Are we ready for top-down therapy for inflammatory bowel diseases: con

Abstract

The main goal of the therapy of inflammatory bowel diseases is the induction and maintenance of disease remission. Whereas the standard medical approach is guided by the clinical symptoms and concurrent therapy of the patients (‘step-up’ approach), a new evolving concept for patients with Crohn’s disease is trying to modify the disease course by treating intestinal inflammation early and very aggressively with anti-TNF therapy and immunosuppressive agents, such as azathioprine (‘top-down’ approach). This review discusses the background of this new approach in Crohn’s disease and places the first available clinical results of ‘top-down’ therapy into perspective with available data on potential adverse effects, the natural course and the therapeutic goal of mucosal healing in Crohn’s disease.