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Crohn's Disease

Treatment of Crohn's Disease

Crohn's Disease: Treatment Overview
Why Choose Temple?
Diet and Nutrition for Crohn's Disease
Medications for Crohn's Disease
Surgery for Crohn's Disease
Ongoing Monitoring and Prevention
New Therapies in Development for Crohn's Disease

Crohn's Disease: Treatment Overview

Today's available medical, nutritional, and surgical treatments may help patients to:

  • Relieve symptoms
  • Make recurrences or flare-ups less frequent
  • Prevent or treat serious complications
  • Correct nutritional deficiencies
  • Feel better overall and get more control over their disease

No one treatment, or combination of treatments, works for all patients. Your therapy will depend on the exact location and severity of your GI inflammation, how often you have flare-ups, and whether or not you are at risk for serious complications (like strictures, fistulas, or bowel obstruction).

Your specialist may perform a variety of tests to create a unique profile your disease and find the safest and most effective therapy for you. Some very ill or high-risk patients will require powerful or aggressive therapies. Others may need only mild anti-inflammatory agents to manage their disease.

Your treatment also depends very much on your choices—such as how badly you want to be rid of symptoms, how you feel about needles versus pills, or how much you worry about possible side effects of drugs or surgery. Your doctor will help you weigh all the risks and benefits. In fact, establishing a trusting long-term relationship with an experienced Crohn's disease specialist who knows your medical condition and personal history in detail helps to keep control over your disease. Chances are, your treatment needs may change over the years. A physician who knows you well may help you adjust therapy and stay ahead of your disease.

No cure yet exists for Crohn's disease. However, today's newest biological therapies have helped many patients get rid inflammation and slow progression of the disease. This absence of inflammation and symptoms is called "remission." That is the goal—to induce a remission and maintain it for years. Today, more and more patients are achieving this goal!

Looking ahead, research on new treatments holds the promise of even better long-term results. For young patients struggling with Crohn's disease, the future is bright.

In this Treatment section, we explain why Temple is a top choice for any patient or family facing Crohn's disease and we describe the main medical, nutritional and surgical options available to patients with Crohn's disease.

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Why Choose Temple?

The Temple Inflammatory Bowel Disease Program offers comprehensive, personalized care for patients with Crohn's disease and ulcerative colitis. Our board – certified gastroenterologists have decades of experience in diagnosing and treating Inflammatory Bowel Disease. In addition, we bring together a multidisciplinary team of specialists including nutritionists, rheumatologists, counselors and other medical professionals to help manage every aspect of the disease and provide ongoing support. To learn more about the Temple Inflammatory Bowel Disease Program, click here.

To schedule an appointment, click here or call 800-TEMPLE-MED [800-836-7536].

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Diet and Nutrition for Crohn's Disease

Diet is not a direct cause of Crohn's disease but what you eat may affect how you feel and how healthy you stay.  Poor nutrition may have many causes: the GI symptoms of Crohn's may cause a loss of appetite; the GI inflammation may reduce uptake of nutrients; and the GI bleeding or diarrhea may cause a loss of nutrients.

To prevent nutritional problems, all patients with Crohn's should eat a nutritious diet and avoid foods that worsen their symptoms. For example, some patients find that specific foods—like mild products, bulky grains, or alcohol—may cause a flare-up. Any Crohn's treatment program should include education and clear instructions on good food choices, proper nutrition, and stress reduction.

To prevent serious problems (like growth delay in children, or lack of energy or infections in adults), some patients will require nutritional supplementation with high-calorie or vitamin-fortified liquids. Those who are extremely ill may need to be fed intravenously (through a tube in the arm) for a brief period. This IV feeding, sometimes called total parenteral nutrition (TPN), bypasses normal eating and digestion but allows proper nutrition.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to a full team of nutrition specialists, psychiatrists, counselors, nurse educators and support groups. We are prepared to help patients control their disease with better diet, exercise, and relaxation methods. In some cases, special supplements are recommended. Those having a severe bout of disease activity may be assisted with temporary intravenous nutrition.

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Medications for Crohn's Disease

Most medications for Crohn's disease suppress inflammation. This is the key to reducing symptoms like pain and diarrhea. Reducing inflammation also allows the GI tract lining to heal, which may decrease the frequency of flare-ups. The main types of anti-inflammatories are described next, along with a few other medications for specific symptoms or complications.

Some of these medications are pills and others are injections. Some are given only during flare-ups while others are "maintenance" therapies that you take even when you are feeling well to prevent a relapse. Your doctor will explain the full risks and benefits of your recommended medications.

  • Anti-inflammatory Drugs:  Several drugs that contain 5-aminosalicylate acid (5-ASA) are commonly given to treat mild-to-moderate episodes of Crohn's disease or to prevent a relapse ("maintenance therapy"). Chemical names of these anti-inflammatory agents include: sulfasalazine, mesalamine, olsalazine, and balsalazide. Side effects of these 5-ASA agents may include nausea, vomiting, diarrhea, headache, and heartburn.
  • Corticosteroids:  These medications (sometimes just called cortisone or steroids) maypowerfully reduce inflammation. But they have widespread actions that may also cause serious side effects.  That's why they are generally given only for a short period to treat more severe episodes of Crohn’s disease. Typically, a large dose is given first to get symptoms under control and then the dose is gradually reduced ("tapered"). Prednisone, hydrocortisone, and budesonide are common corticosteroids. Side effects of these agents, seen especially with longer-term use, may include: weakening of the bones (osteoporosis), great susceptibility to infection, weight gain and high blood pressure.
  • Immunomodulators:  Also called immune system suppressants, these agents attack the immune cells that stimulate inflammation. They are often given together with corticosteroids. Common immune system suppressors include 6-mercaptopurine, azathioprine, cyclosporine A, and methotrexate. Side effects may include nausea, vomiting, diarrhea, and increased risk of infection.
  • Biological Therapies: This is the newest type of medication used to combat Crohn's disease and to induce remission. They are used mainly for people with moderate-to-severe disease. Several of these therapies (infliximab, adalimumab, and certolizumab) work by targeting and blocking one natural molecule that is produced by the immune system to incite inflammation. This molecule is called tumor necrosis factor (or TNF) and so the agents are called anti-TNF agents. Blocking TNF reduces inflammation. Another biologic agent called natalizumab targets an adhesion molecule called an integrin receptor. This action slows the spread of inflammation-causing white blood cells into the intestines. Natalizumab is usually given to those who do not respond to anti-TNF agents. Although these agents are quite effective, taking them may also lead to serious infections or other side effects such as liver failure, lymphoma (a type of cancer), heart failure or viral infections of the brain. Individuals with tuberculosis, heart failure or multiple sclerosis cannot take the anti-TNF agents.
  • Antibiotics:  Pockets of infection (called abscesses) often develop in fistulas, narrowed GI passages, or near the rectum. Antibiotics such as ampicillin, metronidazole, ciprofloxacin, tetracycline, or sulfonamide are often given to treat this bacterial overgrowth.
  • Anti-Diarrheal Agents: Most episodes of diarrhea will pass after the inflammation subsides. Drinking plenty of fluids to prevent dehydration is important. To relieve severe abdominal cramping or diarrhea, agents such as loperamide, codeine, or diphenoxylate may be prescribed. Prolonged episodes of diarrhea may require intravenous fluid replacement.

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Surgery for Crohn's Disease

Despite the improved medications, more than half of patients with Crohn's disease still need GI surgery at least once during their lives. Surgery may relieve intense symptoms or resolve serious complications such as an infection (abscess), intestinal blockage, perforation (leaking), or bleeding. At Temple, our experience with minimally invasive (laparoscopic) and robotic surgery allows us to perform precise GI surgery in a way that conserves as much intestine as possible and that may limit scarring (internal and external) and may allow for less pain and faster healing.

Although surgery may provide great relief or even save a life, it does not cure the disease. The overall goal is to remove only the part of the intestine that causes the problem. These are sometimes called "bowel-sparing surgeries." These are major GI surgeries that typically may require anywhere from 3 to14 days in the hospital to recover. Much less recovery time is typically needed for minimally invasive surgery. Your gastroenterologist and GI surgeon will explain the requirements and benefits and risks for your exact procedure.

  • Intestinal Resection:  In this surgery, only the diseased section of the intestine is removed. This removal is called "resection." The process of reconnecting the healthy ends of the intestine is called "anastomosis."
  • Colectomy:  Some patients need to have the entire colon (large intestine) removed. This is called a "colectomy." An ileostomy or colostomy may be required after a colectomy.
  • Protocolectomy:  In this operation, the rectum and part or all of the colon are removed. This is called a "proctocolectomy." An ileostomy or colostomy is often required after a protocolectomy.
  • Ileostomy or Colostomy: In these "-ostomy" procedures, either the ileum (the end of the small intestine) or the remaining end of the colon is brought to the abdominal skin surface to create a "stoma,' or opening. An ostomy pouch covers this opening to collect stool. The patient discards the pouch as needed. In some patients this stoma is temporary, allowing the intestines to rest and heal before being connected again. In other cases, such as after a proctocolectomy or with infection or severe disease, the stoma is permanent. Temple has enterostomal therapists who specialize in helping patients take care of the ostomy pouch.
  • Stricturoplasty: In this special surgery, a scarred and narrowed portion of the intestine (called a "stricture") is opened up wider to prevent bowel obstruction.
  • Other procedures: Other surgical or interventional radiological procedures that may help patient's with Crohn's disease, especially in the perianal region (near the anus and rectum) include: repair of fissures (torn tissue) or fistulas (channel-like growths off of the intestines); draining of an abscess (pocket of infection); treating minor problems in the small intestine via double balloon enteroscopy; for patients with far advanced Crohn's who have exhausted all medical and surgical options, intestinal transplantation is available at a few centers around the U.S.

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Ongoing Monitoring and Prevention

Whatever your current treatment, and even if you are feeling well, you should schedule regular meetings with your Crohn's specialist or your own primary GI specialist to monitor your health. Reasons for these regular check-ins include:

  • To check general GI health (eg, symptoms, blood test for anemia and infection)
  • To monitor the effectiveness of your therapy (frequency/severity of symptoms)
  • To check for side effects of therapy (eg, anti-TNF agents have skin side effects)
  • After surgery, to ensure proper healing and recovery
  • Routine screening for colon cancer with colonoscopy (including, at Temple, special techniques such as narrow band imaging and chromoendoscopy to highlight areas of potential early cancer (dysplasia) 
  • To administer routine vaccines that will help prevent complications
  • To treat simple health problems (like bronchitis) that may cause complications

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New Therapies in Development for Crohn's Disease

Hundreds of clinical trials are underway in the U.S. to find safer and more effective tests and treatments for Crohn's disease. Your Temple gastroenterologist may help you evaluate all your treatment options including, if needed, participation in clinical trials.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to all the latest medications and advanced surgeries for Crohn's disease. We are experienced in creating care plans that are customized for the patient’s individual needs and preferences.

To schedule an appointment, click here or call 800-TEMPLE-MED [800-836-7536].

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