What is Crohn's disease?

From the Guidelines

Crohn's disease management should prioritize control of inflammation using medications and timely surgical interventions to alleviate symptoms of bowel damage, as stated in the most recent ECCO guidelines 1. The goal of treatment is to reduce inflammation, control symptoms, and improve quality of life.

• The standard regimen often begins with mesalamine or corticosteroids for mild to moderate cases, progressing to immunomodulators and biologics for more severe disease.
• Patients should maintain regular follow-ups with gastroenterologists, adhere to medication schedules, and consider dietary modifications to identify and avoid trigger foods.
• Surgery may be necessary if medications fail or complications like strictures, fistulas, or abscesses develop. According to the ECCO guidelines 1, contemporary therapy is focused on control of inflammation, using medications along with timely surgical interventions to alleviate the symptoms of bowel damage.
• The guidelines emphasize the importance of improving or completely resolving symptoms, improving or restoring quality of life, avoiding hospitalization, and promoting endoscopic mucosal healing whilst minimizing adverse events.
• The European Crohn’s and Colitis Organisation [ECCO] produces several guidelines aimed at providing evidence-based recommendations for the management of Crohn’s disease 1. It is essential to note that Crohn's disease has no cure, but proper management can lead to long periods of remission and improved quality of life, as highlighted in the ECCO guidelines 1 and other studies 1.
• The disease results from an abnormal immune response that mistakenly attacks beneficial gut bacteria, with genetic and environmental factors contributing to its development.
• Regular follow-ups and adherence to treatment plans are crucial to managing the disease and preventing complications.

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.
• The management of mild to moderate Crohn's disease is challenging because the natural history of mild disease is not known and effective treatment options are limited 3.

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, 4.
• Corticosteroids and high-dose budesonide were effective treatments for inducing remission in mild-to-moderate Crohn's disease 5.
• High-dose mesalamine is an option among patients preferring to avoid steroids 5.

Efficacy of Aminosalicylates

• Sulfasalazine has modest efficacy compared to placebo and is inferior to corticosteroids for the treatment of mild to moderately active Crohn's disease 4.
• Olsalazine and low dose mesalamine (1 to 2 g/day) are not superior to placebo 4.
• High dose mesalamine (3 to 4.5 g/day) is not more effective than placebo for inducing response or remission 4.

Maintenance Therapy

• Select patients with mild-to-moderate CD may benefit from maintenance therapy with azathioprines or gut specific biologics, such as vedolizumab 2.
• Although budesonide can be used in the short term (3-6 months) for maintenance of quiescent disease, there are no effective therapies for the long-term maintenance of mild to moderate Crohn's disease 3.