Dietetic treatment of Crohn's disease has the objective to calm down the gut either by a polymeric or elemental diet. In superacute conditions also total parenteral nutrition can be used. In the quiescent stage the patient must have an adequate energy intake and a low-residue (low-fibre) diet. As to medication, sulfasalazine which has some side-effects is abandoned and 5-ASA (5-aminosalicylic acid) preparations are used, either by the oral route or in enemas, while 4-ASA is little used in this country and is known as PAS. The administration of corticoids which also have side-effects will be abandoned in favour of so-called rapidly metabolized corticoids (Tixocortol pivalate, beclomethasone, budenoside and fluticasone) by the oral route and in enemas and foams. As antimicrobial treatment ciprofloxacine is used combined with metronidazole. As to immunosuppressive drugs azathioprine, 6-mercaptopurine, cyclosporin A, cyclophosphamide and methotrexate are tested. A hope for the future is so-called biological treatment (anticytokines, monoclonal antibodies against cytokines, against CD4+ TNF, interleukines IL-10 and 11, immunoglobulin; plasmapheresis is also tested). Treatment must be individual and surgery as late as possible, only in case of complications, and should be very sparing, stenoses should be treated by plastic operations of strictures.

1 interní klinika IPVZ FTN Praha