[Internistic therapy possibilities in therapy-resistant Crohn disease]

About 20% of patients with active Crohn's disease do not respond to acute-phase-therapy with glucocorticoids at an initial dose of 60 mg prednisolone-equivalent and stepwise dose reduction every week. In case of primary failure of this therapeutic scheme the dose of glucocorticoids has to be enhanced. If necessary a combination with total parenteral nutrition or tube feeding should be used. In case of early recurrence of inflammation during dose reduction or chronic steroid-dependent disease activity a combination of glucocorticoids with Azathioprine will be successful in about 75% of patients. In addition a combination of glucocorticoids with tube feeding (elemental or polymeric diet) will lead to remission of inflammatory activity in about 60 to 70% of these patients. In patients, who are still refractory to these therapeutic procedures, operation should be discussed.