Until a cure for Crohn's disease(s) is found, strategies that prolong the time spent in remission offer the greatest hope for reducing the morbidity and significant social costs associated with the disease. Medical therapy to date has been disappointing, and the search for a safe, effective therapy that could be offered at low cost continues. The aminosalicylates, so effective in ulcerative colitis, have shown, at best, minimal efficacy in maintaining remission in Crohn's disease. Conventional corticosteroids are not effective, and any reduction in time to relapse for budesonide-treated patients is measured in weeks not months. Azathioprine, 6-mercaptopurine, and methotrexate are effective in maintaining remission, but all three have significant side effects. Antibiotics may have a role to play. Biological therapy may be considered, but the issues of cost and long-term safety require evaluation. Future studies should segregate patients into two groups, those with a medically induced remission and patients whose concern is the prevention of postoperative recurrence. Key Words: Crohn's disease, prevention of relapse in-Crohn's disease, medications-Crohn's disease, treatment.
Crohn's disease (CD), like many other chronic disorders, follows an erratic clinical course often punctuated by frequent exacerbations. Treatment generally provides only temporary relief. After medically induced remissions, relapse of symptoms occurs in up to 80% of patients (1,2). Up to 74% of patients eventually require surgery (3). After surgical resection of grossly involved tissue, 73-93% of patients exhibit recurrent abnormalities at endoscopy within 1 year and 3 4 6 8 % will suffer symptomatic relapse within 3 years ( 4 3 , which may necessitate at least one more operation.
The return of symptoms is not only immediately