Modern Management of Inflammatory Bowel Disease

The diagnosis of ulcerative colitis should be differentiated from infectious causes of bloody diarrhea by stool culture, examination for ova and parasites, and by flexible sigmoidoscopy without any enema preparation. Biopsies should be obtained as part of the diagnostic work-up at that sigmoidoscopy. *Evaluate any patient with diarrhea awakening him/her at night, or with new onset of incontinence withotit an obvious neuromuscular cause, for inflammatory bowel disease. *Obtain early consultation from both a gastroen-terologist and surgeon for patients with severe ulcerative colitis, who are at risk of colonic dilatation or perforation. In conjunction, with the consultants, try intravenous therapies for a limited time period to bring the disease under control. *Crohn's disease can affect any part of the GI tract and present with great variability, and [right lower quadrant abdominal] pain, fever, weight loss or extra-intestinal manifestations are often more prominent than diarrhea. *While steroids are frequently issed to bring an exacerbation of inflammatory bowel disease under control, there is no evidence that their long-term use will prolong remission and their long-term risks outweigh the benefits of their continued use. *Immunomodulatory drugs [azathioprine, 6-mercap-topurine] should be used sooner [and with confidence in their safety profile] to spare patients the effects of prolonged corticosteroids and to maintain remission in both Grobn’s disease and ulcerative colitis. *After surgical resection for Grohn's disease, maintenance medication [either a mesalamine product or an immunomodulator] can prolong the interval until disease recurs or further surgery is needed.