Treatment

The aim of therapy includes relief of symptoms, suppression of the inflammatory disease, treatment of complications, and maintenance of nutrition. In a disease that is virtually incurable, the emphasis should be on relief of symptoms and avoidance of complications. The pharmacologic agents available for the management of Crohn's disease include symptomatic agents, anti-inflammatory agents, antibiotics, and immunomodulators.

Initial evaluation in the emergency department (ED) should focus on determining the severity of the attack; identifying significant complications such as obstruction, intraabdominal abscess, life-threatening hemorrhage, or toxic megacolon; and eliminating other possible causes of the patient's complaints. Laboratory evaluation should include a CBC, serum electrolytes, BUN, creatinine, and a type and cross-match where appropriate. Plain radiographs of the abdomen may reveal evidence of obstruction, perforation, or toxic megacolon. Initial treatment (T.ab!e..ZZ.-3) consists of adequate fluid resuscitation and restoration of electrolyte balance. Nasogastric decompression should be initiated in any patient with evidence of obstruction, peritonitis, or toxic megacolon. Broad-spectrum antibiotics (ampicillin or a cephalosporin, an aminoglycoside, and metronidazole) should be used in patients with fulminant colitis or peritonitis. Patients with severe disease should receive intravenous steroids such as hydrocortisone 300 mg/day or an equivalent dose of methylprednisolone (48 mg/day) or prednisolone (60 mg/day).

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