Management of Crohn ’ s Disease in Adults

© 2009 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY INTRODUCTION Crohn ’ s disease (CD) encompasses a multisystem group of disorders with speci c clinical and pathological features characterized by focal, asymmetric, transmural, and, occasionally, granulomatous in ammation primarily a ecting the gastrointestinal (GI) tract. $ is multisystem disorder with potential for systemic and extraintestinal complications (1) can a ect any age group, but the onset (diagnosis) is most common in the second and third decades (teenagers and young adults). $ e incidence and prevalence of CD in the United States are rising for reasons that are unclear. $ e incidence and prevalence of CD in the United States are similar to other “ Westernized ” countries, and estimated to be 5 / 100,000 and 50 / 100,000, respectively (2) . It is important to di erentiate CD from other in ammatory bowel diseases that can simulate or complicate its clinical course (1) . CD is a chronic in ammatory disorder that is neither medically nor surgically “ curable, ” requiring therapeutic approaches to induce and maintain symptomatic control, improve quality of life, and minimize shortand longterm toxicity and complications (3) . Newer goals of therapy include the induction and maintenance of mucosal (and histologic) healing (4,5) that are beginning to translate into changing the “ natural history ” of CD (6) . Despite the relatively low incidence and prevalence of CD compared with more common GI disorders, the cost of medical and surgical therapy for patients with CD is estimated to be up to US $ 2 billion annually in the United States and is increasing with the advent of newer biological approaches (7,8) . Estimates of hospitalization rates for CD are di: cult to estimate for the US population. $ e most recent data are from 1998 and have been extrapolated to US dollars in 2000. $ e total direct and indirect costs for CD in the US were estimated at US $ 826 million and based on 84,000 in-patient hospital days and 1.3 million outpatient visits (9) . Once patients are started on corticosteroids, up to 38 % of patients will require surgery within 1 year therea> er (10) , Management of Crohn ’ s Disease in Adults