Crohn’s Disease

Below is a literature search I conducted in December, 2022. Crohn’s disease is increasing in prevalence worldwide (1, 2015). It arises from a complex interplay between both genetic predisposition and environmental influence.  A search of databases and clinical practice guidelines was performed to provide the most up-to-date evidence-based approach for diagnosing and managing patients with Crohn’s disease. No single gold standard investigation exists. Whilst full ileocolonoscopy with biopsies remains the mainstay for diagnosis, other less invasive imaging modalities are being actively considered in the workup, as well as the use of serological markers. Management should incorporate dietary and lifestyle modifications where necessary, the use of medications in induction and remission of disease, and consideration of surgical intervention where medical therapy has failed.

A balanced diet of high fibre and fruits have been shown to be protective against CD and should be encouraged [Hou et al. 2011]. Medications are intended to suppress the inflammatory response and a host of therapeutic agents are now available to treat CD [Seow et al. 2008]. Corticosteroids are widely prescribed for the induction but not the maintenance of remission due to increasing resistance over time, patient dependence and adverse side effects with long-term use [Kuenzig et al. 2014]. The majority of patients diagnosed with CD will have a surgical resection within 10 years of their diagnosis [Bernell et al. 2000]. Surgical treatment is required for failed medical therapy, recurrent intestinal obstruction, malnutrition and for septic complications such as perforations and abscesses [Dasari et al. 2011].

(2022) An international team of researchers led by Israel’s Weizmann Institute, has used macrophages to kill inflammation-causing gut bacteria that cause inflammatory bowel diseases (IBD) such as Ulcerative Colitis and Crohn’s. “Good” bacteria are not harmed. (1) (2) (3)

(2022) Subcutaneously-Administered Infliximab in the Management of Rheumatoid Arthritis, Crohn’s, and other conditions.  The first subcutaneous (SC) formulation of infliximab CT-P13 has been authorized for the treatment of rheumatoid arthritis (RA) in Europe in 2019. Later, in 2020, approved indications were extended also to ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn’s disease (CD) and ulcerative colitis (UC).  The patient can self-inject the medicine at home without going to the hospital.