Medical Management

Abstract

The goal for medical management of Crohn's disease is ultimately to control symptoms and improve the patient's quality of life. A secondary goal is to minimize theeffects of these therapies, including both short-term and long-term toxicity. Ideally, remission is evidenced by mucosal healing, and a number of agents are available to the clinician. Immunomodulators, including corticosteroids, are well-suited to manage acute inflammation. The latest agents including the biologic class, principally antibodies directed against tumor necrosis factor - alpha. Patients may be started on these powerful medications first (the top-down approach,) or by the step-up approach starting with the least potent medications. Drug monitoring, disease monitoring, and endoscopic treatment are all necessary tools in the armamentarium of the gastroenterologist specializing in inflammatory bowel disease.