Inflammatory Bowel Disease: Pathophysiology and Current Therapeutic Approaches

Handb Exp Pharmacol. 2017:239:115-146. doi: 10.1007/164_2016_122.

Abstract

Inflammatory bowel diseases, most commonly categorized as Crohn's disease and ulcerative colitis, are immune mediated chronic inflammatory disorders of the gastrointestinal tract. The etiopathogenesis is multifactorial with different environmental, genetic, immune mediated, and gut microbial factors playing important role. The current goals of therapy are to improve clinical symptoms, control inflammation, prevent complications, and improve quality of life. Different therapeutic agents, with their indications, mechanisms of action, and side effects are discussed in this chapter. Anti-integrin therapy, a newer therapeutic class, with its potential beneficial role in both Crohn's disease and ulcerative colitis is also mentioned. In the end, therapeutic algorithms for both diseases are reviewed.

Keywords: Adaptive immunity; Anti integrins; Anti-TNF drugs; Biologics; Corticosteroids; Crohn’s disease; Immunomodulators; Inflammation; Inflammatory bowel disease; Innate immunity; Mesalamine; Ulcerative colitis.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Animals
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Decision Support Techniques
  • Gastrointestinal Agents / adverse effects
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / metabolism
  • Inflammatory Bowel Diseases / physiopathology*
  • Inflammatory Bowel Diseases / therapy*
  • Integrins / antagonists & inhibitors
  • Integrins / metabolism
  • Intestinal Mucosa / metabolism
  • Intestines / drug effects*
  • Intestines / physiopathology
  • Recurrence
  • Remission Induction
  • Risk Factors
  • Therapeutics
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Anti-Inflammatory Agents
  • Gastrointestinal Agents
  • Integrins
  • Tumor Necrosis Factor-alpha