Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment

The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority...

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Autores principales: Actis, Giovanni C, Pellicano, Rinaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421109/
https://www.ncbi.nlm.nih.gov/pubmed/28533920
http://dx.doi.org/10.4292/wjgpt.v8.i2.114
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author Actis, Giovanni C
Pellicano, Rinaldo
author_facet Actis, Giovanni C
Pellicano, Rinaldo
author_sort Actis, Giovanni C
collection PubMed
description The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn’s; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn’s; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview.
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spelling pubmed-54211092017-05-22 Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment Actis, Giovanni C Pellicano, Rinaldo World J Gastrointest Pharmacol Ther Minireviews The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn’s; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn’s; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization. Against all these caveats, two simple rules still hold true: Strict adherence maintenance and avoidance of colitogenic drugs. This matter is expanded in this minireview. Baishideng Publishing Group Inc 2017-05-06 2017-05-06 /pmc/articles/PMC5421109/ /pubmed/28533920 http://dx.doi.org/10.4292/wjgpt.v8.i2.114 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Minireviews
Actis, Giovanni C
Pellicano, Rinaldo
Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title_full Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title_fullStr Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title_full_unstemmed Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title_short Inflammatory bowel disease: Efficient remission maintenance is crucial for cost containment
title_sort inflammatory bowel disease: efficient remission maintenance is crucial for cost containment
topic Minireviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421109/
https://www.ncbi.nlm.nih.gov/pubmed/28533920
http://dx.doi.org/10.4292/wjgpt.v8.i2.114
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