Top-Down Therapy for Crohn's Disease: Rationale and Evidence (Congress Paper) (Disease/Disorder Overview) (Report‪)‬

INTRODUCTION Inflammatory bowel diseases are chronic, immune mediated inflammatory disorders of the gastrointestinal tract, that are usually classified into two major conditions, Crohn's disease and ulcerative colitis. The inflammation in Crohn's disease is typically focal and transmural and it can affect any part of the gastrointestinal tract, although in most cases the disease is located in terminal ileum and/or colon. In the early phase of Crohn's disease, the disease pathology is predominantly inflammatory resulting in intermittent symptoms of diarrhea and abdominal pain(l). In the late phase of Crohn's disease and as a consequence of transmural inflammation, the disease pathology often leads to complications such as stricture, perforation, and fistula formation that often need surgical treatment. Following surgical resection, recurrence of Crohn's disease is virtually inevitable (2). Thus, the natural history of Crohn's disease over the longer term can be characterized as chronic, progressive and destructive, eventually leading to irreversible structural damage to the bowel and loss of intestinal function. Examples of loss of intestinal function include bile salt diarrhea, steatorrhea, vitamin and mineral deficiencies, anemia, short bowel syndrome with dehydration and malnutrition, stoma, and loss of continence.