Medical Management of Crohn's Disease

Feldman, P. A.; Wolfson, Daniel; Barkin, Jamie S.

doi:10.1055/s-2007-991026

Cited by 14 publications

(13 citation statements)

References 139 publications

(182 reference statements)

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“…83 Onset of action is within 8 to 16 weeks. 97 Side effects are not uncommon with the use of MTX. In one study, MTX was discontinued in 17% of patients as a result of adverse effects.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Crohn Disease: Epidemiology, Diagnosis, and Management

Feuerstein

Cheifetz

2017

Mayo Clinic Proceedings

408

316

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Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications.

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“…83 Onset of action is within 8 to 16 weeks. 97 Side effects are not uncommon with the use of MTX. In one study, MTX was discontinued in 17% of patients as a result of adverse effects.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…When taking MTX, concomitant administration of daily folic acid is recommended. 97 Similar to thiopurines, MTX appears to be associated with an increased risk of both nonmelanoma skin cancer and lymphoma. 98,99 In addition, MTX is contraindicated during pregnancy because it is both an abortifacient and teratogenic.…”

Section: Corticosteroidsmentioning

confidence: 99%

Crohn Disease: Epidemiology, Diagnosis, and Management

Feuerstein

Cheifetz

2017

Mayo Clinic Proceedings

408

316

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“…Feldman et al conducted research on how to treat CD [ 57 ]. The fact that the major causes of CD have remained unknown has hindered the development of strategies and treatments for the disease.…”

Section: Reference Reviewsmentioning

confidence: 99%

A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease

2019

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Ulcerative colitis (UC) and Crohn’s disease (CD) are classified as chronic inflammatory bowel diseases (IBD) which have similar symptoms and lead to digestive disorders and inflammation in the digestive system. The reason why they occur is still a mystery. A number of factors can be attributed to the prevalence of CD and UC, some of which include geographical location, inappropriate diet, genetics, and inappropriate immune response. Both diseases are more often diagnosed in urban areas compared to rural areas and both have their own challenges and side effects, but the patients can still have a good quality of life. Given the fact that the prevalence of this disease is higher at younger ages and that it disrupts half the life of the patient, it will, most likely, become a major health problem in the near future, even in developing countries. By reviewing valid scientific resources and evaluating new methods of addressing this disease, the present study aims to provide researchers and patients with new insights into this field and facilitate access to new treatments.

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“…Oral prednisolone is usually started at 40 mg daily, and titrated up for clinical response for up to 12 wk[18] with commencement of immunomodulators or biological agents. As immunomodulators take up to 16 wk for response, some definitions of failed therapy suggest ongoing symptoms and signs despite medical therapy for up to 16 wk.…”

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

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Medical Management of Crohn's Disease

Cited by 14 publications

References 139 publications

Crohn Disease: Epidemiology, Diagnosis, and Management

Crohn Disease: Epidemiology, Diagnosis, and Management

A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

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