Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Overview of Medical Management of Crohn’s Disease

  • Chapter
  • First Online:
Crohn's Disease

  • 2512 Accesses

Abstract

Crohn’s disease is a chronic relapsing inflammatory disease with both intestinal and extraintestinal manifestations that mainly affects young people, with peak incidence in the early twenties. As the disease does not affect life expectancy and there is as yet no cure, management is a long term undertaking. Crohn’s disease can present and develop in a wide range of ways and management is complex and is now considered a subspecialty of its own.

This chapter provides an overview of the medical management of Crohn’s disease and describes clinical experiences from a tertiary, inflammatory bowel disease unit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cummings J, Keshav S, Travis S. Medical management of Crohn’s disease. BMJ. 2008;336(7652):1062–6.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Travis SPL, Stange EF, Lémann M, Oresland T, Chowers Y, Forbes A, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut. 2006;55:16–35.

    Article  Google Scholar 

  3. Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104(2):465–83.

    Article  PubMed  Google Scholar 

  4. Stange E, Travis S, Vermeire S, Beglinger C, Kupcinkas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55:1–15.

    Article  Google Scholar 

  5. Knutson D, Greenberg G, Cronau H. Management of Crohn’s disease–a practical approach. Am Fam Physician. 2003;68(4):707–14.

    PubMed  Google Scholar 

  6. Sandborn WJ, Feagan BG, Hanauer SB, Lochs H, Löfberg R, Modigliani R, et al. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology. 2002;122(2):512–30.

    Article  PubMed  Google Scholar 

  7. Sinha R, Murphy P, Hawker P, Sanders S, Rajesh A, et al. Role of MRI in Crohn’s disease. Clin Radiol. 2009;64:341–52.

    Article  CAS  PubMed  Google Scholar 

  8. Sinha R, Rajiah P, Ramachandran I, Sanders S, Murphy PD. Diffusion-weighted MR imaging of the gastrointestinal tract: technique, indications, and imaging findings. Radiographics. 2013;33(3):655–76.

    Article  PubMed  Google Scholar 

  9. Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, et al. Diagnostic accuracy of high-resolution MR enterography in Crohn’s disease: comparison with surgical and pathological specimen. Clin Radiol. 2013;68(9):917–27.

    Article  CAS  PubMed  Google Scholar 

  10. Sinha R, Rajiah P, Murphy P, Hawker P, Sanders S. Utility of high-resolution MR imaging in demonstrating Transmural pathologic changes in Crohn disease. Radiographics. 2009;29(6):1847–67.

    Article  PubMed  Google Scholar 

  11. Prantera C, Cottone M, Pallone F, Annese V, Franzè A, Cerutti R, et al. Mesalamine in the treatment of mild to moderate active Crohn’s ileitis: results of a randomized, multicenter trial. Gastroenterology. 1999;116(3):521–6.

    Article  CAS  PubMed  Google Scholar 

  12. Malchow H, Ewe K, Brandes JW, Goebell H, Ehms H, Sommer H, et al. European Cooperative Crohn’s Disease Study (ECCDS): results of drug treatment. Gastroenterology. 1984;86(2):249–66.

    CAS  PubMed  Google Scholar 

  13. Summers RW, Switz DM, Sessions JT, Becktel JM, Best WR, Kern F, et al. National cooperative Crohn’s disease study: results of drug treatment. Gastroenterology. 1979;77:847–69.

    CAS  PubMed  Google Scholar 

  14. Hanauer SB, Strömberg U. Oral Pentasa in the treatment of active Crohn’s disease: a meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol. 2004;2(5):379–88.

    Article  CAS  PubMed  Google Scholar 

  15. Hees PAV, Lier HJV, Elteren PHV, Driessen M, Hogezand RAV, Velde GPT, et al. Effect of sulphasalazine in patients with active Crohn’s disease: a controlled double-blind study. Gut. 1981;22(5):404–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sutherland L, Singleton J, Sessions J, Hanauer S, Krawitt E, Rankin G, et al. Double blind, placebo controlled trial of metronidazole in Crohn’s disease. Gut. 1991;32(9):1071–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Blichfeldt P, Blomhoff JP, Myhre E, Gjone E. Metronidazole in Crohn’s disease. Scand J Gastroenterol. 1978;13(1):123–7.

    Article  CAS  PubMed  Google Scholar 

  18. Rutgeerts P, Löfberg R, Malchow H, Lamers C, Olaison G, Jewell D, et al. A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med. 1994;331(13):842–5.

    Article  CAS  PubMed  Google Scholar 

  19. Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn’s disease. The Global Budesonide Study Group. Gut. 1997;41(2):209–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Thomsen OO, Cortot A, Jewell D, Wright JP, Winter T, Veloso FT, et al. A comparison of budesonide and mesalamine for active Crohn’s disease. International budesonide-mesalamine study group. N Engl J Med. 1998;339(6):370–4.

    Article  CAS  PubMed  Google Scholar 

  21. Thomsen OO, Cortot A, Jewell D, Wright JP, Winter T, Veloso FT, et al. Budesonide and mesalazine in active Crohn’s disease: a comparison of the effects on quality of life. Am J Gastroenterol. 2002;97(3):649–53.

    Article  CAS  PubMed  Google Scholar 

  22. Modigliani R, Mary JY, Simon JF, Cortot A, Soule JC, Gendre JP, et al. Clinical, biological, and endoscopic picture of attacks of Crohn’s disease. Evolution on prednisolone. Groupe d’Etude Thérapeutique des Affections Inflammatoires Digestives. Gastroenterology. 1990;98(4):811–8.

    Article  CAS  PubMed  Google Scholar 

  23. Faubion WA, Loftus EV, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–60.

    Article  CAS  PubMed  Google Scholar 

  24. Franchimont DP, Louis E, Croes F, Belaiche J. Clinical pattern of corticosteroid dependent Crohn’s disease. Eur J Gastroenterol Hepatol. 1998;10(10):821–5.

    Article  CAS  PubMed  Google Scholar 

  25. Pearson DC, May GR, Fick G, Sutherland LR. Azathioprine for maintaining remission of Crohn’s disease. Cochrane Database Syst Rev. 2000;(2):CD000067.

    Google Scholar 

  26. Alfadhli AAF, McDonald JWD, Feagan BG. Methotrexate for induction of remission in refractory Crohn’s disease. Cochrane Database Syst Rev. 2005;(1):CD003459.

    Google Scholar 

  27. Kane SV, Schoenfeld P, Sandborn WJ, Tremaine W, Hofer T, Feagan BG. The effectiveness of budesonide therapy for Crohn’s disease. Aliment Pharmacol Ther. 2002;16(8):1509–17.

    Article  CAS  PubMed  Google Scholar 

  28. Otley A, Steinhart AH. Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2005;(4):CD000296.

    Google Scholar 

  29. Shepherd HA, Barr GD, Jewell DP. Use of an intravenous steroid regimen in the treatment of acute Crohn’s disease. J Clin Gastroenterol. 1986;8(2):154–9.

    Article  CAS  PubMed  Google Scholar 

  30. Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130(3):940–87.

    Article  CAS  PubMed  Google Scholar 

  31. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s disease cA2 study group. N Engl J Med. 1997;337(15):1029–35.

    Article  CAS  PubMed  Google Scholar 

  32. Rutgeerts P, Diamond RH, Bala M, Olson A, Lichtenstein GR, Bao W, et al. Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn’s disease. Gastrointest Endosc. 2006;63(3):433–42.

    Article  PubMed  Google Scholar 

  33. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med. 2004;350(9):876–85.

    Article  CAS  PubMed  Google Scholar 

  34. Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Maintenance infliximab for Crohn’s disease: the ACCENT I randomised trial. Lancet. 2002;359(9317):1541–9.

    Article  CAS  PubMed  Google Scholar 

  35. Colombel JF, Rutgeerts P, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. P087 – SONIC: a randomized, double-blind, controlled trial comparing infliximab and infliximab plus azathioprine to azathioprine in patients with Crohn’s disease naive to immunomodulators and biologic therapy. J Crohns Colitis. 2009;3(1):S45–6.

    Article  Google Scholar 

  36. Lémann M, Mary J-Y, Duclos B, Veyrac M, Dupas J-L, Delchier JC, et al. Infliximab plus azathioprine for steroid-dependent Crohn’s disease patients: a randomized placebo-controlled trial. Gastroenterology. 2006;130(4):1054–61.

    Article  PubMed  Google Scholar 

  37. Beall DP, Fortman BJ, Lawler BC, Regan F. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol. 2002;57(8):719–24.

    Article  CAS  PubMed  Google Scholar 

  38. Fellermann K, Ludwig D, Stahl M, David-Walek T, Stange EF. Steroid-unresponsive acute attacks of inflammatory bowel disease: immunomodulation by tacrolimus (FK506). Am J Gastroenterol. 1998;93(10):1860–6.

    Article  CAS  PubMed  Google Scholar 

  39. McDonald JWD, Feagan BG, Jewell D, Brynskov J, Stange EF, Macdonald JK. Cyclosporine for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2005;(2):CD000297.

    Google Scholar 

  40. D’Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008;371(9613):660–7.

    Article  PubMed  Google Scholar 

  41. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001;345(15):1098–104.

    Article  CAS  PubMed  Google Scholar 

  42. Rutgeerts P, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology. 2004;126(2):402–13.

    Article  CAS  PubMed  Google Scholar 

  43. Sandborn WJ, Hanauer SB, Rutgeerts P, Fedorak RN, Lukas M, MacIntosh DG, et al. Adalimumab for maintenance treatment of Crohn’s disease: results of the CLASSIC II trial. Gut. 2007;56(9):1232–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Rutgeerts P, Van Assche G, Vermeire S. Optimizing anti-TNF treatment in inflammatory bowel disease. Gastroenterology. 2004;126(6):1593–610.

    Article  CAS  PubMed  Google Scholar 

  45. Rutgeerts P, D’Haens G, Targan S, Vasiliauskas E, Hanauer SB, Present DH, et al. Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology. 1999;117(4):761–9.

    Article  CAS  PubMed  Google Scholar 

  46. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362(15):1383–95.

    Article  CAS  PubMed  Google Scholar 

  47. Schreiber S, Rutgeerts P, Fedorak RN, Khaliq-Kareemi M, Kamm MA, Boivin M, et al. A randomized, placebo-controlled trial of certolizumab pegol (CDP870) for treatment of Crohn’s disease. Gastroenterology. 2005;129(3):807–18.

    Article  CAS  PubMed  Google Scholar 

  48. Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel J-F, Sands BE, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013;369(8):711–21.

    Article  CAS  PubMed  Google Scholar 

  49. Van Assche G, Vermeire S, Rutgeerts P. Safety issues with biological therapies for inflammatory bowel disease. Curr Opin Gastroenterol. 2006;22(4):370–6.

    PubMed  Google Scholar 

  50. Siegel CA, Hur C, Korzenik JR, Gazelle GS, Sands BE. Risks and benefits of infliximab for the treatment of Crohn’s disease. Clin Gastroenterol Hepatol. 2006;4(8):1017–24.

    Article  CAS  PubMed  Google Scholar 

  51. Connell WR, Kamm MA, Ritchie JK, Lennard-Jones JE. Bone marrow toxicity caused by azathioprine in inflammatory bowel disease: 27 years of experience. Gut. 1993;34(8):1081–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Osterman MT, Kundu R, Lichtenstein GR, Lewis JD. Association of 6-thioguanine nucleotide levels and inflammatory bowel disease activity: a meta-analysis. Gastroenterology. 2006;130(4):1047–53.

    Article  CAS  PubMed  Google Scholar 

  53. De Boer NKH, Reinisch W, Teml A, van Bodegraven AA, Schwab M, Lukas M, et al. 6-Thioguanine treatment in inflammatory bowel disease: a critical appraisal by a European 6-TG working party. Digestion. 2006;73(1):25–31.

    Article  PubMed  Google Scholar 

  54. Derijks LJJ, Gilissen LPL, Hooymans PM, Hommes DW. Review article: thiopurines in inflammatory bowel disease. Aliment Pharmacol Ther. 2006;24(5):715–29.

    Article  CAS  PubMed  Google Scholar 

  55. Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut. 2005;54(8):1121–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Smedby KE, Baecklund E, Askling J. Malignant lymphomas in autoimmunity and inflammation: a review of risks, risk factors, and lymphoma characteristics. Cancer Epidemiol Biomarkers Prev. 2006;15(11):2069–77.

    Article  CAS  PubMed  Google Scholar 

  57. Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Chen DM, et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol. 2006;4(5):621–30.

    Article  CAS  PubMed  Google Scholar 

  58. Viget N, Vernier-Massouille G, Salmon-Ceron D, Yazdanpanah Y, Colombel J-F. Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut. 2008;57(4):549–58.

    Article  CAS  PubMed  Google Scholar 

  59. Caspersen S, Elkjaer M, Riis L, Pedersen N, Mortensen C, Jess T, et al. Infliximab for inflammatory bowel disease in Denmark 1999–2005: clinical outcome and follow-up evaluation of malignancy and mortality. Clin Gastroenterol Hepatol. 2008;6(11):1212–7.

    Article  PubMed  Google Scholar 

  60. Jørgensen SP, Hvas CL, Agnholt J, Christensen LA, Heickendorff L, Dahlerup JF. Active Crohn’s disease is associated with low vitamin D levels. J Crohns Colitis. 2013;7(10):407–13.

    Article  Google Scholar 

  61. Greene BR, Blanchard EB, Wan CK. Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease. Behav Res Ther. 1994;32(2):217–26.

    Article  CAS  PubMed  Google Scholar 

  62. Loudon CP, Corroll V, Butcher J, Rawsthorne P, Bernstein CN. The effects of physical exercise on patients with Crohn’s disease. Am J Gastroenterol. 1999;94(3):697–703.

    Article  CAS  PubMed  Google Scholar 

  63. Nensey YM, Arlow FL, Majumdar AP. Aging. Increased responsiveness of colorectal mucosa to carcinogen stimulation and protective role of folic acid. Dig Dis Sci. 1995;40(2):396–401.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, South Warwickshire NHS Trust, Warwick Medical School, Warwick, CV345BW, England, UK

    Peter Hawker MD, FRCP

  2. Department of Clinical Radiology, South Warwickshire NHS Trust, Warwick Medical School, Warwick, CV345BW, England, UK

    Rakesh Sinha MBBS, MD, FRCR, FICR

Authors
  1. Peter Hawker MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rakesh Sinha MBBS, MD, FRCR, FICR
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rakesh Sinha MBBS, MD, FRCR, FICR .

Editor information

Editors and Affiliations

  1. University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

    Arumugam Rajesh

  2. Department of Radiology, Warwick Hospital, Warwick, United Kingdom

    Rakesh Sinha

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Hawker, P., Sinha, R. (2015). Overview of Medical Management of Crohn’s Disease. In: Rajesh, A., Sinha, R. (eds) Crohn's Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-01913-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-01913-0_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-01912-3

  • Online ISBN: 978-3-319-01913-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation