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[Crohn's disease]
A Van Gossum1, D Franchimont, J Sternon
1Service Médico-Chirurgical de Gastro-Entérologie, Hôpital Erasme, U.L.B.
The etiology of Crohn's disease remains unclear. However, a better knowledge of the immune alterations at the intestinal mucosa level allowed to improve the therapeutic management of these patients. The alternatives to the usual corticotherapy are the use of budesonide (a topical form of steroids) in the mild to moderate diseases or the use of immunomodulators molecules such as the anti-TNF antibodies (infliximab) in the severe diseases, resistant to conventional medications. In the chronic active diseases that became steroid-dependent, it is recommended to initiate immunosuppressants such as azathioprine or methotrexate. The use of these molecules requires an optimal adaptation of doses and a regular clinical and biological follow-up to prevent drug-related complications. Surgery should be reserved for treating complications.
The etiology of Crohn's disease remains unclear. However, a better knowledge of the immune alterations at the intestinal mucosa level allowed to improve the therapeutic management of these patients. The alternatives to the usual corticotherapy are the use of budesonide (a topical form of steroids) in the mild to moderate diseases or the use of immunomodulators molecules such as the anti-TNF antibodies (infliximab) in the severe diseases, resistant to conventional medications. In the chronic active diseases that became steroid-dependent, it is recommended to initiate immunosuppressants such as azathioprine or methotrexate. The use of these molecules requires an optimal adaptation of doses and a regular clinical and biological follow-up to prevent drug-related complications. Surgery should be reserved for treating complications.