title: How early to take arms against a sea of troubles? The case for aggressive early therapy in Crohn's disease to prevent fibrotic intestinal strictures.
abstract: While potent anti-inflammatory medications have reduced the symptoms of Crohn's disease, more than 60% of patients eventually require surgery due to the development of fibrosis. Even after the introduction of biologic drugs, the population-based rate of surgery for Crohn's disease has not decreased. We suspect this is due to late initiation of these therapies, after the fibrosis cascade is unstoppable. We review the evidence that suggests early aggressive therapy is beneficial, especially in patients diagnosed before age 40, and with ileal or perianal disease. Patients with symptomatic strictures may benefit from early surgery (before penetrating complications) followed by initiation of biologics. With increased early use of biologics and better control of inflammation, we hope to see a global reduction in intestinal fibrosis and related complications of Crohn's disease.
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, United States.
authors.forename: Shail M
authors.initials: SM
authors.lastname: Govani
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Stidham
authors.forename: Peter D R
authors.initials: PD
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007415:Intestinal Obstruction / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents
keywords: CD; Crohn's Disease; Crohn's disease; Fibrosis; Fibrostenotic disease; Strictures; Top-down therapy