The optimal treatment of patients with inflammatory bowel disease requires the physician to obtain a good history, evaluate the patient, perform the necessary diagnostic procedures, and then prescribe an appropriate treatment based on evidence from controlled clinical trials.
The goals of pharmacotherapy in patients with inflammatory bowel disease are to improve the quality of life, reduce the risk of complications and avoid surgery.
The recommendations of the new Montreal classification regarding disease Crohn's and ulcerative colitis should be implemented in our clinical practice. Finally, the introduction of biological therapy (infliximab, adalimumab) has improved treatment options in the management of inflammatory bowel disease.
Before starting or changing treatment for Crohn's disease, the physician should assess the patient well, with a complete medical history including age of onset, duration, extent and course of disease, previous and current medications, response to each intervention, previous surgeries and current status of symptoms. Additionally, you must have recent colonoscopy bowel movement and to define extent, severity and rule out complications such as fistulas, strictures, and exclude drug and infectious causes of colitis (1).
The guidelines of the American College of Gastroenterology (ACG) (2) describe criteria to define the clinical activity of Crohn's disease and recommend using it to establish severity in these patients. This classification is important to define whether the patient is hospitalized and does require management with intravenous steroids. Unlike the above, there is an activity index of Crohn's disease (CDAI), which is used to measure efficacy of medical therapy, particularly in research studies.
Note: Referral: CDAI <150, light activity: CDAI 150-219, moderate: CDAI: 220-450, severe activity: CDAI> 450.
The goal in managing these patients is to induce and maintain clinical remission, and possibly achieve endoscopic remission of the disease. The drugs used for the management of Crohn's disease, as indicated below.
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