Crohn's disease is a chronic relapsing-remitting inflammatory bowel disease affecting any part of the GI tract from mouth to anus. Treatment induces and maintains remission through immune suppression. Biologic therapies have revolutionised outcomes; stem-cell approaches are being studied to repair intestinal damage and tolerance induction.
5-aminosalicylates (mesalamine) treat mild-to-moderate disease and maintain remission. Corticosteroids (prednisone, methylprednisolone) induce remission quickly but are not suitable for maintenance due to side-effects. Immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate) reduce steroid dependence. TNF-alpha inhibitors (infliximab, adalimumab, certolizumab) are first-line biologics, inducing remission in 50–70% of patients. Other biologics target different pathways: vedolizumab (integrin inhibitor), ustekinumab (IL-12/IL-23 inhibitor), risankizumab (IL-23 inhibitor). Janus-kinase inhibitors (tofacitinib, upadacitinib) are emerging oral options. Surgery—segmental bowel resection—may be curative for ileocolic disease but risks recurrence.
Exclusive enteral nutrition (liquid formula diet) induces remission in paediatric Crohn's by 80%, likely through immune tolerance mechanisms. Low-residue, low-fat diets minimise symptoms during flares. Herbal agents (curcumin, boswellia, aloe vera) show modest anti-inflammatory effects in small trials. Probiotics (VSL#3) lack strong evidence but are widely used.
Faecal microbiota transplantation (FMT) and stem-cell therapies are being studied for mucosal healing and immune tolerance. Mesenchymal stem cells may promote regulatory T-cell expansion and reduce TNF-driven inflammation. Tissue-engineering approaches are explored to repair transmural defects. These remain investigational and should accompany biologics. Review candidacy criteria for trial suitability.
| Option | Type | Evidence | Indicative cost | Invasiveness | Recovery |
|---|---|---|---|---|---|
| 5-aminosalicylate (mesalamine) | Standard | Strong | €600–1,200/year | Low | None |
| TNF-alpha inhibitor (infliximab, adalimumab) | Standard | Strong | €8,000–15,000/year | Low | None |
| Vedolizumab or ustekinumab | Standard | Strong | €10,000–18,000/year | Low | None |
| Exclusive enteral nutrition (paediatric) | Standard | Strong | €2,000–4,000 per 8-week course | Medium | None |
| Low-residue diet + probiotics (VSL#3) | Alternative | Moderate | €500–1,000/year | Low | None |
| Faecal microbiota transplantation (FMT) | Regenerative | Moderate | €3,000–6,000 | Medium | 1–2 weeks |
| Immune-tolerance stem-cell therapy | Regenerative | Investigational | €12,000–28,000 (trial-dependent) | Medium | 2–3 weeks |
Current therapy achieves remission—suppression of inflammation—but rarely cures the underlying immune dysregulation. Stem-cell and FMT approaches aim to restore tolerance; results are early-stage.
Induction rapidly suppresses acute flares (steroids, biologics, 8–12 weeks). Maintenance prevents recurrence and uses gentler agents (5-ASA, biologics, long-term).
Diet improves symptoms but cannot induce remission in most patients. Exclusive enteral nutrition is an exception in children. Medical therapy (biologics, immunosuppressants) is essential.
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Educational overview of treatment options; not medical advice. Standard treatments reflect mainstream guidance; regenerative/stem-cell uses are largely investigational. Reviewed by the StemCellAtlas editorial team.
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