The cause of Ulcerative colitis (UC) is still unknown. However, the concept that it may be provoked by changes in the bacteria in the intestine, which trigger off a cascade of events leading first to inflammation in the lining of the gut wall and then to inflammation in more distant tissues appears to remain valid.
This means that there is considerable potential for new research and treatment. Future work will focus on manipulation of bacteria in the bowel and the dissection of the immune response in order to provide agents, which block its development.
Already monoclonal antibodies exist against TNF-a and a-integrins and these are now increasingly used in the management of refractory colitis. Drugs are being developed against NF-KB, an intracellular metabolite which initiates much of the inflammatory process. The value of other compounds such as, Etanercept, Thalidomide, Tacrolimus and Mycophenolate mofetil is being evaluated; new compounds continue to emerge.
The outlook is extremely encouraging.