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Treatment Options for Crohn's Disease

Treatment focuses on relieving symptoms of the disease by inducing and then maintaining remission. This is accomplished by prescribing medicines that reduce the inflammation in the intestinal tract. Common drugs used to treat Crohn's disease are aminosalicylates, steroids, antibiotics, anti-TNF agents (see Infliximab below), and immunomodulators.

The cornerstone for inducing remission in severe Crohn's disease continues to be oral or intravenous corticosteroids such as prednisone. They also have a role in managing less severe disease and in treating small bowel involvement. They are used for short-term therapy and other medications are used to maintain remission following steroids. Steroids work by reducing inflammation throughout the body and thus long-term use is associated with many side effects like osteoporosis, diabetes, and hypertension. Promising results have been obtained with the use of budesonide (Entocort), a corticosteroid with high topical anti-inflammatory activity and low systemic activity (because of extensive hepatic metabolism). This medication, though costly, can reduce the intestinal inflammation while minimizing the side effects that would commonly be experienced with prednisone.

Another category of drugs often used in Crohn's disease is the topically acting 5-aminosalicylates such as mesalamine (Asacol, Pentasa), sulfasalazine (Azulfidine), and balsalazide (Colazal). These medicines are quite safe, but may require large doses. Antibiotic agents, such as metronidazole may be helpful in perianal and/or colonic Crohn's disease. How antibiotics help Crohn's disease is not well understood, but the benefit may be the result of altered concentrations of bacteria in the colon and small bowel.

Immunomodulatory drugs such as azathioprine (Imuran, Azasan), 6-mercaptopurine (Purinethol), or methotrexate are often effective in maintaining remission of Crohn's disease. These medications are used long-term and require monitoring to prevent adverse effects. They work by changing the way certain inflammatory cells in the intestinal lining respond to inflammatory triggers.

Infliximab (Remicade) is a powerful anti-inflammatory drug that blocks the action of a specific molecule called tumor necrosis factor (TNF), a key mediator of the inflammatory process in Crohn's disease. It is indicated for perianal Crohn's disease or intestinal disease not responding to the usual first-line medications. This drug is actually a synthetic antibody and is given as an intravenous infusion for both induction and maintenance of remission. Important side effects of this medication are infusion reactions (rash, fever) and, rarely, serious infections. Other medications known as biologicals, of which infliximab is one, are being studied and may emerge as viable therapies for Crohn's disease in the future.