Steroid resistant crohn's disease

Braun et al (2002) reported the results of a 12-week randomized placebo-controlled clinical trial involving 35 patients with active ankylosing spondylitis treated with intravenous 5 mg/kg infliximab infusion (at weeks 0, 2 and 6) and 35 patients assigned to placebo.  Eighteen (53 %) of 34 patients on infliximab had a regression of disease activity at week 12 of at least 50 % compared with 3 (9 %) of 35 on placebo (difference 44 % (95 % confidence interval [CI]: 23 to 61, p < ).  Function and quality of life also improved significantly on infliximab but not on placebo (p < and p < , respectively).  The investigators reported that treatment with infliximab was generally well-tolerated, but 3 patients had to stop treatment because of systemic tuberculosis, allergic granulomatosis of the lung, or mild leucopenia.

Many diets have been proposed for the management of Crohn's disease, and many do improve symptoms, but none have been proven to cure the disease. [30] The specific carbohydrate diet usually requires adjustments by patients; if a patient finds that certain foods increase or decrease symptoms, they may adjust their diet accordingly. A food diary is recommended to see what positive or negative effects particular foods have. A low residue diet may be used to reduce the volume of stools excreted daily. People with lactose intolerance due to small bowel disease may benefit from avoiding lactose -containing foods. Patients who cannot eat may be given total parenteral nutrition (TPN), a source of vitamins and nutrients.

Clinical Editor's comments (October 2017)
Dr Hayley Willacy recently read a paper looking at lifetime risks of cancer in children who are diagnosed as having inflammatory bowel disease in childhood [ 21 ]  . This group has an increased risk of cancer, especially gastrointestinal cancers, both in childhood and later in life. The increase persists into adulthood, and has not fallen since the introduction of modern drug therapies for inflammatory bowel disease. However, the researchers stress that absolute risks are low - corresponding to one extra case of cancer for every 556 patients with inflammatory bowel disease followed for a year, compared with healthy individuals.

Steroid resistant crohn's disease

steroid resistant crohn's disease


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