Treatment of ulcerative colitis

Advances in the treatment of ulcerative colitis have continued to focus on improved local delivery of existing agents, such as 5-aminosalicylate and c orticosteroids, and on novel immunosuppressive agents. Although newer prepa rations of 5-aminosalicylate continue to provide incremental benefits in sa fety, tolerance, and efficacy, there is a growing understanding of the limi ts of benefit from increasing doses. Knowledge of the safety of these agent s, particularly in regard to their use in pregnancy, continues to expand. N ovel corticosteroids are used in much of the world for the treatment of ulc erative colitis, with the exception of the United States, with anticipated benefits in safety but little additional therapeutic benefit. Innovative us e of oral emulsion preparations of cyclosporine has been reported in the tr eatment of ulcerative colitis and adds to the growing body of literature on the efficacy of cyclosporine in severe disease. Relatively limited experie nce with other immunosuppressive agents, such as tacrolimus, has been repor ted. The role of antibiotics in the treatment of ulcerative colitis has con tinued to present controversy. (C) 1999 Lippincott Williams & Wilkins, Inc.