Medical treatment of Crohn's disease
Crohn’s disease (CD) is an inflammatory disease of unknown etiology that can affect every department of the digestive tract from the mouth to the anus. Unfortunately, now CD can not be completely cured by any medication or surgery. The main objectives of the treatment of this disease are to control symptoms, improve quality of life of patients and reduce the likelihood of complications. Recently, however, with the advent of new, promising treatments focus on the achievement of not only clinical but also endoscopic remission and the possibility of “interruption” of the disease.
Type of therapy used harvested severity, localization of the pathological process and its complications (including extraintestinal). There are several ways to evaluate the activity of CD, but to clinical practice more closely follows:
- CD mild / moderate severity. Ambulatory patients are able to tolerate an oral diet without dehydration, toxicity, abdominal tenderness on palpation, palpable entities, obstruction or loss of more than 10% of body weight.
- CD medium / heavy degrees of severity. Patients with ineffective treatment for the disease mild / moderate or patients with symptoms such as fever, severe weight loss, abdominal pain or tenderness on palpation of his, recurrent nausea and vomiting (without signs of obstruction), or severe anemia.
- Remission. Patients without symptoms, either spontaneously or after medical treatment or surgical intervention. Patients continued to receive steroids, for what would be symptom free, are not considered as being in remission.
Prednisolone (before budesonide) was considered as the drug of choice for patients with mild CD disease who do not respond to the measures described above, or the average or severe CD. The initial dose is usually 40-60mg per day. Approximately 50-70% of receiving a dose of reach clinical remission within 8-12 weeks. Upon reaching effect starts a gradual reduction in dose of 5-10mg per week to 20mg and then to 2-2.5mg, in order to stop treatment with corticosteroids.