The treatment of Crohn's disease is defined by a number of very specific goals.

First, a patient who has active Crohn's disease needs to achieve what is known as remission. Remission is a state in which the symptoms of the disease are gone and the patient feels well. It is our goal to achieve a state in which the patient feels as well as they did before they had this disease. Remission is also defined by the absence of symptoms that wake a patient from sleep, the absence of blood in their stool, return to a normal nutritional and laboratory values are normal, and the patient is off of corticosteroids.

The second goal of therapy is known as "maintenance". Maintenance means the absence of flares of the disease. Because Crohn's disease is a chronic lifelong condition characterized by periods of activity and other periods of remission, the concept of maintenance is one that means prolonging states of disease control and avoiding flare. Because Crohn's disease is a disease that is often diagnosed at young ages, it is common for patients to believe that after they have achieved remission, they do not need to be on any maintenance therapy. It is understandable that once they are under control for the first time, they may not want to accept the fact that this is a disease that has a likelihood of recurring and causing more problems. However, it is extremely important that once the diagnosis of Crohn's disease is confirmed, an adequate maintenance plan is in effect. This should involve safe and effective therapies that patients are willing to take and patients must be willing to stay on their therapies. We encourage adherence to therapy by scheduling regular visits with their gastroenterologist and by educating them about the importance of maintenance therapy.

Patients who do not take their therapies are more likely to require surgery, more likely to have flares of their disease and even more likely to end up in the hospital.

In addition, it is believe that when the disease is under poor control, it becomes harder to get it under control again later. This is probably due to the progression of the inflammation to involve more tissue and potentially cause complications of infections or even bowel obstructions.

It is extremely important to have a very open and ongoing dialogue with your physician about which therapies work and whether you are willing and able to take them. This even includes a discussion about whether you can afford your medications!