Medical management of Crohn's disease

Abstract

The clinical course of Crohn's disease (CD) is characterized by unpredictable phases of disease activity and quiescence. The majority of CD patients experience mild to moderate disease or are in clinical remission over significant periods during the course of their disease. These patients can be treated conservatively with 5-aminosalicylates or budesonide depending on the disease location. Those patients with more severe forms of the disease who require corticosteroids should be treated more aggressively with early introduction of immunomodulator and/or biologic therapy, which may help to prevent the complications associated with CD. It has been suggested that therapies directed at mucosal healing may favorably modify the natural history of CD. As newer, more effective medications become available and new therapeutic approaches are introduced (top-down therapy), mucosal healing, and not solely clinical remission, may well become the preferred treatment objective.

Keywords: Crohn's disease; medical management.

Figure 1

Thiopurine metabolism: azathioprine (AZA) is converted in the body to 6-mercaptopurine (6-MP). 6-MP is metabolized along three competing pathways. (1) Xanthine oxidase (XO) yielding thiouric acid (6-TU), (2) thiopurine methyltransferase (TPMT) yielding 6-methylmercaptopurine (6-MMP), and (3) hypoxanthine-guanine phosphoribosyltransferase (HPRT) yielding 6-thioguanine nucleotides (6-TGN).