CURRENT MANAGEMENT AND TREATMENT OF CROHN'S DISEASE

Main Article Content

Camila Córdova Salazar
Manuel Rafael Aldas Erazo

Keywords

Crohn's disease, Inflammatory bowel disease, Management, Treatment

Abstract

Crohn's disease (CD) is a chronic inflammatory condition that affects the digestive system whose incidence and prevalence has been increasing in recent years. This pathology has been considered idiopathic, however in recent years it has been seen that it has a close relationship with genetic predisposition. Not knowing it's etiology can generate controversies about which treatment is the most appropriate for solving the objectives, however the treatment focuses on the use of monoclonal antibodies, immunomodulators and even surgical procedures. It is of utmost importance to establish a close doctor-patient relationship in this pathology given the persistence of episodes of remission and relapses.


Objective: To describe the updated management and treatment of Crohn's disease.


Materials and Methods: A review of narrative literature with a qualitative approach was carried out by searching the literature in electronic scientific databases such as PubMed, VHL, Redalyc, Science Direct, Cochrane. The search strategy was using specific MESH terms and manual keywords as follows: (UPDATE) AND (MANAGEMENT) OR (USE) AND (TREATMENT) AND (CROHN'S DISEASE) OR (INFLAMMATORY BOWEL DESEASE). After the initial search, 822 studies were located, in which 781 articles that were not relevant to the objective of this review were excluded after reviewing the abstract, so we worked with 41 selected articles


Results: A total of 41 articles selected through abstract review were used. In the update of the management of the disease, various treatments have been developed aimed at controlling the outbreak and keeping the patient under review through a multidisciplinary approach.


Conclusions: The choice of the appropriate treatment for CD is based on multiple factors such as the demographics of the individual, the severity of the disease, and the existence of complications. In this context, doctors need to be up-to-date and familiar with each therapy in order to provide optimal advice to their patients. However, in recent decades, the management of these patients has presented several therapeutic alternatives available, including monoclonal antibody therapies, immuno- modulators, and surgery.

Abstract 127 | pdf Downloads 52

References

1. Gonzalez J, Rodriguez E, Iglesias L. Inflammatory bowel disease, a challenge for paediatric gastroenterology. Rev Medical Sciences. 2022; 26(5).
2. Encalada F, Lemos R, Lopez M. Crohn's disease. Mastery of the Sciences. 2017; 3:246-58.
3. Tregón M, Cervera M, Barrera A, Salvador P, Jiménez L, Domingo M. Crohn's disease. Monographic article. Rev Sanit Investing. 2021;3.
4. Aibar M. Crohn's disease. Rev Sanit Investig. 2022; 3(12).
2. Suau R, Pardina E, Domènech E, Lorén V, Manyé J. The Complex Relationship Between Microbiota, Immune Response and Creeping Fat in Crohn's Disease. J Crohn's Colitis. 2022; 16(3):472–489.
3. Silvaa F, Gaticab T, Pavez C.. Etiology and pathophysiology of inflammatory bowel disease. Rev Médica Clínica Las Condes. 2019; 30(4):262-72.
4. Kumar A, Cole A, Segal J, Smith P, Limdi J A review of the therapeutic management of Crohn's disease. Therap Adv Gastroenterol. 2022;15.
5. Paredes JE, Alosilla PA, Vargas HT, Junes SI, Fernández JL, Mestanza AL, et al. Epidemiology and phenotype of Crohn's disease in a referral hospital in Lima, Peru. Rev gastroenterol Peru. 2020; 40(3):230-7.
6. Sulz MC, Burri E, Michetti P, Rogler G, Peyrin L, Seibold F. Treatment Algorithms for Crohn's Disease. Karger. 2020; 101(1):43-57.
7. Franken S, García A. Diagnostic and therapeutic guide to inflammatory bowel disease. Rev Médica Sinerg. 2021; 6(9).
8. Yamamoto JK, Forests F, Paula J, Galiano MT, Ibañez P, et al. Diagnosis and treatment of inflammatory bowel disease: First Latin American Consensus of the Pan American Crohn's and Colitis Organization. Rev Gastroenterol Mex. 2017; 82(1):46-84.
9. Cushing K, Higgins PDR. Management of Crohn's Disease: A Review. JAMA. 2021; 325(1):69-80.
10. Tumani MF, Pavez C, Parada A. Microbiota, eating habits and diet in inflammatory bowel disease. Rev Chil Nutr. 2020; 47(5):822-9.
11. Feuerstein J, & Cheifetz A. Crohn's Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc. 2017; 92(7):1088-103.
12. Torres J, Mehandru S, Colombel J, Peyrin L. Crohn's disease. Lancet. 2017; 389(10080):1741-55.
13. Rajbhandari R, Blakemore S, Gupta N, Adler AJ, Noble CA, et al. Crohn's disease in low and lower-middle income countries: A scoping review. World J Gastroenterol. 2020; 26(43):6891-908.
14. Torres J, Mehandru S, Colombel J PL. Crohn's disease. Lancet. 2017; 389(10080).
15. Silva Y, Sanchez MC, Rudicindo B. Case Report: Crohn's Disease in Pediatrics, the Challenge of Early Diagnosis. Rev Médica HJCA. 2019; 11(1):63-8.
16. Nakase H, Uchino M, Shinzaki S, Matsuura M, Matosuoka K, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease 2020. J Gastroenterol. 2021; 56:489–526.
17. Bastida G, Garrido A, Valero E, & del Pozo P. Crohn's disease. Med - Accredited Contin Medical Form Program. 2020; 13(11):603-12.
18. Sombrero J, Etchevers MJ. Current strategies in the diagnosis and monitoring of inflammatory bowel diseases. Acta Gastroenterol Latinoam. 2022; 52(3):306-21.
19. De Carpi J, Viada J, Jimenez S. Crohn's disease. Protoc diagn ter pediatr. 2023; 1:191-205.
20. López G, Alba C, Taxonera C. Diagnosis and Treatment of Inflammatory Bowel Disease in 2022. An RANM. 2022; 139(1):31-5.
21. Cienfuegos J, Licano M, Rangel S, Careño MF. Using this methodology, it is possible to determine the extent of the disease and also to clarify situations in which there are uncertainties about the diagnosis. An Radiogradía Mex. 2019;18: 278-87.
22. Ahmad R, Ajlan AM, Eskander AA, Alhazmi TA, Khashoggi K, Wazzan MA, Abduljabbar AH. Magnetic resonance imaging in the management of Crohn's disease: a systematic review and meta-analysis. Insights Imaging. 2021; 12(1):118.
23. Ripollésa, Muñoz F, Martínez MJ, de Miguel E, Poza J, de la Heras B, Páez C. Usefulness of intestinal ultrasound in inflammatory bowel disease. Radiology. 2021; 63(1):89-102.
24. Gompertza M, Sedanob R. Clinical and endoscopic manifestations in inflammatory bowel disease. Rev Medica Clin las Condes. 2019; 30(4):273-82.
25. Sicilia B, Vicente R, Arias L, Echarri A, Zabana Y, Mañosa Me, Beltrán B, et al. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on screening for dysplasia in patients with inflammatory bowel disease. Gastroenterol Hepatol. 2021; 63(1):435-47.
26. Elosua A, Nantes O, Fernández I, López A, Murcia O, Zabana Y. Use of capsule endoscopy in inflammatory bowel disease in clinical practice in Spain. Results of a national survey. Gastroenterol Hepatol. 2021; 44(10):696-703.
27. Tonholi F, Mazarotto E, Gregório P. Doença de Crohn: aspectos integrativos do diagnóstico ao tratamento. Res Soc Dev. 2023; 12(2).
28. Cai Z, Wang S, Li J. Treatment of Inflammatory Bowel Disease: A Comprehensive Review. Front Med. 2021;8.
29. Gajendran M, Loganathan P, Catinella A, Hashash J. A comprehensive review and update on Crohn's disease. Disease-a-Month. 2018; 64(2):20-57.
30. Bermejo F, Aguas M, Chaparro M, Domènech E, Echarri A, et al. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of thiopurines in inflammatory bowel disease. Gastroenterol Hepatol. 2018; 41(3):205-21.
31. Núñez L, Mesonero F, Albillos A, López A. Anti-tumor necrosis factor agents in Crohn's disease and ulcerative colitis: beyond luminal disease. Gastroenterol Hepatol. 2018; 41(9):576-82.
32. Iborra M, Beltrán B, Maroto N, Navarro P, Boscá M, et al.. Vedolizumab, an option in patients with inflammatory bowel disease who are intolerant to thiopurines and refractory to biologics. Gastroenterol Hepatol. 2018; 41(9):535-43.
33. Gisbert J, Chaparro M. Ustekinumab in the treatment of Crohn's disease. Gastroenterol Hepatol. 2018; 40(10):688-98.
34. Gallardo F, Vásquez JA, Molina C. Medical versus surgical treatment in ileal stenosis as the onset of stenosing Crohn's disease. RAPD Online. 2018; 41(6):285-92.
35. Juliao F, Osorio L, Carvajal J, Mosquera G, Medellín A, et al. Clinical characteristics and treatment of fistulizing perianal Crohn's disease in Colombia: results of a multicenter registry. Gastroenterol Hepatol. 2022; 45(9):690-6.
36. Imdad A, Pandit NG, Zaman M, Minkoff NZ, Tanner-Smith EE, Gomez-Duarte OG, Accra S, Nicholson MR. Fecal transplantation for treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2023; (4).
37. Castañeda C. Fecal microbiota transplantation. Rev Cuba Pediatr. 2019; 91(3).
38. Limketkai BN, Akobeng AK, Gordon M, Adepoju AA Probiotics for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2020; (7).