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

Area of Science:

• Gastroenterology
• Internal Medicine
• Inflammatory Bowel Disease

Background:

• Crohn's disease is a chronic inflammatory condition with a relapsing-remitting course.
• Management of mild to moderate Crohn's disease presents challenges due to unknown natural history and limited effective treatments.
• Treatment strategies typically involve both induction and maintenance phases.

Purpose of the Study:

• To provide an overview of evidence for current therapies in mild to moderate luminal Crohn's disease.
• To explore emerging therapeutic options for this patient population.

Main Methods:

• Review of existing evidence for therapeutic options.
• Focus on induction and maintenance strategies.
• Assessment of treatments for mild to moderate luminal Crohn's disease.

Main Results:

• Budesonide demonstrates evidence for induction in terminal ileal and right colonic disease.
• Sulfasalazine is supported for induction in colonic Crohn's disease.
• Budesonide may be used short-term for maintenance of quiescent disease; effective long-term maintenance therapies are lacking.

Conclusions:

• Current evidence supports budesonide and sulfasalazine for induction in specific mild to moderate Crohn's disease presentations.
• There is a significant unmet need for effective long-term maintenance therapies.
• Mesalazine has no established role; data on antibacterials, probiotics, and prebiotics are insufficient.