Crohn’s disease of the small intestine

Crohn’s disease of the small intestine is a chronic relapsing disease that requires all the knowledge and ingenuity of the gastroenterologist to successfully treat the disease and the patient.For mild to moderate disease, the first line of therapy is to utilize maximum doses of mesalamine to achieve a remission.If the patient relapses, the maximum dose of mesalamine required to achieve remission should be continued.If the disease relapses despite maximum mesalamine, antibiotics should be tried (before prescribing corticosteroids) using ciprofloxacin 500 mg b.i.d., alone or in combination with metronidazole 250 mg q.i.d. for 2 to 3 weeks. If successful, antibiotics can be slowly tapered off.If antibiotics are unsuccessful, one may try elemental diet for 2 weeks before starting corticosteroids.For moderate to severe Crohn’s disease, begin 40 mg of prednisone. After 2 weeks, taper slowly and start 6-MP or azathioprine, which can be used for several years.If the disease recurs on 6-MP or azathioprine, or prior to 6-MP or azathioprine having a chance to be effective, give an IV infusion of Infliximab, which can be repeated at 4 to 8 weeks after the initial infusion.If the patient continues to be unwell, surgery should be contemplated.