Pharmacotherapy of inflammatory bowel diseases

Aminosalicylates, corticosteroids, immunosuppressants, and recently also biological therapy are the mainstays of pharmacotherapy of

inflammatory bowel diseases (IBD). Aminosalicylates (sulphasalazine, mesalazine) are essential drugs for both aggressive and maintenance

treatment of patients with ulcerative colitis. They are administered orally, in limited disease they may also be administered locally

in the form of suppository or rectal enema. Corticosteroids with systemic effect have a strong anti-inflammatory effect and are used in

oral or parenteral therapy in patients with a severe course of intestinal inflammations. The treatment with corticosteroids is burdened

with a risk of serious adverse effects the intensity of which increases with the dose and duration of administration. Corticosteroids are

of no importance in preventing the relapse of IBD. An alternative of the treatment of ileocaecal Crohn's disease with a mild to moderate

inflammatory activity are topical steroids (budesonide) administered orally. Immunosuppressants, particularly thiopurines, are indicated

in the treatment of chronically active forms of IBD, in the case of some extraintestinal manifestations, and in the treatment of fistulating

Crohn's disease. They are used in the practice mainly because of their corticoid-sparing effect. In the last ten years, the options of medical

treatment for IBD have been broadened to include biological therapy (infliximab and adalimumab) which is performed in the Czech

Republic in specialized centres. In a high proportion of patients unresponsive to conventional treatment with corticosteroids and immunosuppressants,

the initiation of biological therapy results in improvement in their condition or in achieving remission.

Keywords: Crohn's disease, ulcerative colitis, pharmacotherapy, inflammatory bowel diseases.