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A review of the therapeutic management of Crohn’s disease

In summary, anti-TNF therapies have transformed the care of patients with IBD, re-defining our perceptions around meaningful disease control, moving beyond symptom control to bolder definitions such as mucosal healing, histological and deep remission, and an improvement in QoL. Even as anti-TNF agents fueled our ambitions with hitherto unachievable outcomes, it became obvious that they are not universally effective, with 30–50% of patients being primary non-responders and with further attrition from subsequent loss of response (mechanistic escape, immunogenicity, or intolerance). There is also the real risk of infectious complications attributable to non-specific inhibition of TNF-mediated…

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Featured

 Everything You Need to Know About Crohn’s Disease Medications

One of the many frustrating things about living with Crohn’s disease is that it requires lifelong care. While there’s no cure (yet), there are many Crohn’s disease medications that can help reduce your symptoms, such as severe diarrhea and abdominal pain, so you can hopefully have more control over how you feel in your day-to-day life.

 How Your Diet Can Help Reduce IBD Symptoms

Before diving into options for what you might put on your plate and in your body if you have IBD, know that experts emphasize that dietary changes aren’t a wholesale substitute for medical treatment.

Articles of Interest

Medical Management of Crohn's Disease

Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This article reviews the pharmaceutical options available for the management of CD.

A Clean Slate: Engineering the Gut Microbiome with “Good” Bacteria May Help Treat Crohn’s Disease

An imbalance in the gut microbiome – more “bad” bacteria than “good” – is known as dysbiosis, which is caused by environmental stressors, such as intestinal inflammation, antibiotics, or diet. Gut dysbiosis is believed to fuel Crohn’s disease and other diseases, but the mechanisms behind that relationship is not fully understood by researchers looking to strike a healthier, bacterial balance for patients.

Are You Ready to Swallow a Pill Full of Poop?

Scientists now know that the wrong balance of bugs in your gut—a delicate ecosystem that can collapse as you age, travel, or even take new medi­cation—can lead to all sorts of distress. Seres is one of the first startups aiming to design treatments that would manipulate the microbiome to repair bad guts and cure diseases.

Early, tight control of Crohn’s disease may have lasting benefits

Early approaches to treatment of Crohn’s disease followed a step-up algorithm in which the newer medications would only be used if the patient did not benefit from established therapies. This sequential approach — termed step therapy — has more recently been called into question, as studies have repeatedly shown that the newer drugs for Crohn’s disease are more effective than the old standards, and have preferable side effect profiles.

Infliximab (Remicade)

Infliximab is a type of biological therapy/immunotherapy designed to stimulate our body's immune system and treat certain diseases. Infliximab is a purified, recombinant DNA-derived chimeric IgG monoclonal antibody protein that contains both murine and human components that inhibit tumor necrosis factor-alpha (TNF-a). TNF-a is a signaling protein involved in acute phase reaction and systemic inflammation.

Management of Crohn Disease

Management of Crohn disease includes treatment with monoclonal antibody therapies, immunomodulators, and surgery. The optimal approach depends on patient risk stratification; patient preference; and clinical factors, including age of onset, penetrating complications, smoking, and severity of ulceration. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.

Selective biologics for ulcerative colitis and Crohn’s disease – clinical utility of vedolizumab

Treatment has been dominated by antitumor necrosis alpha agents with significant success but equally potentially serious adverse events. Therapeutic targeting of leucocyte trafficking has emerged as a viable alternative therapy, with vedolizumab being the lead compound. This review focuses primarily on its biological function as a selective gut immunotherapy, its safety and efficacy, and its emerging role as a mainstream therapy in managing IBD.

Stem Cell Therapy: A Potential Crohn's Disease Breakthrough...

Stem cell therapy may be a viable new treatment option for Crohn's Disease. Studies have shown that stem cells may be able to greatly improve patient symptoms without the exorbitant recurring costs of traditional medications.

Stem cell transplants to be used in treating Crohn’s disease

Recent research has shown stem cell transplantation to be very effective in treating other autoimmune disease, such as multiple sclerosis. Our trial, called ASTIClite, will investigate whether transplantation can reduce gut inflammation and offer hope to people with Crohn’s disease for whom all other treatments have been unsuccessful. ASTIClite is a follow up to our previous ASTIC trial in 2015, which investigated a similar stem cell therapy. Although the therapy in the original trial did not cure the disease, we found that many patients benefited from the treatment.

Resources

Breaking the Vicious Cycle

The Specific Carbohydrate Diet™ has helped many thousands of people with various forms of bowel disease and other ailments vastly improve their quality of life. In many cases people consider themselves cured. It is a diet intended mainly for Crohn's disease, ulcerative colitis, celiac disease, diverticulitis, cystic fibrosis and chronic diarrhea.