The efficacy of 5-ASA products, either as mesalamine encapsulated in a controlled-release form (Asacol, Pentasa), or bound via azo bond to an inert compound (balsalazide)

*Editor's Note: Because growth velocity is decreased in as many as 90% of prebuscent adolescents with CD, restoration of growth velocity is a key goal. suppressing all signs of disease activity, providing adequate calories, and avoiding daily steroid use are components of successful therapy.

TABLE 67-1. Prednisone versus Budesonide in Active Crohn's Disease

Budesonide (n = 19)

Prednisone (n = 14)

Initial dose

9 mg/d

40 mg/d

Remission at 12 weeks

9 (47%)

7 (50%)

Patient with medication

6 (32%)

10 (71%)

side effects

Adapted from Levine et al, 2003.

Adapted from Levine et al, 2003.

or to a sulfapyridine group (sulfasalazine) or to itself (olsalazine), in mild to moderate CD is well documented in the adult literature. Despite paucity of data in pediatrics, these drugs have attained widespread use for these indications in our patient population. In a small prospective study, children with CD radiologically confined to the small intestine seemed to benefit from controlled-release mesalamine therapy (Griffiths et al, 1993). Our practice is to use these agents in mild disease, both acutely to induce remission as well as chronically to maintain remission. Patients that develop recurrent relapses and need for corticosteroids while on 5-ASA maintenance therapy are typically moved to immunomodulator maintenance therapy (Table 67-2).

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