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Crohn’s disease of the small intestine

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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.

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Authors and Affiliations

  1. Section of Gastroenterology, Washington Hospital Center, 110 Irving St., N.W. Suite 3A3-A7, 20010, Washington, DC, USA

    Robert Burakoff MD

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  1. Robert Burakoff MD
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Burakoff, R. Crohn’s disease of the small intestine. Curr Treat Options Gastro 3, 59–68 (2000). https://doi.org/10.1007/s11938-000-0062-3

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  • DOI: https://doi.org/10.1007/s11938-000-0062-3

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