Mild to moderate Crohn's disease: an evidence-based treatment algorithm

Crohn's disease is a chronic inflammatory condition with a relapsing-remitting disease course. Treatment often requires both induction and maintenance strategies. The management of mild to moderate Crohn's disease is challenging because the natural history of mild disease is not known and effective treatment options are limited. In this article, our objective is to provide a brief overview of the evidence supporting current therapies in the treatment of mild to moderate luminal Crohn's disease and to explore a few of the newer therapeutic options. As induction agents for mild to moderately active Crohn's disease, there is reasonable evidence to support the use of budesonide for terminal ileal and right colonic disease, and sulfasalazine for colonic disease. Although budesonide can be used in the short term (3-6 months) for maintenance of quiescent disease, there are no effective therapies for the long-term maintenance of mild to moderate Crohn's disease. Mesalazine appears to have no role in either the treatment of active or quiescent disease. Currently, there is insufficient data to draw conclusions on the potential role of antibacterials, probiotics or prebiotics.