title: Medical management of Crohn's disease.
abstract: BACKGROUND
  The medical approach to Crohn's disease has been modified in recent years thanks to the introduction of new therapies, like biologics. Also, well-designed studies and systematic reviews have allowed better evaluation of the role of old drugs like steroids and immunosuppressors. This review aims to evaluate the recent evidence on the medical approach to Crohn's disease in the different settings of the disease.
  
  
  METHODS
  Randomized controlled trials and meta-analyses were included in the review. The research on all the studies discussed was based on the Cochrane Library, Medline and Embase, using the following medical subject headings: Crohn's disease, clinical trial, therapy, 5-aminosalicylic acid, steroid, budesonide, immunosuppressant, anti-meta-analysis TNF and biologics.
  
  
  CONCLUSIONS
  In a mild active inflammatory ileocecal disease, budesonide is considered the best approach. The efficacy of aminosalicylates is limited, but a trial that has recently compared aminosalicylates and budesonide has shown that the two drugs are comparable. In a mild colonic disease, sulfasalazine, antibiotics and steroids are effective but the evidence for antibiotics is less clear. The maintenance of remission in this setting is debatable, but sulfasalazine seems the better choice. In a moderate severe ileal and colonic disease, steroids are the best therapy to induce remission. Once remission is reached, immunosuppressors remain today the better choice to maintain the remission. Anti-TNF therapy is indicated in patients intolerant or not responding to steroids and immunosuppressors and in fistulizing Crohn's disease. Early therapy with biologics may be considered in patients with severe disease.
authors: University of Palermo, Villa Sofia-V. Cervello Hospital, Division of Internal Medicine, DI.BI.MIS, Via Trabucco 180, 90146, Palermo, Italy.
authors: Mario
authors: M
authors: Cottone
authors: Sara
authors: S
authors: Renna
authors: Ambrogio
authors: A
authors: Orlando
authors: Filippo
authors: F
authors: Mocciaro
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000636:Aminosalicylic Acids / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D019819:Budesonide / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007422:Intestines / Q000601:surgery; D008727:Methotrexate / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D012074:Remission Induction; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000636:Aminosalicylic Acids; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001688:Biological Products; D007166:Immunosuppressive Agents; D011687:Purines; D014409:Tumor Necrosis Factor-alpha; D019819:Budesonide; D008727:Methotrexate