Diagnosis and medical management of inflammatory bowel disease *
Crohn's disease (CD) and ulcerative colitis (UC) have both been categorized as "inflammatory bowel disease", because both conditions share some clinical features. However, there arc specific diagnostic features and management for CD and UC because these diseases also have many different characteristics. In 1995, the diagnostic criteria of CD in Japan were extensively revised. Under these new criteria, we can make a diagnosis of CD in patients who have aphthous ulcers alone. A so-called "bamboo joint-like appearance" in the stomach has been noticed in large numbers of CD patients. A recent report stating that aggregations of CD68+ cells are frequently observed in the gastroduodenal mucosa in CD is interesting as regards a convenient diagnosis. In serological tests, anti-Saccharomyces cerevisiae antibody has been reported to be highly positive in CD. As for medical management of CD, nutritional therapy with total parenteral nutrition, elemental diets, or polymerically defined formula diets is widely accepted as both primary treatment and maintenance treatment in Japan. Newly developed drugs, such as 5-aminosalicylic acid, anti-TNF alfa antibody, and anti-CD4 antibody, have been reported to have therapeutic value. A genetic approach using ICAM-1 antisense oligonucleotide may be applied in controlling CD. Endoscopic balloon dilation therapy is easy and convenient enough to be widely accepted, and may become an alternative approach for CD patients with bowel stricture. There have been some noteworthy studies for the diagnosis of UC ; a correlation between appendiceal involvement and disease activity and the application of magnifying colonoscopy for the assessment of severity. Great attention has been paid to the high positivity rate of pANCA in the sera of UC patients. Various investigations have been carried out regarding therapeutic modalities ; leukocytapheresis, intravenous cyclosporin, nicotine, heparin, and antibiotics. A recently synthesized antiinflammatory steroid, which is rapidly metabolized to become inactive upon entry into the systemic circulation (antedrug concept), may be useful for treating patients with refractory or steroid-dependent UC, because systemic adverse effects of this steroid are minimized. We rarely encounter patients with features of both CD and UC, but when we do, we make a diagnosis of indeterminate colitis. To treat patients with bowel inflammation correctly, we must make an accurate diagnosis. An easy diagnosis of indeterminate colitis should be avoided. I wish to interpret the essence and trends of the diagnosis and medical management of inflammatory bowel disease. (Accepted on May 20, 2000) Kawasaki Igakkaishi 26(2) 83-94, 2000
