Overview of management of Crohn disease in adults

Gastroenterological Society of Australia (GESA), 2018 Lichtenstein, 2018

Treatment of Crohn disease aims to change the natural history of the disease and its long-term outcomes, rather than simply to achieve symptom control. This is reflected in the trend towards earlier use of potent immunomodulatory drugs.

Drug therapy for Crohn disease is used to:

• induce remission in active disease (often referred to as clinical remission)—see Induction therapy for mild to moderate Crohn disease in adults and Induction therapy for severe Crohn disease in adults
• maintain corticosteroid-free remission and prevent relapse—see Maintenance therapy for Crohn disease in adults
• achieve mucosal healing (often referred to as endoscopic remission), defined as the resolution of inflammation on endoscopy—this is associated with improved long-term outcomes (eg reduced need for hospital admission, surgery).

The severity of disease and the site(s) of affected bowel determine which drugs and route of administration may be used. In contrast to ulcerative colitis, 5-aminosalicylates and rectal therapy have no significant role in Crohn disease. A degree of trial and error is involved in managing Crohn disease—a drug is started and if it is not effective, other therapeutic options are offered. A patient’s previous response (or lack of response) to drug therapy can often be used to tailor therapy.

The optimal management of Crohn disease commonly requires a multidisciplinary team including surgeons, nurses, pharmacists, dietitians and psychologists.

Relapse rates are lower in patients with Crohn disease who stop smoking, compared with patients who continue to smoke. Counsel patients on the benefits of smoking cessation and provide appropriate support (see Smoking cessation).

Patient information about drug therapies for inflammatory bowel disease is available from NPS MedicineWise.