgical techniques for treating ulcerative colitis include the Kock internal ileal reservoir and endorectal pullthrough of the ileum. In children three forms of Crohn's disease requiring operation have been identified. Ileocecal disease may be treated with resection and anastomosis; colorectal disease is best managed by primary proctocolectomy cutaneous ileostomy; and Crohn's disease of the small bowel should be managed by medical therapy in most cases.

Topics: Cecal Diseases; Child; Colectomy; Colitis, Ulcerative; Colostomy; Crohn Disease; Female; Humans; Ileostomy; Inflammation; Male; Methods; Prednisone; Proctitis; Salicylates; Sulfapyridine

Aetiology of ulcerative colitis and Crohn's disease is unknown. Therefore causal therapy is not possible. Conservative treatment for both diseases is of antiinflammatory, symptomatic and substituting nature. Surgical intervention is indicated if conservative treatment fails or if dangerous complications occur. The right moment for an operation can only be determined in close cooperation between internist and surgeon.

Topics: Adrenocorticotropic Hormone; Anemia; Anti-Inflammatory Agents; Blood Transfusion; Colitis, Ulcerative; Colonic Neoplasms; Crohn Disease; Dietary Proteins; Drug Combinations; Humans; Lactose Intolerance; Parenteral Nutrition; Psychotherapy; Salicylates; Sulfonamides; Vitamins

Topics: Acute Disease; Chronic Disease; Crohn Disease; Diarrhea; Female; Gastrointestinal Agents; Humans; Hypnotics and Sedatives; Male; Salicylates; Sulfanilamides; Vitamins

Topics: Aspirin; Crohn Disease; Humans; Ileitis; Prednisone; Salicylates