Traitement des maladies inflammatoires de l'intestin : état actuel et perspectives

Abstract

The cause of inflammatory bowel diseases is still unknown and their treatment remains symptomatic and only suspensive, except for surgery in ulcerative colitis. The same drugs are available in both ulcerative colitis and Crohn disease, but surgical procedures are quite different. Mild to moderate attacks of inflammatory bowel diseases are treated with sulfasalazine or the most recent 5-aminosalicylate derivates. More severe episodes require corticosteroid therapy. In steroid resistant patients with Crohn disease, artificial nutrition (enteral or parenteral) is useful, When a remission is achieved, a maintenance therapy with 5-aminosalicylate derivates is needed. In case of frequent relapses or corticodependence, azathioprine or 6- mercaptopurine is also indicated, especially in patients with Crohn disease. Studies with other immunosuppressive drugs (cyclosporine, methotrexate) are in progress. Patients with severe attacks of ulcerative colitis resistant to steroids must be operated upon, as those with longstanding and extensive ulcerative colitis because of the risk of cancer. In these patients, total colectomy is performed and until recently, it was associated with permanent ileostomy or ileo-rectal anastomosis. Ileo-anal anastomosis with ileal reservoir is a new procedure providing complete and definitive cure, and sparing the natural anus. Surgery is also frequently required in Crohn disease, and mainly consists in segmental resections with anastomosis ; after surgery, the rate of clinical relapse is about 50 % at 10 years, but a high rate of anatomical recurrence can be detected by endoscopy a few months after surgery.