Crohn's Disease Treatment & Surgery
What is Crohn's disease?
Crohn's disease treatment overview
Crohn's disease drug therapy
Nutritional supplements for Crohn's disease
Crohn's disease surgery
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Crohn's disease treatment overview
Crohn's disease treatment may include nutrition supplements, drugs, surgery, or a combination of these options. The objectives of these treatments are to control inflammation, correct nutritional deficiencies, and relieve symptoms such as diarrhea, abdominal pain, and rectal bleeding. While at present there is no cure for Crohn's disease, treatment can help control the disease by lowering the number of times a person experiences a recurrence. Treatment for Crohn's disease is dependent upon the location and severity of the disease, complications, and the individual’s response to previous medical treatments when treated for reoccurring symptoms.
While Crohn's disease typically recurs at various times over a person's life, people have reported long periods of remission, sometimes years, when they are free of symptoms. Because of the disease's unpredictable changing pattern, one cannot always tell when a treatment has helped, when a remission may occur, or when symptoms will return.
Someone with Crohn's disease may require medical care for a long time and will need to monitor the condition with regular doctor visits.
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Crohn's disease drug therapy
Anti-inflammation drugs. Most people are initially treated with drugs containing mesalamine, a substance that aids in the control of inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from or cannot tolerate these drugs may be prescribed other mesalamine-containing drugs, generally known as 5-ASA agents, such as or Pentasa®, Asacol®, or Dipentum®. Possible side effects of mesalamine-containing drugs include diarrhea, headache, heartburn, vomiting, and nausea.
Cortisone or steroids. Cortisone drugs and steroids, known as corticosteroids, can provide effective results. Prednisone is a common generic name for one of the drugs in this group of medications. Prednisone is usually prescribed in a large dose in the beginning, when the disease is at its worst. Once symptoms are under control, the dosage is then lowered. Corticosteroids can cause serious side effects, including greater susceptibility to infection.
Immune system suppressors. Drugs that suppress the immune system are also used to treat Crohn’s disease. Immunosuppressive agents are designed to block the immune reaction that contributes to inflammation. The most commonly prescribed immunosuppressive agent is 6-mercaptopurine or a related drug, azathioprine. However, these drugs may cause side effects including diarrhea, vomiting, and nausea, and may lower a person's resistance to infection. When patients receive a combined treatment of corticosteroids and immunosuppressive drugs, the dose of corticosteroids may eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.
Infliximab (Remicade®). Approved by The U.S. Food and Drug Administration for the treatment of moderate to severe Crohn's disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas, this drug is the first of a group of medications that blocks the body's inflammation response. Infliximab is a TNF substance and is the first treatment to be approved specifically for Crohn's disease. Additional research is needed to understand fully the beneficial range of treatments Remicade® may offer to people with Crohn's disease.
Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by prior surgery, stricture, or fistulas. For this common problem, the doctor may prescribe one or more of the following antibiotics: cephalosporin, metronidazole, tetracycline, sulfonamide, or ampicillin.
Anti-diarrheal and fluid replacements. Patients who are dehydrated due to diarrhea are treated with fluids and electrolytes. When inflammation subsides, diarrhea and painful abdominal cramping are often relieved – although additional medication may be necessary. In those instances, several antidiarrheal agents are commonly prescribed, such as codeine, loperamide, and diphenoxylate.
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Nutritional supplements for Crohn's disease
Nutritional supplements may be recommended for patients with Crohn's disease, especially for children whose growth has been slowed. Special high-calorie liquid formulas are available for this purpose. A small number of patients may need to be fed intravenously for a short time through a small tube inserted into the vein of the arm. This procedure can assist patients who need temporary extra nutrition, patients whose intestines need to rest, or patients whose intestines cannot absorb enough nutrition from food. There are no known foods that cause Crohn's disease. However, for patients suffering from a flare-up, foods such as alcohol, milk products, hot spices, and bulky grains and may increase diarrhea and cramping.
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Crohn's disease surgery
Two-thirds to three-quarters of patients with Crohn's disease will require surgery at some point in their lives. Surgery becomes necessary when medications are no longer effective at controlling symptoms. Surgery is then performed to relieve symptoms that do not respond to medical therapy or to correct complications such as abscess, blockage, bleeding in the intestine, or perforation. While not a cure, surgically removing part of the intestine can help people with Crohn's disease. Surgery does not eliminate the disease, and it is not uncommon for patients with Crohn's disease to have more than one operation, as inflammation tends to return to the area adjacent to where the diseased intestine was removed.
When Crohn's disease occurs in the large intestine, some patients are required to have a colectomy, an operation in which the entire colon is removed. To compensate, a small opening is made in the front of the abdominal wall, and the tip of the ileum, which is located at the end of the small intestine, is then brought to the skin's surface. This opening, called a stoma, is where waste exits the body. The stoma is approximately the size of a quarter and is usually located in the right lower part of the abdomen near the patient's beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. The majority of colectomy patients go on to live normal, active lives.
In some cases, only the diseased section of the large intestine is removed and no stoma is needed. When this operation is performed, the intestine is cut above and below the diseased area and is reconnected.
Because Crohn's disease often recurs after surgery, patients considering a surgical procedure should carefully weigh its benefits and risks against those of nonsurgical treatments. Surgery may not be appropriate for everyone. People faced with this decision are encouraged to gather as much information as possible from doctors, nurses who care for colon surgery patients (enterostomal therapists), and other Crohn's disease patients. Support group and other information resources are available through patient advocacy organizations.
People with Crohn's disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite occasional hospitalizations and the need to take medication for long periods of time, most people with Crohn's disease are able to maintain jobs, raise families, and function successfully at home and in society.
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Schedule an appointment
To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].
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Sources:
National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) - NIH Publication No. 06–3410, February 2006
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