Abstract
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 induction and maintenance treatments of patients with ulcerative colitis.
They are administered orally, in limited disease they may also be administered locally in the form of suppositorias or enemas or rectal foams. 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 Crohn's disease and ulcerative colitis.
Treatment with corticosteroids is burdened with a risk of serious adverse effects the intensity of which increases with the dose and duration of administration. It has been shown, that corticosteroids have no effect as a maintenance therapy in preventing the relapse of IBD.
The topical steroid (budesonide) is the first choice of therapy in patients with ileo-caecal Crohn's disease with a mild to moderate inflammatory activity. Immunosuppressants, particularly thiopurines, are indicated in the treatment of chronically active course of IBD, in the case of some extraintestinal manifestations, and in patients with perianal fistulating Crohn's disease.
They are used particularly in practice due to its corticoids-sparing effect. In the last ten years, the options of medical treatment for IBD have been broadened by biological therapy (infliximab and adalimumab).
There are chimeric or human immunoglobulins target to the tumor necrotising factor alpha, which is realised from activated leucocytes during inflammatory pathway in intestinal tissue or circulation. In a high proportion of patients (80–90 %) unresponsive to conventional treatment with corticosteroids and immunosuppressants, are significantly improved after biological therapy has been started.