A gyulladásos bélbetegségek kezelésének alapszerei az aminoszalicilátok, amelyeket enyhébb betegségben és a fenntartó kezelésben, a szteroidok, amelyeket súlyosabb aktív betegségben, továbbá az immunszuppresszív szerek és az antibiotikumok, amelyeket súlyosabb betegségekben, valamint a szövődmények kezelésére évtizedek óta használunk. A Crohn-betegség kezelése jelentősen változott az elmúlt években. Az újabb nagy klinikai tanulmányok, metaanalízisek tükrében a régóta alkalmazott szerek értékét, indikációját újraértékelték. Az aminoszalicilátok szerepe mindinkább háttérbe szorul az utóbbi években az aktív betegség kezelésében, de különösen a remisszió fenntartásában. Az aktív, mérsékelten súlyos ileocoecalis betegség kezelésében az aminoszalicilátok és hagyományos szteroidok helyett dominálóvá válik a budesonidkezelés. A vastagbél aktív betegségében az aminoszalicilátok szerény szerepe mellett a hagyományos szteroidok megtartották a helyüket. Súlyosabb betegségben és még inkább a fenntartó terápiában ugyanakkor egyre inkább előtérbe kerül az immunszuppresszív szerek, főként az azathioprin korai és mind kiterjedtebb alkalmazása. Más stratégiát igényel a remisszió fenntartása gyógyszeresen és reszekciós műtéttel elért remisszió esetén. Változott a konzervatív és a sebészi kezelés viszonya is. A változás talán legfőbb tényezője, hogy megjelentek a kezelésben az új, ún. biológiai szerek, amelyek egyre hatékonyabbak a korábban gyógyszeres kezelésre rezisztens esetekben, valamint a fistulosus betegség kezelésében.
Stange, E. F., Travis, S. P. L., Vermeire, S. és mtsai: European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut, 2006, 55 (Suppl. 1) , i1–i15.
Vermeire S. , 'European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis ' (2006 ) 55 Gut : i1 -i15 .
Travis, S. P. L., Stange, E. F., Lémann, M. és mtsai: European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut, 2006, 55 (Suppl. 1) , i16–i35.
Lémann M. , 'European evidence based consensus on the diagnosis and management of Crohn’s disease: current management ' (2006 ) 55 Gut : i16 -i35 .
Nagy F.: Gyulladásos bélbetegségek konzervatív kezelése. Orv. Hetil., 2002, 143 , 2763–2768.
Nagy F. , 'Gyulladásos bélbetegségek konzervatív kezelése ' (2002 ) 143 Orv. Hetil. : 2763 -2768 .
Silverberg, M. S., Satsangi, J., Ahmad, T. és mtsai: Toward an integrated clinical, molecular, and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can. J. Gastroenterol., 2005, 19 (Suppl.) , 5A–36A.
Ahmad T. , 'Toward an integrated clinical, molecular, and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology ' (2005 ) 19 Can. J. Gastroenterol. : 5A -36A .
Hanauer, S. B.: Crohn’s disease: step up or top down therapy. Best. Practice Res., 2003, 17 , 131–137.
Hanauer S. B. , 'Crohn’s disease: step up or top down therapy ' (2003 ) 17 Best. Practice Res. : 131 -137 .
Malchow, H., Ewe, K., Brandes, J. W. és mtsai: European co-operative Crohn’s disease study (ECCDS): results of drug treatment. Gastroenterology, 1984, 86 , 249–266.
Brandes J. W. , 'European co-operative Crohn’s disease study (ECCDS): results of drug treatment ' (1984 ) 86 Gastroenterology : 249 -266 .
Hanauer, S. B., Strömberg, U.: Oral Pentasa in the treatment of active Crohn’s disease: a meta-analysis of double-blind, placebo-controlled trials. Clin. Gastroenterol. Hepatol., 2004, 2 , 379–388.
Strömberg U. , 'Oral Pentasa in the treatment of active Crohn’s disease: a meta-analysis of double-blind, placebo-controlled trials ' (2004 ) 2 Clin. Gastroenterol. Hepatol. : 379 -388 .
Otley, A., Steinhart, A. H., Otley, A.: Budesonide for induction of remission for active Crohn’s disease. Cochrane Library, 4 , Chichester, Wiley, 2005.
Otley A. , '', in Budesonide for induction of remission for active Crohn’s disease , (2005 ) -.
Sutherland, L. R., Singleton, J., Sessions, J. és mtsai: Blind, placebo-controlled trial of metronidazole in Crohn’s disease. Gut, 1991, 32 , 1071–1075.
Sessions J. , 'Blind, placebo-controlled trial of metronidazole in Crohn’s disease ' (1991 ) 32 Gut : 1071 -1075 .
Summers, R. W., Switz, D. M., Sessions, J. T. és mtsai: National co-operative Crohn’s disease study group: results of drug treatment. Gastroenterology, 1979, 77 , 847–869.
Sessions J. T. , 'National co-operative Crohn’s disease study group: results of drug treatment ' (1979 ) 77 Gastroenterology : 847 -869 .
Munkholm, P., Langholz, E., Davidsen, M. és mtsa: Frequency of glucocorticoid resistance and dependency in Crohn’s disease. Gut, 1994, 35 , 360–362.
Davidsen M. , 'Frequency of glucocorticoid resistance and dependency in Crohn’s disease ' (1994 ) 35 Gut : 360 -362 .
Sandborn, W. J., Sutherland, L., Pearson, D. és mtsai: Azathioprine or 6-mercaptopurine for inducing remission of Crohn’s disease. Cochrane Library, 2, John Wiley & Sons, Ltd., Chichester, UK, 2000.
Pearson D. , '', in Azathioprine or 6-mercaptopurine for inducing remission of Crohn’s disease , (2000 ) -.
Markowitz, J., Grancher, K., Kohn, S. és mtsai: A multicenter trial of 6-mercaptopurine and prednisolone in children with newly diagnosed Crohn’s disease. Gastroenterology, 2000, 119 , 895–902.
Kohn S. , 'A multicenter trial of 6-mercaptopurine and prednisolone in children with newly diagnosed Crohn’s disease ' (2000 ) 119 Gastroenterology : 895 -902 .
Feagan, B. G., Rochan, J., Fedorak, R. N. és mtsai: Methotrexate in the treatment of Crohn’s disease. N. Engl. J. Med., 1995, 332 , 292–297.
Fedorak R. N. , 'Methotrexate in the treatment of Crohn’s disease ' (1995 ) 332 N. Engl. J. Med. : 292 -297 .
Targan, S. R., Hanauer, S. B., van Deventer, S. J. és mtsai (Crohn’s Disease cA2 Study Group): A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. N. Engl. J. Med., 1997, 337 , 1029–1035.
Deventer S. J. , 'A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease ' (1997 ) 337 N. Engl. J. Med. : 1029 -1035 .
Rutgeerts, P., Van Assche, G., Vermeire, S.: Optimising anti-TNF treatment in inflammatory bowel disease. Gastroenterology, 2004, 126 , 1593–1610.
Vermeire S. , 'Optimising anti-TNF treatment in inflammatory bowel disease ' (2004 ) 126 Gastroenterology : 1593 -1610 .
Colombel, J. F., Loftus, E. V. Jr., Tremaine, W. J. és mtsai: The safety profile of infliximab in patients with Crohn’s disease: the mayo clinic experience in 500 patients. Gastroenterology, 2004, 126 , 19–31.
Tremaine W. J. , 'The safety profile of infliximab in patients with Crohn’s disease: the mayo clinic experience in 500 patients ' (2004 ) 126 Gastroenterology : 19 -31 .
Zachos, M., Tondeuer, M., Griffith, A. M.: Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochran Database Syst. Rev., 2001, 3 , CD000542.
Griffith A. M. , 'Enteral nutritional therapy for induction of remission in Crohn’s disease ' (2001 ) 3 Cochran Database Syst. Rev. : CD000542 -.
Farmer, R. G., Whelan, G., Fazio, V. W.: Long-therm follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis. Gastroenterology, 1985, 88 , 1818–1825.
Fazio V. W. , 'Long-therm follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis ' (1985 ) 88 Gastroenterology : 1818 -1825 .
Lakatos P. L., Szalay F., Tulassay Z. és mtsai: Clinical presentation of Crohn’s disease: Association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery. Hepatogastroenterology, 2005, 52 , 17–22.
Tulassay Z. , 'Clinical presentation of Crohn’s disease: Association between familial disease, smoking, disease phenotype, extraintestinal manifestations and need for surgery ' (2005 ) 52 Hepatogastroenterology : 17 -22 .
Cosnes, J., Nion-Larmurier, I., Afchain, P. és mtsai: Gender differences in the response of colitis to smoking. Clin. Gastroenterol. Hepatol., 2004, 2 , 41–48.
Afchain P. , 'Gender differences in the response of colitis to smoking ' (2004 ) 2 Clin. Gastroenterol. Hepatol. : 41 -48 .
Steinhart, A. H., Hemphill, D., Greenberg, G. R.: Sulfasalazine and mesalazine for the maintenance therapy of Crohn’s disease: a meta-analysis. Am. J. Gastroenterol., 1994, 89 , 2116–2124.
Greenberg G. R. , 'Sulfasalazine and mesalazine for the maintenance therapy of Crohn’s disease: a meta-analysis ' (1994 ) 89 Am. J. Gastroenterol. : 2116 -2124 .
Cammà, C., Giunta, M., Rosselli, M. és mtsai: Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology, 1997, 113 , 1465–1473.
Rosselli M. , 'Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables ' (1997 ) 113 Gastroenterology : 1465 -1473 .
Akobeng, A. K., Gaedener, E.: Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s disease. Cochran Database Syst. Rev., 2005, 1 , CD003715.
Gaedener E. , 'Oral 5-aminosalicylic acid for maintenance of medically-induced remission in Crohn’s disease ' (2005 ) 1 Cochran Database Syst. Rev. : CD003715 -.
Steinhart, A. H., Ewe, K., Griffith, A. M. és mtsai: Corticosteroids for maintaining remission in Crohn’s disease. Cochran Database Syst. Rev., 2003, 4 , CD000301.
Griffith A. M. , 'Corticosteroids for maintaining remission in Crohn’s disease ' (2003 ) 4 Cochran Database Syst. Rev. : CD000301 -.
Sandborn, W. J., Löfberg, R., Feagan, B. G. és mtsai: Budesonid for maintenance of remission in patients with Crohn’s disease in medically induced remission: a predeterminated pooled analysis of four randomized, double-blind, placebo-controlled trials. Am. J. Gastroenterology, 2005, 100 , 1780–1787.
Feagan B. G. , 'Budesonid for maintenance of remission in patients with Crohn’s disease in medically induced remission: a predeterminated pooled analysis of four randomized, double-blind, placebo-controlled trials ' (2005 ) 100 Am. J. Gastroenterology : 1780 -1787 .
Pearson, D. C., May, G. R., Fick, G. és mtsa: Azathioprine for maintenance of remission in Crohn’s disease. Cochrane Database Syst. Rev., 1998, 4 , CD000067.
Fick G. , 'Azathioprine for maintenance of remission in Crohn’s disease ' (1998 ) 4 Cochrane Database Syst. Rev. : CD000067 -.
Lémann, M., Mary, J.-Y., Colombel, J.-F. és mtsai: A randomized, double blond, controlled withdrawal trial in Crohn’s disease patients in long-term remission on azathioprin. Gastroenterology, 2005, 128 , 1812–1818.
Colombel J.-F. , 'A randomized, double blond, controlled withdrawal trial in Crohn’s disease patients in long-term remission on azathioprin ' (2005 ) 128 Gastroenterology : 1812 -1818 .
Feagan, B., Fedorak, R. N., Irvine, E. J., és mtsai (North American Crohn’s Study Group Investigators): A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. N. Engl. J. Med., 2000, 342 , 1627–1632.
Irvine E. J. , 'A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease ' (2000 ) 342 N. Engl. J. Med. : 1627 -1632 .
Hanauer, S. B., Feagan, B. G., Lichtenstein, G. R. és mtsai: Maintenance infliximab in Crohn’s disease: the ACCENT1 randomised trial. Lancet, 2002, 359 , 1541–1549.
Lichtenstein G. R. , 'Maintenance infliximab in Crohn’s disease: the ACCENT1 randomised trial ' (2002 ) 359 Lancet : 1541 -1549 .
Rolfe, V. E., Fortun, P. J., Hawkey, C. J. és mtsa: Probiotics for maintenance of remission in Crohn’s disease. Cochran Database Syst. Rev., 2006, 4 , CD004826.
Hawkey C. J. , 'Probiotics for maintenance of remission in Crohn’s disease ' (2006 ) 4 Cochran Database Syst. Rev. : CD004826 -.
Rutgeerts, P.: Crohn’s disease recurrence can be prevented after ileal resection. Gut, 2002, 51 , 152–154.
Rutgeerts P. , 'Crohn’s disease recurrence can be prevented after ileal resection ' (2002 ) 51 Gut : 152 -154 .
Caprilli, M., Gassull, M. A., Escher, J. C. és mtsai: European evidence based consensus on the diagnosis and management of Crohn’s disease: Special situations. Gut, 2006, 55 (Suppl. 1) , i36–i48.
Escher J. C. , 'European evidence based consensus on the diagnosis and management of Crohn’s disease: Special situations ' (2006 ) 55 Gut : i36 -i48 .
Lémann, M., Mary, J. Y., Colombel, J.-F. és mtsai: A randomized, double-blind, controlled withdrawal trial in Crohn’s disease patients in long-term remission with azathioprine. Gastroenterology, 2005, 128 , 1812–1818.
Colombel J.-F. , 'A randomized, double-blind, controlled withdrawal trial in Crohn’s disease patients in long-term remission with azathioprine ' (2005 ) 128 Gastroenterology : 1812 -1818 .
McLeod, R. S., Wolff, B. G., Steinhart, A. H. és mtsai: Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease. Gastroenterology, 1955, 109 , 404–403.
Steinhart A. H. , 'Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease ' (1955 ) 109 Gastroenterology : 404 -403 .
Lochs, H., Mayer, M., Fleig, W. E. és mtsai: Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s disease study VI. Gastroenterology, 2000, 118 , 264–273.
Fleig W. E. , 'Prophylaxis of postoperative relapse in Crohn’s disease with mesalamine: European Cooperative Crohn’s disease study VI ' (2000 ) 118 Gastroenterology : 264 -273 .
Cammà, C., Viscido, A., Latella, G. és mtsai: Mesalamine in the prevention of clinical and endoscopic postoperative recurrence of Crohn’s disease: a meta-analysis. Dig. Liver. Dis., 2002, 34 , A86.
Latella G. , 'Mesalamine in the prevention of clinical and endoscopic postoperative recurrence of Crohn’s disease: a meta-analysis ' (2002 ) 34 Dig. Liver. Dis. : A86 -.
Rutgeerts, P., Hiele, M., Geboes, K. és mtsai: Controlled trial of metronidasole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology, 1995, 108 , 1617–1621.
Geboes K. , 'Controlled trial of metronidasole treatment for prevention of Crohn’s recurrence after ileal resection ' (1995 ) 108 Gastroenterology : 1617 -1621 .
Hanauer, S. B., Korelitz, B. I., Rutgeerts, P. és mtsai: Post-operative maintenance of Crohn’s disease remission with 6-mercaptopurinemesalamine or placebo: a 2-year trial. Gastroenterology, 2004, 127 , 723–729.
Rutgeerts P. , 'Post-operative maintenance of Crohn’s disease remission with 6-mercaptopurinemesalamine or placebo: a 2-year trial ' (2004 ) 127 Gastroenterology : 723 -729 .
Ardizzone, S., Maconi, G., Sampietro, G. M. és mtsai: Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease. Gastroenterology, 2004, 127 , 730–737.
Sampietro G. M. , 'Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease ' (2004 ) 127 Gastroenterology : 730 -737 .
Aberra, F. N., Lewis, J. D., Hass, D. és mtsai: Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology, 2003, 125 , 320–327.
Hass D. , 'Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients ' (2003 ) 125 Gastroenterology : 320 -327 .
Colombel, J. F., Loftus, E. V. Jr., Tremaine, W. J. és mtsai: Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunsuppressive therapy. Am. J. Gastroenterol., 2004, 99 , 878–883.
Tremaine W. J. , 'Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunsuppressive therapy ' (2004 ) 99 Am. J. Gastroenterol. : 878 -883 .
Prantera, C., Scribano, M. L., Falasco, G. és mtsai: Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG . Gut, 2002, 51 , 405–409.
Falasco G. , 'Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG ' (2002 ) 51 Gut : 405 -409 .
Schwartz, D. A., Loftus, E. V., Tremaine, W. J. és mtsai: The natural history of fistulizing Crohn’s disease in Olmsted county, Minnesota. Gastroenterology, 2002, 122 , 875–880.
Tremaine W. J. , 'The natural history of fistulizing Crohn’s disease in Olmsted county, Minnesota ' (2002 ) 122 Gastroenterology : 875 -880 .
Sandborn, W. J., Fazio, V. W., Feagan, B. G. és mtsa: AGA technical review on perianal Crohn’s disease. Gastroenterology, 2003, 125 , 1508–1530.
Feagan B. G. , 'AGA technical review on perianal Crohn’s disease ' (2003 ) 125 Gastroenterology : 1508 -1530 .
Korelitz, B. I., Adler, D. J., Mendelsohn, R. A. és mtsa: Long-term experience with 6-mercaptopurine in the treatment of Crohn’s disease. Am. J. Gastroenterol., 1993, 88 , 1198–1205.
Mendelsohn R. A. , 'Long-term experience with 6-mercaptopurine in the treatment of Crohn’s disease ' (1993 ) 88 Am. J. Gastroenterol. : 1198 -1205 .
Present, D. H., Rutgeerts, P., Targan, S. és mtsai: Infliximab for the treatment of fistulas in patients with Crohn’s disease. N. Engl. J. Med., 1999, 340 , 132–142.
Targan S. , 'Infliximab for the treatment of fistulas in patients with Crohn’s disease ' (1999 ) 340 N. Engl. J. Med. : 132 -142 .
Sands, B. E., Anderson, F. H., Bernstein, C. N. és mtsai: Infliximab maintenance therapy for fistulizing Crohn’s disease. N. Engl. J. Med., 2004, 350 , 876–885.
Bernstein C. N. , 'Infliximab maintenance therapy for fistulizing Crohn’s disease ' (2004 ) 350 N. Engl. J. Med. : 876 -885 .
Tremaine, W. J.: Gastroduodenal Crohn’s disease: medical management. Inflamm. Bowel. Dis., 2003, 9 , 127–128.
Tremaine W. J. , 'Gastroduodenal Crohn’s disease: medical management ' (2003 ) 9 Inflamm. Bowel. Dis. : 127 -128 .