The
therapy of
inflammatory bowel diseases is based on 5-aminosalicylates (5-ASAs) that are the forefront of treatment of mild-to-moderate active disease and maintenance;
steroids are used for the treatment of moderate-to-severe active disease; immunosuppressives and sometimes
antibiotics in moderate-to-severe disease; maintenance and for the treatment of selected complications. The last few years have witnessed a significant change in the treatment of
Crohn's disease. Based on evidence from new clinical studies and recent meta-analyses, the role of and indications for conventional
therapy have been reassessed. The 5-ASAs are nowadays less frequently used in both active disease and maintenance
therapy. Instead,
budesonide has been introduced in the treatment of mild-to-moderate
ileal disease. Besides the modest use of 5-ASAs,
steroids are prescribed for active
colonic disease. Immunosuppressives, especially
azathioprine, are more commonly used in moderate-to-severe disease as well as in maintenance. The preferred maintenance regimen following medically- and surgically-induced remission, in addition to relationship between medical and surgical
therapies, has also changed. The recent introduction of new "
biological" therapy represents a major, promising change in the
therapy of resistant and penetrating disease.