Medical management of Crohn's disease

doi:10.1136/bmj.39547.603218.AE

BMJ 2008;336:1062-1066 (10 May), doi:10.1136/bmj.39547.603218.AE

Clinical Review

Medical management of Crohn’s disease

J R Fraser Cummings, specialist registrar, Satish Keshav, consultant gastroenterologist, Simon P L Travis, consultant gastroenterologist

¹ Gastroenterology Unit, John Radcliffe Hospital, Oxford OX3 9DU

Correspondence to: S P L Travis simon.travis@ndm.ox.ac.uk

The first 150 words of the full text of this article appear below.

Summary points

Biological therapies have radically changedthe management of Crohn’s disease but must be used judiciouslywith great awareness of possible adverse events

Treatment strategiesfor the disease are rapidly evolving, with immunomodulator andbiological therapy being considered in patients who have indicatorsfor developing early severe disease

Clinical indicators ofa poor prognosis (at diagnosis) include perianal or stricturingdisease, weight loss >5 kg, or the need for steroids

Treatmentof active disease with mesalazine is little better than placebo;mesalazine is used mainly to reduce the risk of relapse aftersmall intestinal resection

Access to specialist services, parallelmedical and surgical clinics, nurse specialists, dietitians,pharmacists, and other allied professionals is as importantas the medication

Publication of standards of care should driveimprovement in the care and provision of resources for patientswith Crohn’s disease

Crohn’s disease is a chronic, relapsing and remittinginflammatory condition of the gastrointestinal . . . [Full text of this article]

How common is Crohn’s disease?

How does Crohn’s disease present?

When to refer to a specialist

Box 1 Investigation of suspected inflammatory bowel diseasein primary care

What are the treatment objectives?

What are the treatment options?

Mesalazine
Corticosteroids
Antibiotics
Biological therapy and immunomodulators

When should biological therapies be used?

Are we using biological therapies at the correct time in the disease course?

How can biological therapies and immunomodulators be used safely?

Side effects
Opportunistic infections and malignancy
Checks prior to starting anti-TNF ${alpha}$ therapy
Box 2 Relative or absolute contraindications to anti-TNF ${alpha}$ therapy:the STOIC acronym

Surgery

New approaches to treatment

Conclusions

Methods box
Ongoing research
Additional educational resources
For healthcare professionals
For patients
Tips for non-specialists

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Non-invasive markers in Crohn�s: Mohammed A Butt, et al.
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Antibodies in inflammatory bowel disease: Mohammed A Butt, et al.
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Crohn's disease: GEORGE Y CALDWELL, et al.
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Remember lymphogranuloma venereum: Kinesh P Patel, et al.
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