The potential for disease modification in Crohn's disease.

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Crohn's disease (CD) often progresses to disabling complications requiring surgery.
• Endoscopic healing is a key marker for disease modification in CD.
• Current therapies show potential for disease modification, but evidence for preventing specific complications is limited.

Purpose of the Study:

• To review the evidence for disease-modifying potential of therapies in Crohn's disease.
• To evaluate the role of mucosal healing as a surrogate marker.
• To identify gaps in current evidence regarding prevention of CD progression and complications.

Main Methods:

• Literature review of studies on Crohn's disease therapies.
• Analysis of evidence for disease modification and mucosal healing.
• Assessment of data on prevention of hospitalization, surgery, and specific complications.

Main Results:

• Azathioprine and anti-tumor necrosis factor (TNF) agents promote mucosal healing, unlike systemic steroids.
• Anti-TNF agents (infliximab, adalimumab) prevent short- and medium-term hospitalizations and surgeries.
• Evidence is limited for medical therapies preventing fibrotic wall thickening and fistula obliteration.

Conclusions:

• Mucosal healing is a promising surrogate marker for disease modification in Crohn's disease.
• Early introduction of immunosuppressants or biologics may alter disease progression.
• Further prospective studies are needed to validate predictors and assess early interventions in high-risk CD patients.