Current Advances in the Management of Crohn's Disease

Crohn's disease is a chronic relapsing and remitting inflammatory bowel disease believed to develop as a result of the stimulation of a dysfunctional immune response in genetically susceptible individuals. Croh'n disease is most commonly diagnosed in young adults (15 to 30 years) with a female-to-male ratio between unity and 1.2: 1. Prevalence of Crohn's disease rapidly increased all through the world as different countries adopt a Western lifestyle. The incidence is 5.8 cases per 100,000 people per year and the prevalence is 133 cases per 100,000 people. Mortality in Crohn's disease is now low, but morbidity is considerable. Thirty to sixty per cent of patients with Crohn's disease who attain medically induced remission will relapse within 1 year. It is estimated that 50% and 75% of Crohn's disease patients will require surgery within 5 to 15 years of diagnosis. Surgical resection is not curative as evidenced by the near universal recurrence of neo-terminal ileal Crohn's disease following ileocolonic resection. In the absence of a definitive cure, the aim of therapy is to induce and maintain clinical remission at an acceptable cost, avoidance of surgeries, and improvement of health-related quality of life. The first line treatment is still based on combinations of steroids, amino-salicylic acid derivatives, imunomodulators, and nutritional regimens. Biological drugs have opened new therapeutic horizons for treating Crohn’s disease, but have also brought with them issues related to immunogenicity, long-term efficacy, safety and cost. This review will highlight the current advances in the management of Crohn's disease as well as discuss areas that remain controversial and are awaiting resolution.