UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of the medical management of mild to moderate Crohn disease in adults

Authors
Richard J Farrell, MD
Mark A Peppercorn, MD
Section Editor
Paul Rutgeerts, MD, PhD, FRCP
Deputy Editor
Shilpa Grover, MD, MPH

INTRODUCTION

Crohn disease is an inflammatory condition of unknown etiology that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. Its transmural inflammatory nature coupled with the variability of organ distribution gives rise to a spectrum of clinical presentations, each of which has to be considered separately in deciding upon the proper therapeutic approach. (See "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults".)

Numerous therapies are used for the treatment of Crohn disease. The choice of therapy will vary depending upon the anatomic location of disease, the severity of disease, and the goal of therapy (ie, induction or maintenance of remission). Medical therapies that are commonly used for Crohn disease include:

Oral 5-aminosalicylates (eg, sulfasalazine, mesalamine)

Antibiotics (eg, ciprofloxacin, metronidazole)

Conventional glucocorticoids (eg, prednisone)

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Jul 28 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Harvey RF, Bradshaw JM. A simple index of Crohn's-disease activity. Lancet 1980; 1:514.
  2. Vermeire S, Schreiber S, Sandborn WJ, et al. Correlation between the Crohn's disease activity and Harvey-Bradshaw indices in assessing Crohn's disease severity. Clin Gastroenterol Hepatol 2010; 8:357.
  3. Lichtenstein GR, Hanauer SB, Sandborn WJ, Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol 2009; 104:465.
  4. D'Haens G, Baert F, van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet 2008; 371:660.
  5. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med 2010; 362:1383.
  6. Nugent FW, Roy MA. Duodenal Crohn's disease: an analysis of 89 cases. Am J Gastroenterol 1989; 84:249.
  7. Ford AC, Kane SV, Khan KJ, et al. Efficacy of 5-aminosalicylates in Crohn's disease: systematic review and meta-analysis. Am J Gastroenterol 2011; 106:617.
  8. Tromm A, Bunganič I, Tomsová E, et al. Budesonide 9 mg is at least as effective as mesalamine 4.5 g in patients with mildly to moderately active Crohn's disease. Gastroenterology 2011; 140:425.
  9. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60:571.
  10. Travis SP, Stange EF, Lémann M, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: current management. Gut 2006; 55 Suppl 1:i16.
  11. Summers RW, Switz DM, Sessions JT Jr, et al. National Cooperative Crohn's Disease Study: results of drug treatment. Gastroenterology 1979; 77:847.
  12. Van Hees PA, Van Lier HJ, Van Elteren PH, et al. Effect of sulphasalazine in patients with active Crohn's disease: a controlled double-blind study. Gut 1981; 22:404.
  13. Sandborn WJ, Feagan BG, Lichtenstein GR. Medical management of mild to moderate Crohn's disease: evidence-based treatment algorithms for induction and maintenance of remission. Aliment Pharmacol Ther 2007; 26:987.
  14. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology 1984; 86:249.
  15. Benchimol EI, Seow CH, Steinhart AH, Griffiths AM. Traditional corticosteroids for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2008; :CD006792.
  16. Hanauer SB, Sandborn W, Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol 2001; 96:635.
  17. Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 2011; 106:590.
  18. Rutgeerts P, Löfberg R, Malchow H, et al. A comparison of budesonide with prednisolone for active Crohn's disease. N Engl J Med 1994; 331:842.
  19. Barrett KE, Dharmsathaphorn K. Pharmacological aspects of therapy in inflammatory bowel diseases: antidiarrheal agents. J Clin Gastroenterol 1988; 10:57.
  20. Perkal MF, Seashore JH. Nutrition and inflammatory bowel disease. Gastroenterol Clin North Am 1989; 18:567.
  21. Mishkin B, Yalovsky M, Mishkin S. Increased prevalence of lactose malabsorption in Crohn's disease patients at low risk for lactose malabsorption based on ethnic origin. Am J Gastroenterol 1997; 92:1148.
  22. Messori A, Brignola C, Trallori G, et al. Effectiveness of 5-aminosalicylic acid for maintaining remission in patients with Crohn's disease: a meta-analysis. Am J Gastroenterol 1994; 89:692.
  23. Steinhart AH, Hemphill D, Greenberg GR. Sulfasalazine and mesalazine for the maintenance therapy of Crohn's disease: a meta-analysis. Am J Gastroenterol 1994; 89:2116.
  24. Sutherland LR, Martin F, Bailey RJ, et al. A randomized, placebo-controlled, double-blind trial of mesalamine in the maintenance of remission of Crohn's disease. The Canadian Mesalamine for Remission of Crohn's Disease Study Group. Gastroenterology 1997; 112:1069.
  25. Prantera C, Pallone F, Brunetti G, et al. Oral 5-aminosalicylic acid (Asacol) in the maintenance treatment of Crohn's disease. The Italian IBD Study Group. Gastroenterology 1992; 103:363.
  26. Khan KJ, Ullman TA, Ford AC, et al. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol 2011; 106:661.
  27. Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis 2010; 4:28.
  28. Steinhart AH, Ewe K, Griffiths AM, et al. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2003; :CD000301.
  29. Selby L, Kane S, Wilson J, et al. Receipt of preventive health services by IBD patients is significantly lower than by primary care patients. Inflamm Bowel Dis 2008; 14:253.
  30. Sinclair JA, Wasan SK, Farraye FA. Health maintenance in the inflammatory bowel disease patient. Gastroenterol Clin North Am 2012; 41:325.
  31. Wasan SK, Baker SE, Skolnik PR, Farraye FA. A practical guide to vaccinating the inflammatory bowel disease patient. Am J Gastroenterol 2010; 105:1231.