| [ Summary ] |
Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disorder affecting the gastrointestinal system, and it does not respond well to medications, often leading to irreversible complications. However, after the development of anti‒tumor necrosis factor (TNF)‒α biologics, the therapeutic strategy for CD has significantly changed. Previously, the goal of treatment would be to induce remission or control the symptoms, whereas currently, the major therapeutic goal is to achieve mucosal healing and sustained remission. The "Top‒down" therapy that introduces an anti‒TNF‒α biologic early after the diagnosis of CD is intended to induce rapid and sustained remission together with mucosal healing without waiting for the therapeutic effect of slow‒acting conventional medications like corticosteroids. However, in the clinical management of first‒episode CD cases, physicians should use a therapeutically relevant dose of an anti‒TNF‒α biologic after a very thorough evaluation for possible intestinal tract complications, including the presence of stenosis and fistulas in addition to the CD activity index. |