What is included in the top-down approach to the treatment of inflammatory bowel disease (IBD)?

Updated: Oct 17, 2017
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Answer

The top-down approach (ie, earlier use of immunomodulators and biologics) includes the need for steroid-enhanced mucosal healing and achieves an earlier and more complete remission than step-up therapy. A general rule of thumb is that once remission is achieved, the medications used to achieve remission should be continued, except steroids, which should be tapered off, because they have no role in maintaining remission [104] and their use may lead to debilitating illness, particularly after long-term use. Home infusion of IV hyperalimentation is becoming increasingly available for those rare patients with Crohn disease in whom prolonged bowel rest is necessary (eg, cases of severe fistulizing disease). Patients with a short bowel may require prolonged hyperalimentation.


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