ABSTRACT
Malnutrition in inflammatory bowel disease (IBD) is common and multifactorial in origin. Enteral nutritional therapy alters the inflammatory response in Crohn’s disease (CD) and may be useful in therapy. Smoking is an important environmental factor in the pathogenesis of IBD. There are many publications claiming an adverse effect of non-steroidal anti-inflammatory drugs in precipitating de novo IBD or exacerbating pre-existing disease, although the evidence remains contradictory and confusing. Corticiosteroids are used in the form of oral prednisolone, prednisone, intravenous hydrocortisone and methylprednisolone. Metronidazole is used to treat perianal disease. Metronidazole treatment of pouchitis improves diarrhoea without a clear effect on pouch inflammation. Thiopurines are effective for both induction and maintenance of remission in CD. In IBD, large population-based studies have shown no increased risk of developing lymphoproliferative disorders. Cytomegalovirus should be considered in refractory colitis as reactivation is common in patients with IBD on immunosuppression and the presentation can mimic ulcerative colitis or CD.
