Child Health 4 - Alfie

Crohn’s disease:

Treatment to induce remission includes:  

   1. Exclusive enteral nutrition (EEN) for 6 weeks then reintroduce food.

   2. Steroids

Treatment to maintain remission includes:

   1. Aminosalicylates

   2. Thiopurines (Mercaptopurine/azathioprine (for severe disease at diagnosis or >2 flares in a year)

   3. Anti TNF agents – Infliximab/Adalimumab

   4. Methotrexate (consider risk of pregnancy in teenage girls)

   5. Surgery reserved for complications – e.g. abscess, fistula, strictures

Ulcerative colitis:

Mild to left sided UC

   1. Oral mesalazine

   2. Oral steroids

   3. Mesalazine or prednisolone enemas can be offered in distal disease but compliance is usually an issue.

Moderate to severe UC

   1. Corticosteroids

   2. Cyclosporin

   3. Anti TNF agents – Infliximab

N.B. Exclusive enteral nutrition is not effective in UC. Surgery is curative (but think of long-term diarrhoea)