I think the answer to that farmerswifey boils down to two things...your GI's beliefs and preferences and your geographical location.
Many doctors now believe in the top down approach which is hit it hard and fast and in doing so limit the damage done. Rather than step up which escalates as each treatment fails and all the while inflammation remains under treated.
Then there is geographical location...
This becomes apparent in initial treatment. For children EEN is frequently used as a first line treatment in most western countries aside from the US.
This then moves to the next step of treatment. Most, if not all, western countries aside from the US have universal health care. It means our treatments are 'free' but with that comes a set of strict guidelines at which point a person can access the more expensive treatments. It often means failing certain medications before you are approved for things like Remicade, so much like a step up approach.
You will find under Medicare that the guidelines for children are not as strict as they are for adults as are certain types of Crohn's or severity of disease, e.g. severe refractory disease and/or fistulising.
The aim of medication once past initial treatment, steroids and EEN, are to continue the process of inducing remission and then maintain it. The differences in the classes of drugs...5ASA's, immunosuppressants and biologics...is the way they are designed to action that task in the body.
Dusty. xxx
