Review article

CLASSICAL MEDICATIONS IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES

MARKO DUVNJAK ; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre , Zagreb, Croatia
ANTE BILIĆ ; Division of Gastroenterology and Hepatology, Department of Internal Medicine, ‘Sveti Duh Clinical Hospital, Zagreb, Croatia
NEVEN BARŠIĆ ; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre , Zagreb, Croatia
VEDRAN TOMAŠIĆ ; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre , Zagreb, Croatia
SANJA STOJSAVLJEVIĆ ; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre , Zagreb, Croatia

Abstract

The treatment of inflammatory bowel diseases is complex and requires individual approach to every single patient. Traditionally, the approach is based on introduction of so called ‘’classical’’ medication into the treatment regimen, from ones less potent and with fewer side effects to the ones more toxic but also therapeutically more effective. Aminosalicylates were the first choice of treatment for a long time. However, the role of aminosalicylates is becoming more and more diminished, although they are still the drug of choice in the treatment of mild to moderate ulcerative colitis. Corticosteroids are the therapy of choice in treatment of active IBD for achieving remission in moderate to severe disease. Azathioprine and 6- mercaptopurine belong to a group of thiopurines with an immunomodulatory effect which, in Crohn’s disease as well as in ulcerative colitis, primarily have a role in a steroid dependant or steroid refractory type of disease and in maintenance of remission. Lately, early introduction of these medications is proposed to enhance the number of patients that remain in remission. Methotrexate is used for the therapy of active and relapsing Crohn’s disease and represents an alternative in patients who do not tolerate or do not respond to azathioprine or 6-mercaptopurine therapy. Cyclosporine is used in treating steroid refractory ulcerative colitis and in some patients can postpone the need for colectomy. Antibiotics do not have a proven effect on the course of inflammatory bowel diseases and their primary role is to treat septic complications. Classic medications today represent a standard in the management of inflammatory bowel diseases, and the combination of the previously mentioned drugs often has a more potent effect on the course of the disease than any medication on its own and their combination is still an object of investigations and clinical studies.

Keywords

Crohn’s disease; ulcerative colitis; aminosalicylates; azathioprine; corticosteroids; 6-mercaptopurine; methotrexate; cyclosporine; antibiotics

Hrčak ID:

111616

URI

https://hrcak.srce.hr/111616

Publication date:

28.11.2013.

Article data in other languages: croatian

Visits: 7.014 *