title: An update on medical management on Crohn's disease.
abstract: BACKGROUND
  The management of Crohn's disease (CD) is continuously evolving. New issues emerging from more recent studies could influence the decision-making process in clinical practice.
  
  
  METHODS
  The aim of this review article is to highlight critical issues on the management of CD, new evidence from clinical trials, long-term prospective studies and real life experience, beyond the current guidelines.
  
  
  CONCLUSIONS
  The role of mucosal healing in clinical practice is uncertain, clinical remission remains the primary end point. The timing for the definition of steroid-resistant CD should be considered between 2 and 4 weeks. Early treatment strategy with immunomodulators is effective for inducing remission but no controlled data are available regarding long-term outcome. Combination therapy (anti-TNFs agents and immunosuppressors) is more effective than single therapy but there is a lack of long-term data and an increased risk of malignancy. The effect of mesalazine, metronidazole and azathioprine in reducing postoperative recurrence is not clinically relevant; biologics are effective, but the duration of treatment is unknown. New drugs are under investigation in order to find exit strategy for patients who no longer respond to biologics. Combination therapy set on anti-TNF-α is until now the best option both to achieve fistula healing and avoid recurrence.
authors.affiliation: University of Palermo, Ospedali Riuniti Villa-Sofia Cervello, Department of Internal Medicine , via trabucco, 180, Palermo , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Affronti
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.forename: Mario
authors.initials: M
authors.lastname: Cottone
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003424:Crohn Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000276:Adjuvants, Immunologic; D001688:Biological Products; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Crohn’s disease; aminosalicylates; anti-TNFs; antibiotics; combotherapy; corticosteroids; early treatment; immunosuppressants; mucosal healing; new drugs; recurrence; steroid resistance