Favorable effects of sulfasalazine on small bowel Crohn's disease: a long-term study

Due to conflicting reports in the literature regarding the efficacy of sulfasalazine for Crohn's disease (CD) involving small bowel alone, we reviewed the treatment results of our systematic sulfasalazine treatment in CD over a 23-yr period. We identified 28 patients with CD of small bowel alone treated between 1 and 23 yr by means of sulfasalazine alone and who went into complete clinical remission. Of these, 12 also showed total regression of radiographic abnormalities, 12 showed partial regression, while four patients still await radiographic reexamination. While our data do not permit a precise estimate, it seems that about 25% of patients with small bowel CD respond to sulfasalazine alone. Reasons are discussed why our data are at variance with some and in accord with other reports. While our study of necessity could not be carried out in double-blind fashion, patients served as their own controls, having previously failed to respond to other treatment modalities or no treatment. We conclude that sulfasalazine should be tried in the treatment of CD of small bowel because of its relatively low toxicity and reasonably high efficacy.