Observations on the Medical Treatment of Inflammatory Bowel Disease

IN THE absence of decisive knowledge of the causes of inflammatory bowel disease (IBD), there continues to be no consistently curative medical treatment for ulcerative colitis and Crohn's disease.¹⁻³Treatment has included such widely diverse approaches as prefrontal lobotomy,⁴hog extract,⁵Calmette-Guérin bacillus,⁶,⁷vaccines including Bargen'sStreptococcus, irradiation,⁸gonadotropins, "regulation of abnormal electrical rhythm of the bowel" with coherin,⁹fasting, tranquilizers, phenylbutazone,¹⁰lithium carbonate,¹¹psychotherapy,¹²mineral water,¹³immunosuppressive drugs, and empirical measures for which rationale is not apparent. Many patients with mild ulcerative colitis and with mild regional enteritis respond favorably to simple treatments, including adequate rest, dietary adjustments, sedation, and perhaps sulfasalazine and other antibacterial agents. The emphasis in this article, therefore, is on selected aspects of the medical treatment of the moderately or severely ill IBD patient. A major flaw in the evaluation of therapeutic agents in IBD is