From the Guidelines
Treatment of Crohn's disease affecting the ileum and small intestine with normal bowel movements should start with budesonide 9 mg once daily for 8 weeks to induce remission, as recommended by the British Society of Gastroenterology consensus guidelines 1. This approach is supported by high-quality evidence, which shows that budesonide is effective in inducing clinical remission in patients with mild to moderate Crohn's disease limited to the ileum and/or ascending colon 1. The use of budesonide has a better safety profile compared to conventional steroids, with low systemic absorption and bioavailability, making it a preferred option for patients with Crohn's disease affecting the ileum and small intestine.
Some key points to consider when treating Crohn's disease include:
- The importance of inducing remission to reduce inflammation and prevent complications
- The use of anti-inflammatory drugs, such as mesalamine, as an alternative option for patients who cannot tolerate budesonide
- The role of immunomodulators, such as azathioprine, and biologic agents, such as adalimumab, in maintaining remission and managing moderate to severe disease
- The need for regular monitoring with blood tests and colonoscopies to assess disease activity and medication effectiveness
According to the ECCO guidelines on therapeutics in Crohn's disease, budesonide was superior to placebo for inducing clinical response and clinical remission in patients with mildly active CD in the small and/or large intestine limited to the ascending colon 1. Additionally, the British Society of Gastroenterology consensus guidelines recommend the use of budesonide for mild to moderate ileocaecal Crohn’s disease, with a strong recommendation and high-quality evidence 1.
Overall, the treatment of Crohn's disease affecting the ileum and small intestine with normal bowel movements should prioritize the use of budesonide to induce remission, with ongoing monitoring and adjustment of treatment as needed to maintain remission and prevent complications.
From the FDA Drug Label
RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy The recommended dose of RENFLEXIS is 5 mg/kg given as an intravenous induction regimen at 0,2 and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter for the treatment of adults with moderately to severely active Crohn's disease or fistulizing Crohn's disease
The treatment for Crohn's disease affecting the ileum and small intestine with normal bowel movements is infliximab (IV), with a recommended dose of 5 mg/kg given as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks 2.
- Key points:
- Infliximab (IV) is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease.
- The recommended dose is 5 mg/kg given as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks.
From the Research
Treatment of Crohn's Disease Affecting the Ileum and Small Intestine
- Crohn's disease is characterized by recurrent transmural inflammation of the gastrointestinal tract, most commonly the terminal ileum and the colon 3.
- The goal of therapy is to break the cycle of inflammation by inducing and maintaining remission.
Normal Bowel Movements
- Normal bowel movements are not directly addressed in the provided studies, but the studies focus on the treatment of Crohn's disease, which can affect bowel movements.
Treatment Options
- Budesonide, a potent corticosteroid, has been demonstrated to be a safer alternative to conventional corticosteroids and of proven efficacy in the induction of remission in mild to moderate Crohn's disease 3.
- Azathioprine is superior to budesonide in achieving and maintaining mucosal healing and histologic remission in steroid-dependent Crohn's disease 4.
- Infliximab, azathioprine, or combination therapy can be effective for Crohn's disease, with combination therapy showing the best results in achieving corticosteroid-free clinical remission 5.
- First-line therapies for inflammatory bowel disease include 5-aminosalicylates, budesonide, systemic steroids, azathioprine, and biologics such as infliximab and adalimumab 6.
- The optimal management approach for Crohn's disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making 7.
Complications and Side Effects
- Uncontrolled inflammation can lead to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia 7.
- Adverse reactions to therapy include antibody formation and infusion reactions, infections, and cancers associated with immune modulators and biologics 7.
- Both Crohn's disease and corticosteroid use are associated with osteoporosis 7.