Medical management of Crohn's disease: current therapy and recent advances

Crohn's disease is a chronic inflammatory disease involving the gastrointestinal tract and affects millions of people worldwide. Despite significant advances in the medical management of Crohn's disease over the past decade, there is no consensus on what constitutes optimal medical treatment. For many years, corticosteroids and sulfasalazine were the mainstay of therapy. More recently, immunomodulators such as azathioprine and methotrexate have been used in both the induction and maintenance of remission. The 1998 introduction of infliximab, a biologic agent active against tumor necrosis factor-α, has also led to considerable advances in the management of Crohn's disease. In addition, data from randomized controlled trials involving the immunomodulators azathioprine, 6-mercaptopurine and methotrexate have been accumulated, advancing our knowledge on how to best to use these agents for the induction and maintenance of remission in patients with Crohn's disease. This advancement of knowledge has allowed clinicians to use a more rational, evidence-based approach to the management of Crohn's disease.