Heritage small molecule immunosuppressants and the immune-acting biologics have a major place in the management of luminal gastrointestinal disease and especially so in inflammatory bowel disease. This narrative review considers their current use, concentrating on issues not already well addressed in the literature. An evidence-based approach is taken, supplemented by advice based on observations from clinical practice when data are missing. There is a general trend towards earlier use of the biologics for perceived greater safety and impact on disease modification, despite their substantially greater cost and systemic administration. Early semi-prophylactic treatment is now considered for patients with high-risk Crohn's disease. In other conditions the immune active agents remain a back-up for those failing to respond to simpler options. There are few and mostly unimportant differences between the different antibodies to TNFα, but it is beginning to be possible to identify patients who could be preferentially treated with an anti-integrin approach or by addressing other cytokines.

传统小分子免疫抑制剂和免疫作用生物制剂在管腔胃肠疾病的治疗中占有重要地位，尤其是在炎症性肠病中。这篇叙述性评论考虑了它们目前的用途，重点关注文献中尚未很好解决的问题。当数据缺失时，采用基于证据的方法，并辅以基于临床实践观察的建议。尽管生物制剂的成本和全身给药显着增加，但总体趋势是更早地使用生物制剂以获得更高的安全性和对疾病改变的影响。现在考虑对高危克罗恩病患者进行早期半预防性治疗。在其他情况下，免疫活性剂仍然是那些无法对更简单的选择做出反应的人的后备。