%0 Journal Article
%T Practical Medical Management of Crohn¡¯s Disease
%A Bulent Baran
%A Cetin Karaca
%J ISRN Gastroenterology
%D 2013
%R 10.1155/2013/208073
%X Crohn¡¯s disease is a chronic inflammatory disease of diagnostic and therapeutic challenges. After proper diagnosis, treatment decisions must be made on precise clinical judgment. During the course of the disease there are variable clinical features, so each case must be managed individually. Physicians who care for patients with Crohn¡¯s disease should be prepared for treatment options in different states of the disease and possible complications of both the disease and medications. This paper will focus on the management of Crohn¡¯s disease. We aim to discuss current treatment options in different presentations of the disease and to provide algorithmic management strategy. 1. General Principles of Management Crohn¡¯s disease can affect any area of the gastrointestinal tract. Transmural inflammation and segmental pattern are the classical features of the disease [1]. A treatment plan should be organized according to disease activity, behavior and localization of disease, and associated complications. Whatever treatment plan is chosen, it is most appropriate to individualize treatment according to clinical response and tolerance of the patient. It is certain that smoking is an independent risk factor for complications and has a direct influence on disease activity. All patients diagnosed with Crohn¡¯s disease should be informed about the negative impact of smoking and strongly encouraged to cease smoking [2]. Nonsteroidal anti-inflammatory drug usage is known to be associated with mucosal damage in gastrointestinal tract. There is substantial evidence that exacerbation of inflammatory bowel disease occurs after nonsteroidal anti-inflammatory drug usage, although the available data is conflicting to make definitive conclusions. Regarding the mechanisms of relapse, the inhibition of prostaglandin synthesis appears to be the hallmark of the nonsteroidal anti-inflammatory drug effects [3¨C5]. The patients should be informed about the adverse effects of nonsteroidal anti-inflammatory drugs, and limited usage must be ensured. As a principle current treatment options are chosen sequentially from safer drugs with less adverse events to more potent and potentially more toxic drugs to induce clinical remission. In this ¡°step-up¡± strategy, main purpose is to induce and maintain remission by safer and less expensive drugs by identifying patients who will benefit from conventional treatments. However, some authors recently suggested using a ¡°top-down¡± strategy in which more potent treatment options are chosen early in the course of the disease, particularly in patients
%U http://www.hindawi.com/journals/isrn.gastroenterology/2013/208073/