Crohn's Disease

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Treatment

There is no cure for Crohn's disease and the goals of treatment are to manage symptoms, maintain proper nutrition, and reduce inflammation and complications. Patients usually receive medical care on a long-term basis. Treatment options include lifestyle modifications, medications, and surgery.

Lifestyle Modifications
Patients who have Crohn's disease often benefit from changes in diet. While foods do not cause the disorder, they can aggravate symptoms. It is also important for patients to maintain good nutrition, since Crohn's disease can prevent the proper absorption of necessary nutrients, fluids, vitamins, and minerals.

Uncomfortable digestion also may decrease the appetite and patients often need extra calories to manage the disease. Soft, bland foods may be recommended instead of spicy or high-fiber foods. Nutritional supplements, such as high calorie milkshakes may be helpful. In some cases, patients are fed temporarily through an IV so the intestines can rest and heal.

Maintaining emotional health is also important for patients who have Crohn's disease. Feeling unwell can cause stress and make socializing more difficult. Support from family, friends, or support groups may be helpful.

Patients sometimes can manage stress levels by planning day-to-day activities. Knowing where restrooms are in advance of a concert, for example, or bringing extra clothing to a dinner party may help the patient to feel more at ease. When traveling, patients who have Crohn's disease should always make sure to take enough medication.

Medications
A variety of medications are used to treat Crohn's disease. In many cases, anti-inflammation drugs are used for mild to moderate symptoms. The most common is sulfasalazine; however, patients who cannot tolerate this drug often are prescribed 5-ASA agents such as Asacol, Dipentum, or Pentasa. Side effects of anti-inflammation drugs include headache, heartburn, diarrhea, nausea, and vomiting. People who are allergic to sulfa drugs should not take sulfasalazine.

Corticosteroids, which suppress the immune system, are another type of medication used to treat Crohn's disease. In most cases, these drugs are used only at the beginning of the illness and only for a short time, generally 3 to 4 months. Corticosteroids can have serious side effects, including bone fractures, cataracts, type 2 diabetes, osteoporosis, and high blood pressure.

Corticosteroids also can increase the risk for infection, and can cause night sweats, puffiness in the face, additional facial hair, insomnia, and hyperactivity. Children who take them long term may have stunted growth. Patients taking corticosteroids often start with a higher dose to alleviate immediate symptoms and once these symptoms are under control, the dose is lowered. Prednisone is a commonly prescribed generic corticosteroid.

Immune system suppressors, sometimes called immune modifiers, often are prescribed to help avoid the need for high doses of corticosteroids. These drugs also help heal fistulas. Common immune system suppressors include 6 mercaptopurine and azathioprine. Side effects include increased risk of infection, diarrhea, nausea, and vomiting.

Infliximab, often called Remicade, has been approved by the FDA to treat mild to moderate Crohn's disease in patients who cannot tolerate other medications. This drug can also be used to help drain fistulas. Researchers are investigating other possible uses. Side effects include muscle pain, rash, fever, sore throat, and headache.

Antibiotics (e.g., ampicillin, sulfonamide, cephalosporin, tetracycline, metronidazole) are sometimes prescribed to treat bacterial infections caused by fistulas, intestinal blockage, or surgery.

In some patients, anti-diarrheal medications and fluid replacements may be helpful. Diarrhea can cause dehydration, lowering levels of important fluids and electrolytes.

Surgery
Up to 75% of Crohn's disease patients eventually require surgery to relieve symptoms or treat complications, such as stricture, abscess, fistulas, bleeding, or anal fissures. Surgery is not helpful in all cases and may need to be repeated, as Crohn's disease can re-develop, especially at the surgery site.

The most common surgery is resection, in which the affected section of the bowel is removed. Following resection, the two ends of healthy bowel are attached using a surgical procedure called anastomosis.

Other procedures include colectomy, which involves removing the entire colon, and a type of ostomy procedure called an ileostomy. Ileostomy involves removing the colon and bringing the small bowel to the surface of the skin. Patients who have undergone ileostomy wear a small pouch on the outside of the body that collects waste from the intestines.

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