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 changed the management of Crohn’s disease but must be used judiciously with great awareness of possible adverse events
Treatment strategies for the disease are rapidly evolving, with immunomodulator and biological therapy being considered in patients who have indicators for developing early severe disease
Clinical indicators of a poor prognosis (at diagnosis) include perianal or stricturing disease, weight loss >5 kg, or the need for steroids
Treatment of active disease with mesalazine is little better than placebo; mesalazine is used mainly to reduce the risk of relapse after small intestinal resection
Access to specialist services, parallel medical and surgical clinics, nurse specialists, dietitians, pharmacists, and other allied professionals is as important as the medication
Publication of standards of care should drive improvement in the care and provision of resources for patients with Crohn’s disease


Crohn’s disease is a chronic, relapsing and remitting inflammatory 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 disease in 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

Rapid Responses:

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GEORGE Y CALDWELL, et al.
bmj.com, 14 May 2008 [Full text]

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