IBD management in 2010: highlight report from the annual meeting of the BSG, Liverpool 2010

摘要

A refreshingly iconoclastic view of the ECCO guidance was delivered by Professor Stange (Stuttgart), all the more impressive as he is a principle author of the guidance. His thoughtful interpretation was particularly useful in the minefield of when to start anti-tumour necrosis factors (TNFs). The ECCO consensus strongly recommends budesonide as firstline therapy in mild to moderately active disease and anti-TNFs if relapse occurs. However, all patients with Crohn's disease (CD) will eventually relapse and only a proportion of these will require anti-TNFs. He recommended "use what worked last time" and this includes antibiotic and dietary therapy (neither of which are endorsed by ECCO). His general recommendations as indications for anti-TNFs were: those refractory to oral steroids and those in whom there is a predictable poor response to conventional therapy (early age at onset, extensive small bowel disease, perianal disease, smokers).