Inflammatory bowel disease--its history, current status and outlook.

In conclusion, it seems there has been a definite change in the epidemiology and course of IBD since earlier this century. Several points are worth emphasising: The diseases are relatively common, and there has been a general increase in their incidence, more so in some regions than others. The largest group affected is young adults, who will have their disease over several decades. This could potentially impact markedly on the workforce and on health care services. There is clearly a range of severity of this disease, and a greater number of mild cases have probably been diagnosed recently. This also helps to explain the differences in severity, need for surgery, and survival noted between community based studies and referral centre groups. Treatment has improved, particularly surgery (which usually takes place earlier on less critically ill patients), better operations, including continence surgery for most patients with UC and gut sparing procedures in Crohn's disease such as stricturoplasty. Medical management of acute disease has also improved which, in particular, has reduced mortality in elderly patients. Except for a subset of patients, life expectancy is close to normal, and time lost from the workforce, when considered in perspective over a working lifetime, is negligible. We can therefore be justifiably optimistic about the current long term outcome of IBD, and encourage our patients, their families and their employers to share in this outlook. With the promise of newer medical therapies on the horizon, prognosis may be further improved. Corticosteroids with little or no systemic side effects are currently in clinical trials and new anti-inflammatory agents are being examined for their efficacy through prostaglandin, leukotriene, or oxygen free-radical inhibition. Now that mortality from IBD is largely a thing of the past, we need to concentrate our attention more closely on the associated morbidity. It is to be hoped that future long term studies attempt the difficult clinical measurements of morbidity and quality of life.