Claytor Jennifer, Kumar Pushkar, Ananthakrishnan Ashwin N, Colombel Jean-Frederic, Agrawal Manasi, Ungaro Ryan C
The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
Center for Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Curr Gastroenterol Rep. 2023 Mar;25(3):45-51. doi: 10.1007/s11894-023-00863-y. Epub 2023 Feb 8.
Crohn's Disease (CD) is a chronic inflammatory disease that can lead to progressive damage to the gastrointestinal tract and significant disability. Early, "top-down" biologic therapy is recommended in moderate-to-severe CD to induce remission and to prevent hospitalization and complications. However, an estimated 20-30% of patients with CD have a mild disease course and may not garner sufficient benefit from expensive, immunosuppressing agents to justify their risks. Herein, we review characteristics of patients with mild CD, the available options for disease treatment and monitoring, and future directions of research.
For ambulatory outpatients with low-risk, mild, ileal or ileocolonic CD, induction of remission with budesonide is recommended. For colonic CD, sulfasalazine is a reasonable choice, although other aminosalicylates have no role in the treatment of CD. No large, randomized trial has supported the use of antibiotics or antimycobacterials in the treatment of CD. Partial Enteral Nutrition and Crohn's Disease Exclusion Diets may be appropriate for inducing remission in some adult patients, with trials ongoing. Select patients with mild-to-moderate CD may benefit from maintenance therapy with azathioprines or gut specific biologics, such as vedolizumab. The role of complementary and alternative medicine is not well defined. The identification, risk stratification, and monitoring of patients with mild CD can be a challenging clinical scenario. Some patients with low risk of disease progression may be appropriate for initial induction of remission with budesonide or sulfasalazine, followed by close clinical monitoring. Future research should focus on pre-clinical biomarkers to stratify disease, novel therapies with minimal systemic immune suppression, and validation of rigorous clinical monitoring algorithms.
克罗恩病（CD）是一种慢性炎症性疾病，可导致胃肠道进行性损伤并造成严重残疾。对于中度至重度CD，推荐早期“自上而下”的生物疗法以诱导缓解并预防住院和并发症。然而，估计有20%-30%的CD患者病程较轻，可能无法从昂贵的免疫抑制剂中获得足够的益处来证明其风险是合理的。在此，我们综述轻度CD患者的特征、疾病治疗和监测的可用选项以及未来的研究方向。
对于低风险、轻度、回肠或回结肠型CD的门诊患者，推荐使用布地奈德诱导缓解。对于结肠型CD，柳氮磺胺吡啶是一个合理的选择，尽管其他氨基水杨酸类药物在CD治疗中没有作用。尚无大型随机试验支持使用抗生素或抗分枝杆菌药物治疗CD。部分肠内营养和克罗恩病排除饮食可能适合诱导一些成年患者缓解，相关试验正在进行中。部分轻度至中度CD患者可能从硫唑嘌呤或肠道特异性生物制剂（如维多珠单抗）的维持治疗中获益。补充和替代医学的作用尚不明确。识别、风险分层和监测轻度CD患者可能是一个具有挑战性的临床情况。一些疾病进展风险低的患者可能适合先用布地奈德或柳氮磺胺吡啶诱导缓解，然后进行密切的临床监测。未来的研究应集中在用于疾病分层的临床前生物标志物、全身免疫抑制最小的新型疗法以及严格临床监测算法的验证上。
