AGA updates Crohn's disease treatment guidelines

Kathleen Blanchard's picture
New guidelines for Crohn's disease issued
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The American Gastroenterological Association (AGA) has release new evidence based guidelines for treating Crohn's disease that are the first to make specific medication recommendations.

The recommendations were formed from a review of risks and benefits, clinical evidence and patient preferences.

"Crohn's disease is a lifelong, relapsing disorder that can damage the bowel and lead to multiple abdominal operations over time. Deciding which medications are the best is a common dilemma for gastroenterologists and the Crohn's patients we treat. The disease can be disabling, but the drugs to control the disease can be toxic too and they can be costly," said Jonathan P. Terdiman, MD, lead author of the guidelines, and Chief of the Gastroenterology Service at the University of California, San Francisco Medical Center. "The new AGA guideline and clinical decision support tool will ease the decision process by providing transparent and actionable recommendations," Terdiman adds.

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Biological agents for Crohn's disease remission come first

The guidelines are as follows:

  • For active cases of Crohn's disease that are moderately severe anti-TNF-α drugs are recommended. The drugs are biological agents that block activity of the immune system that leads to Crohn's and other diseases. Examples include Remicade and Enbrel that are perhaps the most popularly prescribed treatment for the inflammatory bowel disease (IBD).
  • The guidelines also suggest anti-TNF-α drugs over thiopurines that are used to treat Crohn's disease when cases are moderately severe as a single therapy. Popular thiopurine examples include Azasan® and Imuran®.
  • The groups suggests a combination of anti-TNF-α drugs and thiopurines could also be used for moderately severe Crohn's disease treatment.

For people whose Crohn's disease is in remission:

  • Drugs like Imuran and Azasan that are called immunumodulators should supercede the use of anti-TNF -α agents once remission is achieved from steroids or the biological agents suggested above.
  • The guidelines also advise against methotrexate for inducing remission of Crohn's disease that is moderately severe.
  • Standard therapy should include mesalamine, antibiotics, steroids and immunumodulators

You can read the new guidelines for Crohn's disease treatment here.

Image credit: Wikimedia Commons

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Comments

I have severe crohns disease just wondering if I would be able to qualify for disability insurance
It is extremely difficult to be approved for disability w ibd. I had emergency surgery for a herniated bowel. Spent 6 weeks in the hospital, total of 3 major surgeries, battled sepsis, & was discharged w a picc line for twice daily IV antibiotics, 2 large abdominal drains & an ostomy. Plus I had dropped to 88 lbs & started receiving TPN. I could check off just about every IBD ailment on SSA's list of qualifying diseases and yet, I was denighed twice. So, now im working w the judge... its been 2.5 years!
Jody, first, I'm sorry you are dealing with this. To know if you would qualify you can fill out an online form at SocialSecurityandDisability.com. You can also call to speak with someone at your local Social Security office. Keep records of your symptoms and medications and response to your meds also, especially when meds, doctor visits, treatments, hospitalizations and symptoms interfere with your ability to work. If you are not participating in an online forum, you may want to do that to ask others about their own experience and whether anyone else has received disability. Best to you.
Hi sorry for the last post that was suppose to go to a lawyer. I do have a question though I was told I have 5 fistulas and the doctor stated that I need setons placed and possible starting Remicade. My question is I am a travel sleep tech and need to work to keep my insurance up and hopefully will be starting a new contract mid Jan. If I don't get the setons placed asap what would happen? thank you for all the input you can give me
Hi Jody. Since your doctor is the only one who has seen you it really is best to ask that question directly from your health care provider. I would think having the setons placed would improve things and not prevent you from working except for some recovery time. Don't forget you can always take medical leave of absence and still maintain insurance and other benefits until you can again travel. You can postpone your January contract. I traveled as a nurse and when my father died I had to leave. Most contracts allow for an extension - the idea is that you fulfill the amount of contract time and sometimes that is interrupted. Emergencies happen and other life events. Speak with the contracting agency about options. I feel certain it can be worked out.
Thank you Kathleen I will do that