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Maximizing the efficacy of IBD-directed therapies while minimizing their toxicity remains the principal objective in developing management strategies for all IBD patients. Maintaining good quality of life and adherence to therapies are also important considerations. Moreover, maximizing both physical and psychosocial growth during the most dynamic phase of a child's development truly highlights the importance of optimizing the management of children with IBD. An optimal treatment strategy requires the implementation of a single medication or combination thereof that both induce a state of remission and maintain the disease in a quiescent state long-term with minimal safety concerns. To date no single therapy meets the criteria of “the ideal IBD therapy”. Corticosteroids remain the mainstay for effective induction therapies in the short term for patients with moderate to severe disease activity given their rapid onset of action and proven efficacy. However the unacceptable safety profile, in particular its negative effect on growth in children and reported natural history of steroid resistance and dependence renders corticosteroids an undesirable maintenance therapy (1,2). A pivotal study by Markowitz et al demonstrated that the combination of prednisone and 6-mercaptopurine (6-MP) in newly diagnosed pediatric Crohn's disease was very effective in both the induction and maintenance of disease remission (3). The steroid sparing advantage of this combination regime is what exemplifies this management strategy as an important part of the therapeutic approach to pediatric IBD patients.

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Controversies in IBD
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