BMJ 2008;336:1062-1066 (10 May).
Clinical Review
By: J R Fraser Cummings, specialist registrar, Satish Keshav, consultant gastroenterologist, Simon P L Travis, consultant gastroenterologist (Gastroenterology Unit, John Radcliffe Hospital, Oxford)
Summary points
- Biological therapies have radically changed the management of Crohn’s disease but must be used judiciously with great awareness of possible adverse events
- Treatment strategies for the disease are rapidly evolving, with immunomodulator and biological therapy being considered in patients who have indicators for developing early severe disease
- Clinical indicators of a poor prognosis (at diagnosis) include perianal or stricturing disease, weight loss >5 kg, or the need for steroids
- Treatment of active disease with mesalazine is little better than placebo; mesalazine is used mainly to reduce the risk of relapse after small intestinal resection
- Access to specialist services, parallel medical and surgical clinics, nurse specialists, dietitians, pharmacists, and other allied professionals is as important as the medication
Publication of standards of care should drive improvement in the care and provision of resources for patients with Crohn’s disease
