Medical therapy for Crohn's disease

While the etiopathogenesis of Crohn's disease (CD) remains enigmatic, progress in basic and cUnical research, and the successful application of specific therapies in clinical trials, have led to the formulation of evidence-based therapeutic guidelines. However, there remain significant gaps in the evidence base that preclude complete reliance on controlled trials to define guidelines. Nevertheless, therapeutic algorithms for CD have been defined that sequence therapy from induction of clinical remission followed by maintenance therapy to prevent relapse. Two corollaries to maintenance therapy include the treatment of steroid dependence and prevention of postoperative recurrence. This chapter will review the therapeutic agents used to treat CD according to the phase of therapy (induction or maintenance), with emphasis on each agent's position according to disease severity (mild to moderate, severe, or fulminant) and extent (location in small and/or large intestine).