Medical and surgical management of chronic ulcerative colitis.

I diopathic inflammatory bowel disease is divided into 2 major disease processes, Crohn disease (CD) and chronic ulcerative colitis (CUC). Often, both diseases are characterized by intermittent exacerbation of symptoms and periods of remission that may occur spontaneously or in response to treatment. The etiology of these diseases is unknown but most likely represents an interaction between the environment and host genetic susceptibility. Both medical and surgical treatment are used in the treatment of CD and CUC. However, given the different distribution of disease activity along the intestinal tract and the nature of the inflammatory process, the role and scope of medical and surgical management for each specific disease are different. Crohn disease may arise anywhere along the length of the intestine. It is characterized by transmural inflammation of the bowel wall. Such inflammation leads to a unique set of complications, including abscess and fistula formation and intestinal stenosis. By its very nature, therefore, CD does not allow for a definitive surgical treatment of the disease, and surgery should be reserved to address complications.