Introduction

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon affecting mainly young people, with a peak incidence between the ages of 10 and 40 years; 15% of patients are over the age of 60 at diagnosis. Its incidence is approximately 10-20 per 100 000 per year with a reported prevalence of 100-200 per 100 000 and is stable over time. The value of prevalence is less reliable, but it is probably underestimated because it implies an average disease duration of 10 years for a condition that is known to last for life [1]. A hospital serving a population of 300 000 will typically see 45-90 new cases per year and have 500 under follow-up.

Patients find symptoms of UC and CD embarrassing and humiliating. Inflammatory bowel diseases (IBD) can result in loss of education and difficulty in gaining employment or insurance [2]. It can also cause psychological problems, growth failure or a retardation in the sexual development of young people. Medical treatments with corticosteroids or immunosuppressants may cause major health problems, and surgery may result in complications such as impotence or intestinal failure. There is only a small increase in mortality for both UC (hazard ratio 1.44) and CD (hazard ratio 1.73), largely dependent on age and extension of the disease [3]. However, even if some patients have only functional symptoms (which are not in themselves an indication to potentiate the treatment and which may benefit from symptomatic drugs such anti-diarrheals, antispasmodics or fibres), the impact of IBD on society is disproportionately high, as presentation often occurs at a young age and has a potential to cause lifelong illness.

These considerations explain the peculiar expectations that patients with inflammatory bowel diseases have concerning both the pharmacological treatment and the overall clinical management. These considerations and their rationale have been summarised in recent clinical guidelines by the British Society of Gastroenterology, and reported in Table 1 [4].

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