[Crohn's disease - the new European guidelines on therapeutics]

The recently updated guidelines on medical and surgical therapeutics of Crohn's disease issued by the European Crohn's and Colitis Organization (ECCO) critically review the various drug and surgical treatment approaches. To optimize the delivery of care and therapeutic endpoints, involvement of multidisciplinary teams and treat-to-target approaches are recommended. Conventional medical therapies have only limited relevance. 5-aminosalicylates should not be used and corticosteroids are at best suitable for short-term control of acute flares. The therapeutic benefit of thiopurines is viewed with caution due to potential side effects and their inferior efficacy compared to infliximab. Advanced therapies (antibodies and small molecules) should be selected with regard to individual patient factors. TNF antibodies continue to be a mainstay of Crohn's therapy. IL-23 antibodies appear to be effective alternatives following loss of response to TNF antibodies. Nutritional therapies have so far been given too little consideration in clinical practice. Exclusive enteral nutrition can be used in children or compliant adults. Other diets including Mediterranean diet can be applied to maintain remission. Surgical treatment of Crohn's disease may be increasingly used in early stages of the disease, as it can avoid long-term complications and medical therapies. Whenever possible, operations are performed laparoscopically, with preoperative conditioning (avoidance of corticosteroids, correction of malnutrition) playing a particularly important role.