Paper Details

  1. Home
  2. Paper Details

Mild to moderate Crohn's disease: still room for step-up therapies?

Author: Bar-MeirSimon

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Overview

Treatment for Crohn's disease typically involves starting with less intensive medications and gradually increasing treatment as the disease worsens (step-up therapy). A newer approach, using biologics and thiopurines as initial treatment (top-down therapy), has been debated, but current recommendations favor the step-up approach. Budesonide is recommended for mild to moderate Crohn's disease, while mesalazine is only slightly better than placebo for small bowel disease. Antibiotics are only recommended for suspected infections. For mild symptoms, no treatment may be an option. Budesonide is preferred to prednisone for mild Crohn's disease as it has fewer side effects. Sulfasalazine and, if needed, steroids can be used for mild colon involvement. Topical treatment may be helpful for disease in the lower part of the colon. Corticosteroids effectively induce remission in Crohn's disease, with success rates of 60-83%. Azathioprine and 6-mercaptopurine are effective for maintaining remission. Methotrexate is another effective option. Once remission is achieved with steroids, long-term treatment with azathioprine is recommended. Mesalazine may reduce the risk of colon cancer, but this is not proven for Crohn's disease. Overall, most people with Crohn's disease have a relatively mild course, making step-up therapy a good approach. While most medications are as effective as infliximab but with fewer side effects, infliximab should be reserved for patients who haven't responded to other treatments.
Paper Details　
Original Abstract of the Article :
Step-up therapy in Crohn's disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where biologicals together with thiopurines were used as firs...See full text at original site
Dr.Camel IconDr.Camel's Paper Summary Blogラクダ博士について

ラクダ博士は、Health Journal が論文の内容を分かりやすく解説するために作成した架空のキャラクターです。
難解な医学論文を、専門知識のない方にも理解しやすいように、噛み砕いて説明することを目指しています。

* ラクダ博士による解説は、あくまで論文の要点をまとめたものであり、原論文の完全な代替となるものではありません。詳細な内容については、必ず原論文をご参照ください。
* ラクダ博士は架空のキャラクターであり、実際の医学研究者や医療従事者とは一切関係がありません。
* 解説の内容は Health Journal が独自に解釈・作成したものであり、原論文の著者または出版社の見解を反映するものではありません。


引用元：
https://doi.org/10.1159/000228572

データ提供：米国国立医学図書館（NLM）

Navigating the Treatment Landscape of Crohn's Disease

Crohn's disease, a chronic inflammatory bowel disease, often presents with a range of symptoms and severity. This review explores the current therapeutic approaches for managing Crohn's disease, particularly in mild to moderate cases. It examines the 'step-up' strategy, where therapies are progressively intensified based on disease severity, and compares it to the 'top-down' strategy, which utilizes biologics as first-line treatment. The review highlights the effectiveness of various medications, including budesonide, mesalazine, corticosteroids, and thiopurines, and emphasizes the importance of personalized treatment plans tailored to individual patient needs.

Tailoring Therapy: Navigating the Individual Journey of Crohn's Disease

This review underscores the importance of individualizing treatment approaches for Crohn's disease, recognizing that each patient's journey is unique. The 'step-up' strategy, which gradually increases therapy based on disease severity, remains a widely accepted approach. The review also highlights the effectiveness of various medications, emphasizing the need for individualized treatment plans to optimize outcomes and minimize potential side effects.

Managing Crohn's Disease: A Collaborative Approach

This review highlights the importance of a collaborative approach between patients and healthcare providers in managing Crohn's disease. Just as a camel navigates the desert with its inherent knowledge and adaptability, patients need to actively participate in their treatment plan, understanding their options and working closely with their healthcare provider to achieve the best outcomes.

Dr. Camel's Conclusion

Crohn's disease can be a challenging condition, but with the right treatment approach, individuals can manage their symptoms and live fulfilling lives. This review provides valuable insights into the current therapeutic landscape of Crohn's disease, emphasizing the importance of individualizing treatment plans and embracing a collaborative approach to care. Just as a camel thrives in the harsh desert environment, we need to be resilient and adaptable in our approach to managing chronic conditions like Crohn's disease.

Date :
  1. Date Completed 2009-12-02
  2. Date Revised 2018-12-01
Further Info :

Pubmed ID

19786763

DOI: Digital Object Identifier

10.1159/000228572

SNS
PICO Info
in preparation
Languages

English

Positive IndicatorAn AI analysis index that serves as a benchmark for how positive the results of the study are. Note that it is a benchmark and requires careful interpretation and consideration of different perspectives.

This site uses cookies. Visit our privacy policy page or click the link in any footer for more information and to change your preferences.