Management of Inflammatory Bowel Disease

The key to successful management of inflammatory bowel disease (iBD) is an accurate diagnosis. Misinterpretation of biopsies leading to over-interpretation or the misdiag- nosis of lymphoma, or a failure to uncover underlying causes of intestinal inflammation are potential pitfalls, but are discussed elsewhere.

The mainstay of treatment of idiopathic iBD has always been immunosuppression. Despite the concept that iBD is a loss of immunological tolerance to the normal intestinal flora, antibiotics alone are not effective. furthermore, there may also be lack of tolerance to dietary antigens. Highly digestible, restricted-fat ‘intestinal’ diets are helpful in the management of iBD. they provide less ‘work’ for the compromised intestine, and hope- fully contain the optimum amounts of n3:n6 fatty acids, fibre and micronutrients etc. nec- essary for general intestinal health. response to an exclusion diet suggests a dietary sen- sitivity rather than iBD. However, recent studies have shown a positive clinical response to hydrolysed diets in cases that would previously have been immmunosuppressed.

Prednisolone (and methylprednisolone) remains the first-choice immunosuppressive agent in dogs and cats. Dexamethasone has similar immunosuppressive effects, but deleterious effects on brush border enzyme activity, and is not recommended. there is little new in the usage of prednisolone, although its mechanism of action through the binding of nuclear transcription factors and inhibition of tumour necrosis factor (tnf)- alpha mrna transcription is now better understood. the aim of therapy is always to find the minimum effective dose. [...]