Crohn's disease: an update

Abstract

Crohn's disease (CD) is a chronic, relapsing and remitting inflammatory bowel disease (IBD) that is increasing in incidence and prevalence globally. Management aims to achieve endoscopic healing, symptom resolution and improvement in quality of life. Therapeutic approaches in CD vary depending on disease phenotype. Thiopurines are important in steroid-sparing maintenance therapy, while anti-tumour necrosis factor agents play a fundamental role, especially in fistulising CD. Suboptimal response to these medications may require escalation to other immunosuppressive and biologic therapies, and surgical intervention is still required in a proportion of patients. Tailoring treatment to target specific patient phenotypes, disease severity and patient wishes is becoming more feasible with the growing array of therapeutic options in CD.

Keywords: Crohn's disease; biologics; inflammatory bowel disease.

Fig 1

Mechanism of action for biologics and small molecules used in Crohn's disease. TNF = tumour necrosis factor; JAK = Janus kinase; STAT = signal transducer and activator of transcription; IL = interleukin; CXCL = chemokine.

Fig 2

Crohn's disease treatment landscape. a) Risk factors leading to Crohn's Disease. b) Treatment Targets for Crohn's Disease as per STRIDE II recommendations. c) Tools to monitor severity of disease and risk for colon cancer. d) Current treatment options for CD. e) Future therapies for CD.