10 October 2012

Help for the Treatment of Crohn's Disease

New guidance from NICE provides GPs and other healthcare professionals with advice on the use of glucocorticosteroids for the remission and management of people with Crohn's disease.

Crohn's disease is a chronic inflammatory disease that mainly affects the gastrointestinal tract.

Around 115,000 people currently have the condition in the UK, with between 3000 and 6000 new cases diagnosed each year.

The disease affects slightly more women than men and can start at any age, though it usually starts between the ages of 15 and 30.

Typical management options for the condition include drug therapy, smoking cessation, attention to nutrition and surgery in cases of severe or chronic active disease.

In new guidelines on the management of Crohn's disease in adults, children and young people, NICE provides recommendations on a number of new drugs that have been licensed for the condition over the past decade.

These include conventional glucocorticosteroids such as prednisolone, methylprednisolone or intravenous hydrocortisone.

NICE says monotherapy should be offered with a conventional glucocorticosteroid to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn's disease in a 12-month period.

Healthcare professionals should consider adding azathioprine or mercaptopurine to a conventional glucocorticosteroid or budesonide to induce remission of Crohn's disease in two cases.

This is either when there are two or more inflammatory exacerbations in a 12-month period, or the glucocorticosteroid dose cannot be tapered.

NICE says that GPs and other healthcare professionals should discuss with people with Crohn's disease, and/or their carer if appropriate, the options for managing disease when in remission include treatment and no treatment.

Such discussions should cover the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. The person's views should be recorded.

The guideline also recommends that GPs and other healthcare professionals should provide appropriate additional information on the effects the condition has on a person's lifestyle.

Information should be given on the possible delay of growth and puberty in children, diet and nutrition, fertility and sexual relationships, prognosis, side effects of their treatment, cancer risk, surgery, care of young people in transition between paediatric and adult services, and contact details for support groups.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE said: "Crohn's disease is affecting increasing numbers of people in England including children and young people.

"Its symptoms can be painful and unpleasant, and have a significant negative impact on quality of life.

"Therefore it is important that there are clear, evidence-based guidelines in place that can help improve the care offered to people with Crohn's disease."

Andy Player, patient/carer member of the guideline development group, addeed: "Any Crohn's patient reading these guidelines should be confident that the best evidence has been picked over, discussed and debated to produce robust recommendations on the treatment of their condition.

"As someone with Crohn's disease who took part in this process, I was impressed by how the discussion of every recommendation had the interests of each and every Crohn's patient at its heart."