Abstract
The management of luminal Crohn’s disease, the most common form of initial presentation of the disease, depends on the location and the severity of the lesions. Mild to moderate disease represents a relatively large proportion of patients with a first flare of luminal disease, which may also be associated with perianal disease. As quality of life of these patients correlates with disease activity, adequate therapy is a central goal of the overall patient management. Treatment options include mainly sulfasalazine, budesonide and systemic steroids, while the role of mesalazine and antibiotics remains controversial. The role of biological therapies in mild to moderate disease has not been thoroughly evaluated and will not be discussed here.
Journal Section:
Review
References
1.
Loftus EV, Schoenfeld P, Sandborn WJ: The epidemiology and natural history of Crohn’s disease in population-based patient cohorts from North America: A systematic review. Aliment Pharmacol Ther 2002;16:51–60.
2.
Louis E, et al: Behaviour of Crohn’s disease according to the Vienna classification: Changing pattern over the course of the disease. Gut 2001;49:777–782.
[PubMed]
3.
Louis E, et al: Early development of stricturing or penetrating pattern in Crohn’s disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype. Gut 2003;52:552–557.
[PubMed]
4.
Witte J, et al: Disease outcome in inflammatory bowel disease: Mortality, morbidity and therapeutic management of a 796-person inception cohort in the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Scand J Gastroenterol 2000;35:1272–1277.
[PubMed]
5.
Cohen RD: The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther 2002;16:1603–1609.
[PubMed]
6.
Guthrie E, et al: Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease. Am J Gastroenterol 2002;97:1994–1999.
[PubMed]
7.
Hanauer SB, Sandborn W: Management of Crohn’s disease in adults. Am J Gastroenterol 2001;96:635–643.
[PubMed]
8.
Summers RW, et al: National Cooperative Crohn’s Disease Study: Results of drug treatment. Gastroenterology 1979;77:847–869.
[PubMed]
9.
Malchow H, et al: European Cooperative Crohn’s Disease Study (ECCDS): Results of drug treatment. Gastroenterology 1984;86:249–266.
[PubMed]
10.
Anthonisen P, et al: The clinical effect of salazosulphapyridine (Salazopyrin®) in Crohn’s disease. A controlled double-blind study. Scand J Gastroenterol 1974;9:549–554.
[PubMed]
11.
Van Hees PA, et al: Effect of sulphasalazine in patients with active Crohn’s disease: A controlled double-blind study. Gut 1981;22:404–409.
[PubMed]
12.
Singleton JW, et al: A trial of sulfasalazine as adjunctive therapy in Crohn’s disease. Gastroenterology 1979;77:887–897.
[PubMed]
13.
Rijk MC et al: Sulphasalazine and prednisone compared with sulphasalazine for treating active Crohn disease. A double-blind, randomized, multicenter trial. Ann Intern Med 1991;114:445–450.
[PubMed]
14.
Goldstein F, et al: Favorable effects of sulfasalazine on small bowel Crohn’s disease: A long-term study. Am J Gastroenterol 1987;82:848–853.
[PubMed]
15.
Rasmussen SN, et al: 5-Aminosalicylic acid in the treatment of Crohn’s disease. A 16-week double-blind, placebo-controlled, multicentre study with Pentasa. Scand J Gastroenterol 1987;22:877–883.
[PubMed]
16.
Mahida YR, Jewell DP: Slow-release 5-amino-salicylic acid (Pentasa) for the treatment of active Crohn’s disease. Digestion 1990;45:88–92.
[PubMed]
17.
Tremaine WJ, et al: A randomized, double-blind, placebo-controlled trial of the oral mesalamine (5-ASA) preparation, Asacol, in the treatment of symptomatic Crohn’s colitis and ileocolitis. J Clin Gastroenterol 1994;19:278–282.
[PubMed]
18.
Singleton JW, et al: Mesalamine capsules for the treatment of active Crohn’s disease: Results of a 16-week trial. Pentasa Crohn’s Disease Study Group. Gastroenterology 1993;104:1293–1301.
[PubMed]
19.
Singleton J: Second trial of mesalamine therapy in the treatment of active Crohn’s disease. Gastroenterology 1994;107:632–633.
[PubMed]
20.
Hanauer SB, Stromberg U: Oral Pentasa in the treatment of active Crohn’s disease: A meta-analysis of double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2004;2:379–388.
[PubMed]
21.
Prantera C, et al: Mesalamine in the treatment of mild to moderate active Crohn’s ileitis: Results of a randomized, multicenter trial. Gastroenterology 1999;116:521–526.
[PubMed]
22.
Gross, V et al: Comparison between high dose 5-aminosalicylic acid and 6-methylprednisolone in active Crohn’s ileocolitis. A multicenter randomized double-blind study. German 5-ASA Study Group. Z Gastroenterol 1995;33:581–584.
[PubMed]
23.
Thomsen OO, et al: A comparison of budesonide and mesalamine for active Crohn’s disease. International Budesonide-Mesalamine Study Group. N Engl J Med 1998;339:370–374. Erratum appears in N Engl J Med 2001;345:1652.
[PubMed]
24.
Greenberg GR, et al: Oral budesonide for active Crohn’s disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994;331:836–841.
[PubMed]
25.
Tremaine WJ, et al: Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn’s disease: A randomized placebo-controlled study in the United States. Am J Gastroenterol 2002;97:1748–1754.
[PubMed]
26.
Kane SV et al: Systematic review: The effectiveness of budesonide therapy for Crohn’s disease. Aliment Pharmacol Ther 2002;16:1509–1517.
[PubMed]
27.
Thomsen OO, et al: Budesonide and mesalazine in active Crohn’s disease: A comparison of the effects on quality of life. Am J Gastroenterol 2002;97:649–653.
[PubMed]
28.
Campieri M, et al: Oral budesonide is as effective as oral prednisolone in active Crohn’s disease. The Global Budesonide Study Group. Gut 1997;41:209–214.
29.
Rutgeerts P, et al: A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med 1994;331:842–845.
[PubMed]
30.
Bar-Meir S, et al: Budesonide versus prednisone in the treatment of active Crohn’s disease. The Israeli Budesonide Study Group. Gastroenterology 1998;115:835–840.
31.
Gross V, et al: Oral pH-modified release budesonide versus 6-methylprednisolone in active Crohn’s disease. German/Austrian Budesonide Study Group. Eur J Gastroenterol Hepatol 1996;8:905–909.
[PubMed]
32.
Sutherland L, et al: Double-blind, placebo-controlled trial of metronidazole in Crohn’s disease. Gut 1991;32:1071–1075.
[PubMed]
33.
Allan R, Cooke WT: Evaluation of metronidazole in management of Crohn’s disease. Gut 1977;18:A422–A422.
34.
Blichfeldt P, et al: Metronidazole in Crohn’s disease. A double-blind cross-over clinical trial. Scand J Gastroenterol 1978;13:123–127.
[PubMed]
35.
Schneider MU, et al: Metronidazole in the treatment of Crohn disease. Results of a controlled randomized prospective study. Dtsch Med Wochenschr 1985;110:1724–1730.
[PubMed]
36.
Ursing B, et al: A comparative study of metronidazole and sulfasalazine for active Crohn’s disease: The cooperative Crohn’s disease study in Sweden II. Result. Gastroenterology 1982;83:550–562.
[PubMed]
37.
Arnold GL, et al: Preliminary study of ciprofloxacin in active Crohn’s disease. Inflamm Bowel Dis 2002;8:10–15.
[PubMed]
38.
Steinhart AH, et al: Combined budesonide and antibiotic therapy for active Crohn’s disease: A randomized controlled trial. Gastroenterology 2002;123:33–40.
[PubMed]
39.
Colombel JF, et al: A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn’s disease. Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives (GETAID). Am J Gastroenterol 1999;94:674–678.
[PubMed]
40.
Prantera C, et al: An antibiotic regimen for the treatment of active Crohn’s disease: A randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol 1996;91:328–332.
[PubMed]
41.
Sandborn WJ, Feagan BG: Mild to moderate Crohn’s disease – Defining the basis for a new treatment algorithm. Aliment Pharmacol Ther 2003;18:263–277.
[PubMed]
© 2005 S. Karger AG, Basel
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2005
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