Crohn's disease is characterized by chronic
inflammation involving any portion of the gastrointestinal tract. Treating
Crohn's disease is a major challenge for clinicians, as no curative
therapy currently exists.
Pediatric Crohn's disease is characterized by frequent relapses, a wide extent of disease, a high prevalence of extraintestinal manifestations, and a severe
clinical course. The classic therapeutic approach is known as the 'step-up' strategy, and follows a progressive course of treatment intensification as disease severity increases. Although this approach is usually effective for symptom control, many patients become either resistant to or dependent on
corticosteroids. The efficacy of
infliximab suggests that, rather than a progressive course of treatment, early intense induction may reduce complications associated with conventional treatment and improve quality of life. Intensive
early therapy with
infliximab is known as the 'top-down' strategy. Such
therapy offers the potential for altering the natural history of
Crohn's disease, and is changing treatment paradigms. However, the relatively new concept of an early aggressive or 'top-down' treatment approach is not yet widely accepted, especially in pediatric patients. The results of our current study demonstrate that early and intensive treatment of
pediatric Crohn's disease patients with
infliximab, at initial diagnosis, was more effective for maintaining remission and reducing flares.