Ten Common Errors in the Management of Inflammatory Bowel Disease

Four years ago, the editors-in-chief of this journal approached me with the idea of creating a new feature, in which internationally renowned clinical investigators would share their personal perspectives on hot topics in IBD. Since then, 15 sets of authors from around the world have generously contributed their “Clinical Viewpoints” to this column. This year, as the editorship of the section transfers to the capable hands of Ted Bayless and Cosimo Prantera, I have marked the occasion by offering a Clinical Viewpoints article of my own. What follows is a strictly personal essay on “Ten Common Errors in the Management of IBD.” Although I cite references in support of my views, my opinions remain just that—opinions. The data in the references have been collected by their respective authors, but any biases in their selection or flaws in their interpretation are mine alone. Many patients with ulcerative colitis or Crohn's disease, just like 15% or more of the general population, will have “functional”-type symptoms irrespective of or at least out of proportion to the active inflammatory components of their disease (1). These patients, like anyone else with IBS, may complain of gas, bloating, fulness, mild urgency, or similar nonspecific symptoms. Simply because they happen to carry a diagnosis of IBD is not an indication in and of itself to intensify the antiinflammatory regimen. For every extra cramp or bowel movement, we need not automatically reach for steroids, immunomodulators, infliximab, or cyclosporine. When simple neuromotor symptoms call for simple symptomatic measures, antidiarrheals, antispasmodics, or fiber products may well suffice.