ANALYSIS OF DISEASE DISTRIBUTION, ACTIVITY AND COMPLICATIONS IN THE PATIENT WITH INFLAMMATORY BOWEL-DISEASE

Management strategies in Crohn's disease and ulcerative colitis should be based on up-to-date information on disease distribution, extent, a ctivity and complications. A system of structured analysis is suggeste d, with separate consideration of destructive ulceration, inflammatory activity and other factors. Direct investigation of gut immunity by u sing whole gut lavage fluid (WGLF) is a valuable new technique of clin ical investigation in IBD and related disorders. Recent studies have s hown that the concentrations of plasma-derived proteins in WGLF provid e objective measures of disease activity; and that this activity is a separate phenomenon from destructive ulceration and fibrosis. Neutroph ils in the lumen can be in-investigated by cytology, or by assay of ne utrophil elastase in WGLF. Cytokines and other immunoregulatory mediat ors can also be detected. These new techniques can provide a descripti on of intestinal immunity and inflammation, based on a non-invasive te st of 2-4 h duration. Work in progress shows that patients who respond clinically to elemental diet treatment have unusually high concentrat ions of soluble IL2 receptor in WGLF; cytokine profiles may facilitate the selection of patients suitable for other new treatment modalities .