Therapy for Crohn's Disease

This chapter provides an evidence‐based approach to the medical management of Crohn's disease (CD). Five classes of drugs are currently available for the treatment of active CD: 5‐aminosalicylates (ASA), corticosteroids, antibiotics, small molecule immunosuppressants, and biologics, including TNF antagonists, integrin inhibitors, and interleukin 12/23 inhibitors. Fecal microbial transplant attempts to restore a normal colonic microbiome through infusion of a fecal filtrate from a healthy donor to a patient. The chapter discusses the existing data for each drug class in both induction and maintenance therapy. It presents treatment optimization and management algorithms for CD. Sphingosine‐1‐phosphate is a G protein‐coupled protein that has widespread tissue distribution and multiple biologic activities. In the immune system, these cell surface receptors facilitate migration of lymphocytes from peripheral lymph nodes to the blood. Practical implementation of highly effective therapy would be greatly facilitated by the development of clinical prediction rules that accurately identify high‐risk patients.