Journal Mobile

S Ghosh
Journal Issue: 
Volume 35: Issue 1: 2005




Inflammatory bowel disease comprising of ulcerative colitis and Crohn’s disease can no longer be considered to be diseases confined to the West.  Genetic susceptibility,  mucosal  immune  dysregulation  and  intestinal  bacterial  flora contribute  to  the  pathogenesis,  but  the  exact  causes  remain  uncertain.   The identification  of  Nod2  gene  mutations  associated  with  Crohn’s  disease  points  to defects in innate immune system that alter interaction with microbial agents.  Early recognition is important to prevent morbidity and complications. This poses special challenge  in  countries  where  the  incidence  is  lower  than  that  in  the  West  and infective diseases involving the intestinal tract is common.  Management requires a multidisciplinary medical-surgical team effort and is focussed on disease modifying therapy rather than simply management of acute relapses.  Corticosteroid therapy, though valuable, is not disease modifying and is associated with considerable side effects  and  morbidity.  Specific  targeted  therapy  using  monoclonal  antibodies  has been  a  most  important  advance  in  recent  years, but  the  cost  of  such  therapy continues to be prohibitive.