Bottom up: You got diagnosed, your doc/GI said you got "mild" Crohn's and you were put on 5-Asa (asacol, pentasa etc.), then once 5-Asa fails (it often fails), you got switched to azathioprine/6mp and then (if that failed) to biologics (remicade, humira, cimzia etc.) or combinations etc.
Top down: You got diagnosed and your doc/GI started you on biologics and potentially in addition on azathioprine/6mp right away. Then, if things get manageable, the doc/GI tries to get you off biologics/aza/6mp again.
I have found an interesting article (although in German) which looks at the benefits of top down vs. bottom up strategies. http://www.dccv.de/typo3temp/br_pdf/PDF_j2nAhx.pdf The article classifies patient developments into 4 groups (page 21) based on how the Crohn's is developing. For two groups (chronical development of disease with continued flares - 25% of patients - and high up and down developments - 30% of patients) the authors say they think top down is the right strategy, while for the other two groups (high flare initially, then good management of Crohn's - 40% of patients - and little in terms of problems for years, then big problems - about 5% of patients) the bottom up strategy would be more beneficial.
I was wondering whether people are being told about the two strategies by doctors when they were diagnosed and told about the history of how those strategies developed.
Top down: You got diagnosed and your doc/GI started you on biologics and potentially in addition on azathioprine/6mp right away. Then, if things get manageable, the doc/GI tries to get you off biologics/aza/6mp again.
I have found an interesting article (although in German) which looks at the benefits of top down vs. bottom up strategies. http://www.dccv.de/typo3temp/br_pdf/PDF_j2nAhx.pdf The article classifies patient developments into 4 groups (page 21) based on how the Crohn's is developing. For two groups (chronical development of disease with continued flares - 25% of patients - and high up and down developments - 30% of patients) the authors say they think top down is the right strategy, while for the other two groups (high flare initially, then good management of Crohn's - 40% of patients - and little in terms of problems for years, then big problems - about 5% of patients) the bottom up strategy would be more beneficial.
I was wondering whether people are being told about the two strategies by doctors when they were diagnosed and told about the history of how those strategies developed.
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