New approaches for inflammatory bowel disease

Abstract

To the Editor.—

We read with interest the article by Cotton¹that summarizes recent reports of promising new medical therapies for inflammatory bowel disease. We are concerned, however, that the author's enthusiasm about the use of such drugs as mesalamine, hydroxychloroquine sulfate, methotrexate, and cyclosporine appears to have limited him from sounding a note of caution concerning some of the risks of prolonged use of certain drugs for the treatment of ulcerative colitis. We recently reported our clinical experience with the surgical management of 177 consecutive patients with severe ulcerative colitis using the ileoanal pouch procedure.²By the time these patients underwent colectomy, 14 (8%) had developed adenocarcinoma of the colon or rectum. In two patients, such extensive carcinoma was found at operation that the endorectal ileal pull-through procedure could not be performed. Pathological changes, ranging from low-grade dysplasia to frank carcinoma, were present in 52 (29%) of