How is colon and small bowel inflammation treated in Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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For colon and small bowel inflammation in Crohn disease, anti-inflammatory drugs or antibiotics are helpful. Sulfasalazine is useful mainly in colonic disease; the active compound 5-ASA is released in the large bowel by bacterial degradation of the parent compound. Sulfasalazine does not alleviate small bowel disease and has no additive effect or steroid-sparing effect when used together with corticosteroids. In addition, in contrast to its action in ulcerative colitis, sulfasalazine seems not to maintain remission in Crohn disease. [88]

Products such as mesalamine, which release 5-ASA in the distal small bowel when triggered by pH changes, are more useful in patients with small bowel Crohn disease. Long-term maintenance with mesalamine may delay clinical relapse. Controlled release of mesalamine is thought to begin at the pylorus and to continue at a constant rate throughout the small bowel and colon; consequently, this drug is sometimes used when proximal intestinal and gastric Crohn disease is found.

5-ASA provides only modest benefit in preventing relapse of Crohn disease in remission after surgery. It can be considered for mild Crohn disease when immunosuppressive therapy is either not warranted or contraindicated.

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