Management of Crohn's disease
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1480 (Published 04 December 1999) Cite this as: BMJ 1999;319:1480
- David S Rampton, reader in gastroenterology (drampton@mds.qmw.ac.uk)
- Gastrointestinal Science Research Unit and Digestive Diseases Research Centre, St Bartholomew's and the Royal London School of Medicine and Dentistry, London E1 2AD
- Correspondence to: Department of Gastroenterology, Royal London Hospital, London E1 1BB
Introduction
Over recent decades the incidence of Crohn's disease has increased in the United Kingdom and it now affects about 1 in 1500 people Symptoms start at any age, with peaks in early and late adulthood Although the disease is incurable its adverse effects on health and quality of life can be substantially reduced by appropriate treatment. This paper reviews the current management of adults with common presentations of Crohn's disease.
Summary points
Morbidity from Crohn's disease can be lessened by meticulous specialist management
New techniques for clarifying the site of disease, activity, and complications include scanning with radiolabelled leucocytes, ultrasound, computed tomography, and magnetic resonance imaging
Budesonide, high dose mesalazine and, for refractory disease, methotrexate and antitumour necrosis factor α antibody are new therapeutic options
Other new therapeutic possibilities include a liquid formula diet, endoscopic stricture dilatation, and laparoscopic surgery
The most effective measure for maintenance of remission is stopping smoking
Patients should participate in decisions about their treatment
Methods
I searched Medline with the key terms Crohn's disease, drug therapy, dietary therapy, surgery, and therapy. Pharmacotherapeutic advances were derived from peer reviewed controlled clinical trials and meta-analyses published since 1993. Recent data were from the annual meeting of the American Gastroenterological Association. Citations about other aspects of Crohn's disease were mainly from review articles.
Aetiopathogenesis
The progressive elucidation of the pathogenesis, if not yet the cause, of Crohn's disease has improved our understanding of the possible modes of action of conventional treatment and has led to the development of new anti-inflammatory agents aimed at specific pathophysiological targets.
Epidemiological and genetic studies suggest that Crohn's disease is a polygenic disorder without any single Mendelian pattern of inheritance. Susceptibility loci for the disease have been reported recently on chromosomes 16, 3, 7, and 12; the latter three being shared with ulcerative colitis.1 Several environmental …
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