Review article: medical treatment of active Crohn's disease

Crohn's disease, a heterogeneous inflammatory process that can affect various sites in the gut, presents an ongoing management challenge for the clinician. The treatment of active disease and complications is one of the main goals in the therapy of this disease. New therapies are aimed at delivering the active compounds to the diseased site, reduction or suppression of enteral flora and modulation of more focal targets within the immune response. The use of antibiotics in the therapy of Crohn's disease is gaining popularity, on the grounds that intestinal bacteria may play a role in the pathogenesis of Crohn's disease lesions. Metronidazole is one of the most widely used antibiotics, especially in the treatment of perianal disease. Corticosteroids are the mainstays of medical treatment in active Crohn's disease and induce the remission of symptoms in about 60-80% of patients. The use of immunosuppressive agents, such as cyclosporine and methotrexate, in patients with active disease resistant to standard therapy has gained acceptance in recent years. With new therapies the outlook for patients with Crohn's disease is more optimistic than it has been for a long time.