Classification of Crohn's disease: implications for management

Principles of therapy are determined by the presenting form of Crohn's disease, which may be considered in three broad categories: inflammatory, fistulizing or fibrostenotic. Whether inflammatory activity occurs in the small bowel or colon, it is best treated with anti-inflammatory drugs and/or antibiotics. Fistulizing disease encompasses a wide spectrum, but for practical purposes can be considered in three main subgroups: the benign or 'innocent' fistula, which may need no specific treatment at all; the mildly symptomatic or 'nuisance' fistula, which often responds to medical therapy; and the 'complicated' fistula, which almost always requires definitive surgery. The fibrostenotic form of Crohn's disease results in bowel obstruction. Although acute obstruction due to fibrostenotic Crohn's disease virtually never requires emergency surgery, chronic recurrent obstructive episodes are an inevitable indication for elective resection, Principles of therapy are determined by the presenting form of the disease, which may be considered in three broad categories: inflammatory, fistulizing, or fibrostenotic(1).