How is therapy for Crohn disease typically administered?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Therapy is typically administered in a “step-up” approach, in which patients with mild disease are treated with 5-aminosalicylic acid (5-ASA), antibiotics, and nutritional therapy. If the patient does not respond to this approach or if the disease is more severe than was initially thought, corticosteroid and immunomodulatory therapy with 6-mercaptopurine (6-MP) or methotrexate is attempted. Finally, biologic and surgical therapies, at the tip of the treatment pyramid, are used. [9] (See Treatment.)

A subpopulation of patients with risk factors for complicated disease and rapid progression may benefit from a “top-down” approach. This approach involves early and aggressive use of tumor necrosis factor (TNF) antagonists, which may alter the natural history of the disease, improve treatment response, and decrease the need for steroid therapy. (See Treatment.)

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