Clinical and Experimental Gastroenterology (Mar 2024)
Optimal Management of Refractory Crohn’s Disease: Current Landscape and Future Direction
Abstract
Kate E Lee,1 Violet Y Tu,1 Adam S Faye2 1Department of Medicine, Duke University School of Medicine, Durham, NC, USA; 2Department of Gastroenterology, New York University School of Medicine, New York, NY, USACorrespondence: Adam S Faye, Medicine & Population Health, NYU Langone Division of Gastroenterology, New York University, 303 East 33rd Street, New York, NY, 10016, USA, Tel +1 (855) 698-4232, Fax +1 212-263-3096, Email [email protected]: Refractory Crohn’s disease, defined as ongoing inflammation despite the trial of multiple advanced therapies, impacts a number of individuals with Crohn’s disease, and leads to significant burden in quality of life and cost. Interventions such as early implementation of advanced therapies, optimization of current therapies prior to switching to an alternative, as well as understanding the overlapping pathophysiology between immune-mediated disorders, however, can help shift the current landscape and reduce the number of patients with refractory disease. As such, in this review we summarize the key takeaways of the latest research in the management of moderate-to-severe Crohn’s disease, focusing on maximization of our currently available medications, while also exploring topics such as combination advanced therapies. We also describe evidence for emerging and alternative therapeutic modalities, including fecal microbiota transplant, exclusive enteral feeding, hyperbaric oxygen, stem cell therapy, bone marrow transplant, and posaconazole, with a focus on both the potential impact and specific indications for each.Keywords: Crohn’s disease, surgery, advanced therapies, biologics
