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Inflammatory bowel disease: a new assessment.

The etiologies of Crohn's disease and inflammatory bowel disease remain undefined. A growing body of evidence suggests that genetic factors play at least a permissive role while a variety of initiating agents, varying from bacteria to viruses, to a vast array of inert antigens have been postulated, but clear-cut cause and effect relationships have not been established. Recently, a resurgence of interest in Mycobacteria paratuberculosis has developed. Regardless of the initiating cause, growing evidence continues to suggest an immunomodulatory role for the immune system in perpetuating the chronicity of these illnesses. Treatment approaches have been directed against possible initiating agents as well as against the elements which may establish chronicity. Thus currently antibiotics and anti-mycobacterial drugs are being utilized. A variety of anti-inflammatory and/or immunosuppressive agents, including prednisolone, cyclosporine, 6-mercaptopurine, as well as many 5-aminosalicylic acid products comprise a growing armamentarium.