Lower Gastrointestinal Conditions: Inflammatory Bowel Disease

Sonnenberg WR1. FP Essent. 2019 Aug;483:11-19.


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119 East Mechanic St, Titusville, PA 16354.


Inflammatory bowel disease (IBD) is a group of diseases that result from an abnormal response to intestinal microbes in a genetically susceptible host. The two major forms are Crohn disease and ulcerative colitis (UC). Crohn disease can involve the entire gastrointestinal tract and the full thickness of the bowel wall. UC is confined to the mucosal layer of the colon. Steroids are used mainly for management of moderate to severely active (ie, acute flares of) IBD. However, steroid use should be limited to the short term because of adverse effects related to long-term usage. Methotrexate is useful for induction and maintenance treatment of Crohn disease. (This is an off-label use of methotrexate.) 5-Aminosalicylates are effective for UC management. Surgery theoretically is curative for UC but is a last resort intervention for Crohn disease. Newer biologic agents are proving useful in IBD management. For patients with these conditions, health maintenance often is the responsibility of the family physician. Patients with IBD should be monitored for osteoporosis, nutritional deficiencies, infections, depression, and cancer.

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