Abstract
Crohn’s disease (CD) is characterized by patchy, transmural inflammation that may affect any part of the gastrointestinal tract. It may be defined by location (distal ileum, colonic, ileocolic, upper gastrointestinal) or by pattern of disease (inflammatory, fistulizing, or stricturing). Both these aspects have been combined in the Vienna classification. CD may cause intestinal obstruction due to strictures, fistulae (often perianal), or abscesses, and the clinical course of the disease is characterized by exacerbations and remission. Therapy for inflammatory bowel disease (IBD) is a rapidly evolving field, with the many new biological agents under investigation likely to change therapeutic strategies in the future. The general approach for treating active CD must consider the degree of activity, location, and behavior of the disease, including its course, response to previous medications, side effects of medication, and possible presence of extraintestinal manifestations). In this chapter, the principal drugs employed as a first-line treatment are discussed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Sandborn WJ, Hanauer SB (2003) Systematic review: the pharmacokinetic profiles of oral mesalazine formulations and mesalazine prodrugs used in the management of ulcerative colitis. Aliment Pharmacol Ther 17:29–42
Prantera C, Cottone M, Pallone F et al (1999) Mesalamine in the treatment of mild to moderate active Crohn’s ileitis: results of a randomized multicenter trial. Gastroenterology 116:521–526
Lochs H, Mayer M, Fleig WE et al (2000) Prophylaxis of post-operative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s Disease Study VI. Gastroenterology 118:264–273
van Staa T P, Travis S P L, Leufkens H J M et al (2004) 5-aminosalicylic acids and the risk of renal disease: a large British epidemiological study. Gastroenterology 126:1733–1739
Franchimont D, Kino T, Galon J et al (2003) Glucorticoids and inflammation revisited: the state of the art. Neuro immunomodulation 10:247–260
Summers RW, Switz DM, Sessions JT et al (1979) National co-operative Crohn’s disease study group: results of drug treatment. Gastroenterology 77:847–869
Steinhart AH, Ewe K, Griffiths AM et al (2001) Corticosteroids for maintaining remission of Crohn’s disease. Cochrane Database Syst Rev (3) CD000301
Sandborn W, Sutherland L, Pearson D et al (2000) Azathioprine or 6-mercaptopurine for inducing remission of Crohn’s disease. Cochrane Database Syst Rev (2): CD000545
Lemann M, Bouhnik Y, Colombel J et al (2002) Randomized, double-blind, placebo-controlled, multicentre, azathioprine withdrawal trial in Crohn’s disease. Gastroenterology 122:A23
Colombel JF, Ferrari N, Debuysere H et al (2000) Genotypic analysis of thiopurine S-methyltransferase in patients with Crohn’s disease and severe myelosuppression during azathioprine therapy. Gastroenterology 118:1025–1030
Fraser AG (2003) Methotrexate: first or second-line immunomodulator? Eur J Gastroenterol Hepatol 15:225–231
Alfadhli AA, McDonald JW, Feagan BG (2003) Methotrexate for induction of remission in refractory Crohn’s disease (Cochrane Review). Cochrane Database Syst Rev (1):CD003459
Feagan BG, Fedorak RN, Irvine EJ et al (2000) A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. North American Crohn’s Study Group Investigators. N Engl J Med 342:1627–1632
Feagan BG, McDonald JW, Rochon J et al (1994) Low-dose cyclosporine for the treatment of Crohn’s disease. The Canadian Crohn’s Relapse Prevention Trial Investigators. N Engl J Med 330:1846–1851
Feagan BG (1995) Cyclosporin has no proven role as a therapy for Crohn’s disease. Inflamm Bowel Dis 1:335–339
Egan LJ, Sandborn WJ, Tremaine WJ (1998) Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn’s disease with intravenous cyclosporine. Am J Gastroenterol 93:442–448
Sandborn WJ, Present DH, Isaacs K L et al (2003) Tacrolimus for the treatment of fistulas in patients with Crohn’s disease. Gastroenterology 125:380–388
Sasaki M, Sitaraman SV, Babbin BA et al (2007) Invasive Escherichia coli are a feature of Crohn’s disease. Lab Invest 87:1042–1054
Prantera C, Scribano ML (2009) Antibiotics and probiotics in inflammatory bowel disease why, when, and how. Curr Opin Gastroenterol 25:329–333
Prantera C, Zannoni F, Scribano M L et al (1996) An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol 91:328–332
Prantera C, Lochs H, Campieri M et al (2006) Antibiotic treatment of Crohn’s disease: results of a multicentre, double-blind, randomized, placebo-controlled trial with rifaximin. Aliment Pharmacol Ther 23:1117–1125
Stange EF, Travis SPL, S Vermeire S et al for the European Crohn’s and Colitis Organisation (ECCO) (2006) European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis Gut 55 (Supplement 1): i1–i15
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Italia
About this chapter
Cite this chapter
Mangiarotti, R. (2010). Standard Therapeutic Approach. In: Tersigni, R., Prantera, C. (eds) Crohn’s Disease. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-1472-5_11
Download citation
DOI: https://doi.org/10.1007/978-88-470-1472-5_11
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-1471-8
Online ISBN: 978-88-470-1472-5
eBook Packages: MedicineMedicine (R0)