Current Treatment Options in Gastroenterology

, Volume 3, Issue 1, pp 59-68

First online:

Crohn’s disease of the small intestine

  • Robert BurakoffAffiliated withSection of Gastroenterology, Washington Hospital Center

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Opinion statement

  • Crohn’s disease of the small intestine is a chronic relapsing disease that requires all the knowledge and ingenuity of the gastroenterologist to successfully treat the disease and the patient.

  • For mild to moderate disease, the first line of therapy is to utilize maximum doses of mesalamine to achieve a remission.

  • If the patient relapses, the maximum dose of mesalamine required to achieve remission should be continued.

  • If the disease relapses despite maximum mesalamine, antibiotics should be tried (before prescribing corticosteroids) using ciprofloxacin 500 mg b.i.d., alone or in combination with metronidazole 250 mg q.i.d. for 2 to 3 weeks. If successful, antibiotics can be slowly tapered off.

  • If antibiotics are unsuccessful, one may try elemental diet for 2 weeks before starting corticosteroids.

  • For moderate to severe Crohn’s disease, begin 40 mg of prednisone. After 2 weeks, taper slowly and start 6-MP or azathioprine, which can be used for several years.

  • If the disease recurs on 6-MP or azathioprine, or prior to 6-MP or azathioprine having a chance to be effective, give an IV infusion of Infliximab, which can be repeated at 4 to 8 weeks after the initial infusion.

  • If the patient continues to be unwell, surgery should be contemplated.