From the Guidelines
Crohn colitis should be treated with a focus on controlling inflammation and preventing bowel damage, using medications such as anti-inflammatory agents, immunomodulators, and biologic therapies, as recommended by the most recent ECCO guidelines 1.
Treatment Approach
The treatment approach for Crohn colitis typically involves a step-up strategy, starting with mild cases and progressing to more severe cases.
- For mild to moderate flares, anti-inflammatory medications like mesalamine (1-4g daily) or corticosteroids such as prednisone (40mg daily, tapered over 8-12 weeks) may be used 1.
- For maintenance therapy, immunomodulators like azathioprine (2-2.5mg/kg/day) or 6-mercaptopurine (1-1.5mg/kg/day) are often used.
- In moderate to severe cases, biologic agents including anti-TNF medications (infliximab 5mg/kg at weeks 0,2, and 6, then every 8 weeks; adalimumab 160mg initially, 80mg at week 2, then 40mg every other week), anti-integrins (vedolizumab), or IL-12/23 inhibitors (ustekinumab) may be necessary.
Disease Monitoring and Nutritional Support
Patients with Crohn colitis should maintain regular follow-up appointments for disease monitoring, including colonoscopies every 1-3 years to assess mucosal healing and screen for dysplasia.
- Nutritional support is important, with a diet low in insoluble fiber during flares and adequate hydration.
- The goal of treatment is to control inflammation, prevent bowel damage, and improve quality of life, as outlined in the ECCO guidelines 1.
Key Differences from Ulcerative Colitis
Crohn colitis differs from ulcerative colitis in that it can affect any part of the digestive tract in a discontinuous pattern and may involve deeper layers of the intestinal wall, leading to complications like strictures, fistulas, and abscesses that may require surgical intervention if medical management fails.
- The treatment approach for Crohn colitis is often more complex and may require a combination of medications and surgical interventions, as recommended by the ECCO guidelines 1.
From the Research
Definition and Management of Crohn's Disease
- Crohn's Disease (CD) is a chronic inflammatory disease that can lead to progressive damage to the gastrointestinal tract and significant disability 2.
- Early, "top-down" biologic therapy is recommended in moderate-to-severe CD to induce remission and to prevent hospitalization and complications 2.
Treatment Options for Crohn's Disease
- For ambulatory outpatients with low-risk, mild, ileal or ileocolonic CD, induction of remission with budesonide is recommended 2.
- For colonic CD, sulfasalazine is a reasonable choice, although other aminosalicylates have no role in the treatment of CD 2.
- Select patients with mild-to-moderate CD may benefit from maintenance therapy with azathioprines or gut-specific biologics, such as vedolizumab 2.
- Infliximab, azathioprine, or combination therapy can be effective for Crohn's disease, with combination therapy showing higher rates of corticosteroid-free clinical remission 3.
Comparison with Ulcerative Colitis
- While Crohn's disease and ulcerative colitis (UC) are both inflammatory bowel diseases, their treatment approaches differ 4, 5.
- Optimized 5-ASA is the first-line treatment in all clinical guidelines for UC, but may not be sufficient to induce remission in all patients 4.
- Corticosteroids, such as budesonide MMX®, can be used as second-line therapy for UC 4.
Patient-Centered Care and Risk Stratification
- Patient-centered care, such as the iSTART approach, can provide benefits to patients and healthcare systems by allowing patients to self-assess symptomology and self-start treatment when necessary 4.
- Risk stratification is important in Crohn's disease, with patients at high risk of disease progression requiring more aggressive treatment 6.
- Effective control of inflammation reduces the risk of penetrating complications, although more than half of patients will develop complications that require surgery 6.