Inflammatory bowel disease (IBD), classified as a global disease in the 21st century, comprises Crohn's disease (CD) and ulcerative colitis (UC), and is manifested by chronic inflammation of the gastrointestinal tract of unknown etiology. The step-up approach is effective for inducing remission and controlling inflammation, whereas the top-down therapy appears to be a better solution for the maintenance of remission with an improved bowel function. A systematic search was performed in Ovid MEDLINE and Embase (1946-December 2018) to identify relevant trials that support medication therapy in IBD. Thirty-nine potential trials were retrieved, of which 29 focused on CD, and 10 studied UC. There is mounting evidence on both benefits and disadvantages in the application of early initiation of top-down therapy in suitably selected patients. Nevertheless, there are uncertainties about the appropriateness of these approaches for the management of IBD and there are conflicting results in overall outcomes including mucosal healing and rehospitalization. The choice of either top-down or step-up therapy in the treatment of IBD should be an individualized approach and cannot be recommended as a part of a generalized guideline. Further prospective studies are warranted to determine whether combination therapy or aggressive therapy is superior to monotherapy.

Item Type:	Refereed Article
Keywords:	Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Step-up therapy; Top-down therapy; Gastrointestinal disorders
Research Division:	Biomedical and Clinical Sciences
Research Group:	Pharmacology and pharmaceutical sciences
Research Field:	Clinical pharmacy and pharmacy practice
Objective Division:	Health
Objective Group:	Clinical health
Objective Field:	Clinical health not elsewhere classified
UTAS Author:	Salahudeen, MS (Dr Mohammed Salahudeen)
ID Code:	134814
Year Published:	2019
Web of Science® Times Cited:	1
Deposited By:	Pharmacy
Deposited On:	2019-09-06
Last Modified:	2020-03-11
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