General Measures Additional therapies depend on location of disease:
- Oral lesions: Hydrocortisone and carboxymethyl-cellulose or topical sucralfate for aphthous ulcers, cheilitis, and/or granulomatous sialadenitis.
- Gastroduodenal CD: No clinical trials, although the slow-release form of mesalamine may be of benefit, as it is partially released in the proximal small bowel. Case reports detail success with anti-TNF therapies. Otherwise, symptomatic relief may be obtained from proton pump inhibitors, H2-receptor antagonists, and/or sucralfate.
- Ileitis: Patients often require supplementation of fat-soluble vitamins, as well as iron, B12, and/or folate, and calcium to prevent bone loss.
- Treatment toxicity: Pancreatitis, bone marrow toxicity, lymphoma, nonmelanoma skin cancer, infections (TB, histoplasmosis, others), malignancy
- Peritonitis: Bowel rest and antibiotic therapy (7–10 days parenteral antibiotics, followed by 2–4 week course of PO ciprofloxacin and metronidazole); surgery as indicated:
- Consider holding steroids, which mask sepsis.
- Abscess: Antibiotics, percutaneous drainage, or surgery with resection of affected segments.
- Small bowel obstruction: IV hydration, NG suction, TPN for malnutrition, with resolution typically in 24–48 hours. Surgery for nonresponders.
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