Modern Management of Inflammatory Bowel Disease

Diagnosis and Classification

IBD diagnosis combines clinical presentation, endoscopic findings, histopathology, and imaging. Crohn's disease can affect any GI tract segment (often terminal ileum) with skip lesions, while ulcerative colitis is limited to the colon with continuous inflammation.

Treatment Strategies

5-aminosalicylates remain first-line for mild UC. Moderate-severe disease often requires biologics (anti-TNF, anti-integrins, or IL-12/23 inhibitors). Recent JAK inhibitors offer oral options. Treatment goals have shifted from symptom control to endoscopic healing.

Monitoring Disease Activity

Calprotectin stool tests help monitor inflammation non-invasively. Regular endoscopic assessment guides treatment adjustments. Cross-sectional imaging evaluates for complications like strictures or fistulas in Crohn's disease.

Surgical Considerations

About 30% of UC patients may eventually need colectomy. Crohn's disease often requires stricturoplasty or resection for complications. Multidisciplinary teams optimize timing and approach of surgical interventions.

Emerging Therapies

Newer biologics target different inflammatory pathways. Microbiome modulation and stem cell therapies show promise. Personalized medicine approaches based on genetic markers are under investigation.