Fast Five Quiz: Test Yourself on Crohn Disease

Jamie Shalkow, MD

Disclosures

March 13, 2017

Therapy for mild Crohn disease is typically administered in a sequential "step-up" approach, in which less aggressive and less toxic treatments are indicated first, followed by more potent medications or procedures when appropriate.

For the treatment of moderate to severe Crohn disease, current recommendations include the "top-down" approach, which differs from the conventional step-up approach in that more potent agents are administered initially. Top-down therapies include biologic agents and steroids as needed vs combination therapy with both biologic drugs and immunomodulator agents.

If medical therapy for active Crohn disease fails, surgical resection of the inflamed bowel with restoration of continuity is indicated. Urgent surgery may be required in rare cases of sustained or recurrent hemorrhage, bowel ischemia, perforation, peritonitis, fistulae, and toxic megacolon. Localized abscesses may be treated with percutaneous drainage, plus bowel rest and broad-spectrum antibiotics. Outcomes are better when medical and surgical therapies are used in conjunction.

Sulfasalazine is useful mainly in colonic disease. It does not alleviate small-bowel disease, and has no additive or steroid-sparing effect when used in combination with corticosteroids. In addition, as opposed to its usefulness in ulcerative colitis, sulfasalazine seems not to maintain prolonged remissions in patients with Crohn disease.

For more on the treatment of Crohn disease, read here.

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