[Focus on Crohn's disease]

Abstract

Crohn's disease is an inflammatory bowel disease that affects the entire digestive tract, from the mouth to the anus. The inflammatory disease is transmural and may be complicated by abscesses, fistulas, strictures. Budesonide is used as first-line treatment for a first episode of ileitis. Thiopurines and methotrexate are used as immunosuppressive maintenance therapy. Anti-tumour necrosis factors (TNF) alpha therapy is used as induction and maintenance therapy in case of severe flares or corticodependence. Combination of immunosuppressive therapy and anti-TNF-alpha (combotherapy) prevents the appearance of specific anti drug antibodies. Combotherapy is used in case of severe disease. The goal of the treatment is to achieve clinical remission, endoscopic mucosal healing, and to prevent the occurrence of complications such as strictures, fistulas or abscesses. Anoperineal lesions are found in 10% of the patients at diagnosis. Surgical treatment is indicated for severe medical treatment-resistant patients or complications such as symptomatic stenosis, fistula or abscess unresponsive to medical treatment or immediately complicated.