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Henry Ford Hospital Medical Journal

Abstract

Progress in the management of Crohn's disease is limited by our inability to compare different patients. Two methods of evaluating the severity of disease have recently been published. Of these, the National Cooperative Crohn's Disease Study (NCCDS) method has been utilized in a study reported on at several national meetings but still in progress. Antibiotics in intensive prolonged dosage, e.g. ampicillin, 500 mg qid for several months, have recently been reported to benefit greater than 90% of patients not responding to conventional therapy. Metronidazole and dapsone continue to be mentioned in letters to journals. Sulfasalazine has been found useful in active small intestinal as well as colonic Crohn's in the NCCDS, although not in preventing relapses. Corticosteroids have been shown to be of value in active Crohn's but not in asymptomatic patients. A new preparation is parenteral coherin, a peptide from bovine posterior pituitary. In a study of 19 critically ill Crohn's patients, it reduced or eliminated steroids in 14 cases. Immunosuppressants continue to have indefinite support. The NCCDS showed no definite benefit, yet adherents persist. Immunostimulants, in the light of recent T-cell deficiency, warrant consideration, and preliminary reports are interesting. Elemental diets and total parenteral nutrition have been reported to induce remissions, but recurrences have followed. Surgical indications have been significantly correlated statistically with features associated with different clinical groups, small intestinal, ileocolic, and colic. IIeorectostomy has been found useful in a small group of patients, while hemorrhoid treatment has been shown to have more complications in Crohn's than in CUC.

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