Classification and treatment of Crohn's disease

Proper management of Crohn's disease depends upon accurate clinical classif ication. Primarily inflammatory disease (Vienna classification B1) requires antiinflammatory medication and responds poorly to surgery. By contrast, p rimarily stricturing (obstructive) disease (Vienna classification B2) manda tes surgery - either resection or strictureplasty. The third principal phen otype, penetrating (fistulizing) disease (Vienna classification B3), is the most heterogeneous. "Innocent" or "trivial" (asymptomatic) fistulae may re quire no specific therapy at all, whereas "nuisance" fistulae may respond a dequately to antimetabolites or infliximab. However, "complicated" fistulae , especially when accompanied by severe or advanced underlying bowel diseas e, will not be controlled without definitive surgery, (C) 2000 Prous Scienc e. Alt rights reserved.