Fig. 16.2 (a, b) Retinal vasculitis and ischemia in a patient with Crohn’s disease. Observe cotton-wool spots and intraretinal hemorrhages. (c) Late phase of fluorescein

angiography shows staining of the retina vessels, areas of ischemia also observed in the color photographs and optic disk staining

Anti-tumor necrosis factor (TNF) monoclonal antibodies (infliximab, etanercept, adalimumab) have been proven effective to regulate the immune response in IBD and reestablish the antiinflammatory effects of T cells. They are particularly useful in patients with uveitis or scleritis that have been refractory to other types of treatment. Unfortunately, their use is limited by the high cost and high rate of reactions upon infusion (up to 20%), serious infections (particularly tuberculosis), and hypersensitivity reactions after multiple doses.

Other strategies include use of antibiotics for active infections, or agents such as metronidazole or ciprofloxacin, which have been shown to alter the intestinal flora and reduce inflammation. Nutritional therapies have also been shown to alter the immune response. They have been proven more useful for CD than UC.

Finally, nearly half the patients with extensive chronic UC undergo surgery within the first 10 years

of their illness. Many different surgical techniques are used dependent upon the extent and location of the inflammation, but this information is beyond the scope of this chapter.

Whipple’s Disease

Whipple’s disease is a rare, multisystemic chronic infectious disease that primarily involves the gastrointestinal tract and usually manifests as malabsorption, weight loss, diarrhea, and nondeforming seronegative polyarthralgias. It can manifest with extraintestinal involvement, compromising the central nervous system, lungs, heart, and eyes.

Whipple’s disease was first described by George Hoyt Whipple in 1907, but it was not until almost a century later that the causative organism and the pathogenesis of the disease