الفهرس 
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Abstract
IBDs are chronic inflammatory conditions affecting the digestive system. The two most common forms of inflammatory bowel diseases are ulcerative colitis (UC), which affects only the colonic mucosa, and Crohn’s disease (CD), which can segmentally, affects the entire digestive tract.
Inflammatory bowel diseases are related to an immunological imbalance of the intestinal mucosa, mainly associated with cells of the adaptive immune system, which respond against self-antigens producing chronic inflammatory conditions in these patients. UC and CD are the most studied types of inflammatory bowel diseases, having the highest prevalence in the world population. The pathophysiological mechanisms of inflammatory bowel diseases are not fully understood, although these diseases have been discovered several decades ago.
It is widely known that the number of bacteria in the gastrointestinal tract is about 10 times higher when compared to eukaryotic cells in the body. Also, the normal enteric bacterial flora is a complex ecosystem of approximately 300–500 bacterial species. Moreover, the balance of the innate and adaptive immunity is critical for this microenvironment homeostasis. In this sense, the immune system has the important role of promoting immune tolerance, thereby avoiding the specific immune response against the large mass of commensal bacteria. The local immunity in intestinal mucosa is basically ensured by gut associated lymphoid tissue, constituted by Payer’s patches, lymphoid follicles, and mesenteric lymph node.
Recently, an exaggerated immune response is thought to contribute to disease; thus, agents referred to as “biologic therapy” have been developed to diminish this immune activity. Biologic agents attempt at altering the natural course of inflammatory bowel diseases by aiding in steroid withdrawal while preserving disease remission.
Biologic therapies, or “biologics,” are a relatively new form of treatment for people with moderate-to-severe inflammatory bowel diseases. These medications contain living organisms called antibodies developed in a laboratory to specifically target and interfere with the process of inflammation that inflammatory bowel diseases cause. by reducing inflammation at its source.
This is why this study was selected to be conducted to compare the effectiveness and safety of Steroids, 5’ASA, immunosuppressive, Infliximab and adalimumab in patients with Ulcerative colitis or Crohn’s disease.
This was cross sectional, multi central study was conducted, including 174 patients who received 5’ASA and/or Azathioprine (Imuran) with steroid, infliximab or adalimumab for treatment of Ulcerative colitis or Crohn’s disease at multiple centers in Egypt. The duration of the study ranged from 1-24months.
Patients were classified into the following groups according to treatment regimen: • group I: 58 patients who received steroid with 5’ASA • group II: 42 patients who received Azathioprine with 5’ASA • group III: 52 patients who received infliximab • group IV: 22 patients who received adalimumab.