[Current medical therapies for Crohn's disease in Japan]

Current available therapies for Crohn's disease in Japan are reviewed in this report. Elemental diet is most effective for both inducing and maintaining remission in Japan. There appears to be no difference between elemental diet, oligopeptide diet and intact nutrients in effectiveness for active Crohn's disease. Although corticosteroid is also useful for treating active Crohn's disease, low dose of it is not effective for maintaining remission. Steroid has important role in combined therapy with elemental diet. New steroid, budesonide appears to be fascinate because of less adverse effects. Recently, instead of salazosulfapyridine, 5-aminosalicylic acid (5-ASA) proved to be more effective not only for active disease but also for maintenance of remission including small intestinal type of Crohn's disease with reduced adverse effects. Azathioprine, 6-mercaptopurine (6-MP), methotrexate and metronidazole are second choice treatment in patients whose disease relapse frequently. Although methotrexate appears to be effective for active Crohn's disease, the role of it has to be defined. Evidences support the use of 5-ASA and methotrexate for prophylaxis after surgery. It is important to chose and combine the therapies, thinking of the situation of each patient.