A. Dignass – författare

In spite of significant scientific progress in recent years, the aetiopathogenesis of chronic inflammatory bowel diseases (IBD) remains elusive. With a prevalence of 1:700 to 1:500 in central Europe, both diseases are not rare. However, most physicians will generally treat only a few patients with IBD in their clinical practice. Because of this limited experience and the variety of clinical IBD manifestations, IBD patients are frequently treated in specialized tertiary care centres. Nevertheless, IBD patients will also consult less specialized general practitioners, who will not be able to focus extensively on the management of IBD patients due to time constraints. Physicians who take care of IBD patients have to select among an ever-increasing amount of new scientific information in order to provide optimal and up-to-date care to their patients. In the era of evidence-based medicine it is often under debate whether evidence-based medicine may really improve the management of IBD patients or whether the diversity and complexity of IBD needs an individual and patient-oriented approach.This book, the proceedings of the Falk Symposium 134 on 'Trends and Controversies in IBD - Evidence-Based Approach or Individual Management', held in Berlin, Germany, on 12-13 June 2003, critically discusses established and emerging new concepts in the field of IBD. It critically analyzes evidence-based and individual approaches in the management of IBD and discusses these approaches with the help of selected case reports.

The topical glucocorticoid budesonide has long been well known in the medical community because of its beneficial effects in the treatment of chronic obstructive pulmonary diseases. Budesonide is characterized by a high first-pass effect and a rapid metabolism in the liver resulting in low systemic bioavailability and reduced frequency of side-effects compared to conventional glucocorticoids. For about a decade, budesonide has been used by gastroenterologists, and it has been proven especially effective in the treatment of distal ulcerative colitis and ileocolonic Crohn's disease in a number of randomized controlled clinical studies. In recent years, budesonide has also been successfully used in the management of other diseases in the field of gastroenterology, hepatology, surgery and oncology. This book, the proceedings of a Falk Workshop on 'Topical Steroids in Gastroenterology and Hepatology', held in Berlin, Germany, on 14 June 2003, critically discusses the current role of budesonide in gastroenterology, hepatology, surgery and oncology and focuses especially on potential new indications for the use of budesonide.A number of smaller clinical studies and anecdotal case reports with impressive clinical effects are reported in patients with gastrointestinal, hepatic, oncological and surgical problems. In addition, the use of budesonide for the treatment of distal ulcerative colitis and ileocolonic Crohn's disease is evaluated with respect to its role in an evidence-based management of IBD. Finally, as clinical experience with the use of budesonide is increasing, safety issues and the side-effect profile of budesonide is addressed.

Significant scientific progress has been made in recent years in the aetiopathogenesis of chronic inflammatory bowel diseases (IBD), that has changed or will change in the future the diagnostic and therapeutic approach in these diseases.