Medical Therapy for Crohn’s Disease

Abstract

Antibiotics, probiotics, diets, and fecal transplant do not appear offer clinically significant benefit for treatment of Crohn's disease.• Exclusive enteral nutrition is beneficial in children but has not yet be shown to be of benefit in adults.• 5-Aminosalicylates are widely recognized to have role in treatement of mucosal ulcerative colitis, but have a very limited role in the treatment of CD. • Budesonide is efficacious for induction of clinical remission for CD patients when compared with placebo. • Systemic steroids are indicated for induction of remission, but not for maintenance of remission due to its side effects; steroid dependency is an indication for surgery. • Thiopurine and methotrexate monotherapy is not efficacious for induction of remission, but for maintenance of remission as a steroid-sparing agent; these medications are most commonly used in combination with biologics to decrease immunogenicity to the biologic agent. • Biologic agents are indicated for induction and maintenance of remission in patients with moderate-to-severe Crohn's disease. • Biosimilars present no differences in efficacy or safety compared to their originator compounds and have the advantage of lower cost. • Therapeutic drug monitoring (TDM) of drug levels and anti-drug antibodies (ADA) allows more precise management of patients with Crohn's disease. HistoryThe first case series describing regional enteritis was published in 1932 by a group of physicians at Mount Sinai Medical Center in New York City [1-3]. A senior surgeon, Dr. A.A. Berg, operated on 12 patients with terminal ileitis, and Drs. Leon Ginzburg and Gordon Oppenheimer wrote the initial manuscript. Of note, after Dr. Berg declined to be involved as a coauthor, Dr. Burrill Crohn was brought in as a third contributing author with two additional patients. At that time, the journal's publication policy was to order the authors alphabetically -thus Dr. Crohn was the first author, and regional enteritis subsequently became known as Crohn's disease, not Berg's disease, nor Ginzburg-Oppenheimer disease [3,4].