[Ulcerative colitis]

Ulcerative colitis is an immunologic disorder of the intestine which involves the mucosa and sometimes the submucosa. It has a chronic relapsing course, affects the colon and occasionally the terminal ileum. This so called backwash ileitis is overall very rare and of limited clinical importance. Usually the inflammation starts in the rectum and may extend in a proximal and continuous fashion to the rest of the colon. Symptoms consist of frequent loose bloody stools, cramps and weight loss. It is important and frequently neglected that patients especially (but not exclusively) with a limited degree of colonic involvement up to the splenic flexure are treated topically with mesalamine and budesonid or hydrocortisone by suppository, enema or foam. In case of more severe colitis oral mesalamine, systemic corticosteroids and other immunosupressors should be added to the therapy.

[Therapy of complicated Crohn's disease]

During their disease course, the majority of Crohn's disease patients will develop a complicated disease which is characterized by the occurrence of fistulas and/or stenosis. Symptomatic, perianal fistulas should be surgically drained before anti-inflammatory therapy will be initiated. Antibiotics, such as metronidazole, improve disease symptomatic however, they are not sufficient to induce continuous fistula closure. For this purpose, azathioprine/6-mercaptopurine as well as anti-TNF antibodies are useful when administered continuously. Surgical options include seton drainage, fistula excision, fistula plugs and mucosa flaps. As ultima ratio, temporary ileostomy and proctectomy are to be discussed. Non-perianal fistulas often require surgical approaches. Symptomatic strictures or stenosis can be treated by anti-inflammatory medications (only if they are cause by inflammation), endoscopic balloon dilatation or surgery.

[Colitis-associated colorectal carcinoma: epidemiology, pathogenesis and early diagnosis]

Colitis-associated colorectal carcinoma (CRC) accounts for about 5% of all CRC and the risk for CRC in inflammatory bowel disease (IBD) patients - according to older meta-analyses - is slightly increased when compared to normal population. Effective anti-inflammatory therapy seems to decrease this risk. Main risk factors for colitis-associated CRC are pancolitis, duration of colitis and presence of primary sclerosing cholangitis. In contrast to sporadic CRC, a characteristic adenoma-carcinoma sequence in the pathogenesis of colitis-associated CRC cannot be found. Nevertheless, numerous cell and gene defects occur. Reactive oxygen species also seem to play a pivotal role in the pathogenesis of colitis-associated CRC. Particularly patients with chronically active pancolitis should undergo regular surveillance colonoscopy, since prognosis of colitis-associated CRC is poor.