Prevention of relapse of Crohn's disease

Until a cure for Crohn's disease(s) is found, strategies that prolong the t ime spent in remission offer the greatest hope for reducing the morbidity a nd significant social costs associated with the disease. Medical therapy to date has been disappointing, and the se-arch for a safe, effective therapy that could be offered at low cost continues. The aminosalicylates, so effe ctive in ulcerative colitis, have shown, at best, minimal efficacy in maint aining remission in Crohn's disease. Conventional corticosteroids are not e ffective, and any reduction in time to relapse for budesonide-treated patie nts is measured in weeks not months. Azathioprine, 6-mercaptopurine, and me thotrexate are effective in maintaining remission, but all three have signi ficant side effects. Antibiotics may have a role to play. Biological therap y may be considered, but the issues of cost and long-term safety require ev aluation. Future studies should segregate patients into two groups, those w ith a medically induced remission and patients whose concern is the prevent ion of postoperative recurrence.