engleski

"Step up" and "Top down" therapeutic approach in patients with inflammatory bowel disease

Background: Ulcerative colitis and Crohn’s disease are idiopathic autoimmune diseases whose incidence is constantly increasing, consequently representing a significant health problem of a developed Western society. They are characterized by chronic inflammation of the gastrointestinal wall and the high occurrence of relapse. Drug groups used in the treatment of inflammatory bowel disease are aminosalicylates, corticosteroids, immunomodulators and biological agents. By developing new drugs, therapeutic approach has changed from the simpler “step up” to the “topdown” approach, where more complex and more effective drugs are applied from the start. The basic goal of the treatment is to develop a deep remission and its longer duration, along with the smaller number of relapses. The aim of this study was to determine frequency of disease relapses in various types of the therapy. Materials and Methods: The research was based on medical documentation of patients affected by inflammatory bowel disease, treated at the Department of Gastroenterology and Hepatology, at Clinical Hospital Osijek. In total, 79 patients were involved, of which 40 of them were diagnosed with ulcerative colitis and 39 with Crohn’s disease. Results: Patients with Crohn’s disease achieved the longest remission, up to 2450 days, when receiving biological therapy. Much shorter remission is seen in patients taking aminosalicylates. However, there was no significant difference in remission duration between different treatment strategies (Mann-Whitney U test, P = 0, 2836). For patients with ulcerative colitis, the best results, with the remission up to 2500 days, gave the combination of aminosalicylates and immunosuppressives. Still, there was no significant difference in remission duration between different treatment strategies (Mann- Whitney U test, P = P = 0, 4762). Conclusion: Almost all patients in this study started treatment with a »step-up« approach, and only at later stages of the disease were treated with biological therapy. Because of the reason mentioned above, there was no statistically significant difference between the »step up« and »top down« therapeutic approaches, and further assessment of these investigated groups is required.

Step up ; Top down, inflammatory bowel disease

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