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Management of Crohn DiseaseA Review

Educational Objective
To review the clinical management of Crohn disease.
1 Credit CME
Abstract

Importance  Crohn disease, a chronic gastrointestinal inflammatory disease, is increasing in incidence and prevalence in many parts of the world. Uncontrolled inflammation leads to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia. Therefore, early and effective control of inflammation is of critical importance.

Observations  The optimal management approach for Crohn disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making. First-line therapy generally consists of steroids for rapid palliation of symptoms during initiation of anti–tumor necrosis factor α therapy. Other treatments may include monoclonal antibodies to IL-12/23 or integrin α4β7, immunomodulators, combination therapies, or surgery. Effective control of inflammation reduces the risk of penetrating complications (such as intra-abdominal abscesses and fistulae), although more than half of patients will develop complications that require surgery. Adverse reactions to therapy include antibody formation and infusion reactions, infections, and cancers associated with immune modulators and biologics and toxicity to the bone marrow and the liver. Both Crohn disease and corticosteroid use are associated with osteoporosis. Vaccinations to prevent infections, such as influenza, pneumonia, and herpes zoster, are important components of health maintenance for patients with Crohn disease, although live vaccines are contraindicated for patients receiving immune suppression therapy.

Conclusions and Relevance  The treatment of patients with Crohn disease depends on disease severity, patient risk stratification, patient preference, and clinical factors, including age of onset and penetrating complications, and includes treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Peter D. R. Higgins MD, PhD, MSc, 1150 W Medical Center Dr, University of Michigan, Ann Arbor, MI 48109 (phiggins@med.umich.edu).

Accepted for Publication: September 8, 2020.

Author Contributions: Drs Higgins and Cushing had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Administrative, technical, or material support: Higgins.
Supervision: Higgins.
Other - Literature review: Cushing.

Conflict of Interest Disclosures: Dr Higgins reported receiving grant funding from the National Institutes of Health, the Crohn's and Colitis Foundation, Pfizer, AbbVie, Eli Lilly, Twine Clinical Consulting, Target PharmaSolutions, Shire, Seres, Genentech, Janssen, Takeda, and UCB and consulting for Pfizer, Eli Lilly, Takeda, and Arena Pharmaceuticals. No other disclosures were reported.

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