Therapeutic Aspects and Prognosis

Flare-up episodes are usually treated with aminosalicylates or prednisolone, according to their clinical severity. When steroid therapy fails (10%-30% of patients), the anti-tumor necrosis factor-alpha antibody infliximab 5 mg/kg is usually active.

Maintenance treatment prescribed with the goal of preventing flare-ups uses aminosalicylates and, in more severe forms, immunosuppressive drugs (azathioprine or methotrexate). Immunosuppressants are very effective as maintenance treatment, achieving and maintaining remission, sparing steroids, leading in some cases to mucosal healing, and improving quality of life [15]. Accordingly, there is a clear tendency over time to initiate immunosuppressants earlier and in a larger proportion of patients [16]. Nowadays about two-thirds of patients receive immunosuppressants. Repeated perfusions of infliximab may be used in the few patients who are non-responders to classical immuno-suppressants. Surgery is reserved for stenotic and extra-parietal complications, or intractable forms after a well-conducted medical management. The cumulative risk of intestinal surgery is 82% after 20 years.

CD is an all-life chronic disease with no tendency to burn out over time. However, most patients are able to have an almost normal life. Mortality is slightly increased when compared to the general population [17].

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