Crohn Disease

Azathioprine has been shown to be beneficial in maintaining remission in Crohn disease, either alone or after surgery, and has a corticosteroid-sparing effect, but it is associated with important adverse effects. * Cyclosporine or oral corticosteroids alone are unlikely to be beneficial in maintaining remission after medical treatment. * Methotrexate and infliximab may also maintain remission compared with placebo. * Smoking cessation reduces the risk of relapse, and enteral nutrition may be effective. * Fish oil and probiotics have not been shown to be effective. Beneficial Smoking cessation Likely to be beneficial Enteral nutrition (compared with unrestricted diet) Unknown effectiveness Fish oil Probiotics Definition Crohn disease is a chronic inflammatory condition of the gastrointestinal tract, characterized by transmural granulomatous inflammation, a discontinuous pattern of distribution, and fistulae. After exclusion of infection, ischemia, irradiation, and malignancy as causes for intestinal inflammation, a combination of at least three of the following findings on clinical examination, radiologic investigation, endoscopy, and histologic examination of endoscopic biopsies or excised specimens is considered diagnostic: chronic inflammatory lesions of the oral cavity, pylorus or duodenum, small bowel, or anus; a discontinuous disease distribution (areas of abnormal mucosa separated by normal mucosa); transmural inflammation (fissuring ulcer, abscess, or fistula); fibrosis (stricture); lymphoid aggregates or aphthoid ulcers; retention of colonic mucin on biopsy in the presence of active inflammation; and granulomata (of the noncaseating type and not caused by foreign bodies). [...]there have been debates since Mycobacterium avium paratuberculosis was cultured from intestinal tissue of persons with Crohn disease, with little agreement on whether this bacterium is an infective cause of Crohn disease.