Treating Crohn’s Disease

August 15th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Crohn’s Disease is an inflammatory bowel disease that causes damage to the intestinal tract. Unfortunately there is no known cure for the disease; however there are many treatment options. In a previous article we looked at some of the symptoms, complications and diagnostic tests regarding Crohn’s disease. In this article we will focus on treatment options.

The main goal of treatment is to minimize inflammation in order to control symptoms. Most of the treatment options involve prescription medications and, in some cases, surgery.

Anti-inflammatory Drugs and Crohn’s Disease

These drugs reduce the inflammation associated with Crohn’s disease. Some of the medications in this category are:

  • Sulfasalazine (Azulfidine): This drug does not always work, and it is typically more useful in disease that affects the colon. Some side effects can be nausea, vomiting, acid reflux and headache.
  • Mesalamine (Asacol, Rowasa): Depending on the location of disease, mesalamine is taken by mouth, as an enema or rectal suppository. This medication does not work well for small intestinal disease. Some side effects can be nausea, heartburn, vomiting, diarrhea and headache.
  • Steroids (corticosteroids): These reduce inflammation very effectively and are used in moderate to severe disease. Steroids can have serious side effects especially with long term use. These can be diabetes, osteoporosis, high blood pressure, eye problems and increased risk of infections. Steroids can also cause facial puffiness, increased facial hair, nervousness, insomnia and sweating at night. These drugs should only be used for the short term (3-4 months) in order to induce the remission of serious symptoms.
  • Budesonide (Entocort EC): This is a newer steroid that appears to work faster and have fewer side effects. It is most effective for disease limited to the last part of the small intestine and the beginning part of the colon.

Immune Suppressor Drugs and Crohn’s Disease

These medications reduce inflammation by acting on your immune system. Immune system suppressors are often used with steroids to maintain remission after the steroids have been stopped. Frequent checkups and blood tests are required when taking these medications. They can also be associated with and increased risk of lymphoma. In every case, the benefit of the drug (avoid surgery, hospitalization, etc…) must outweigh the risk. Some examples of this class of drugs are:

  • Azathioprine (Imuran), Mercaptopurine (Purinethol): The most commonly used drugs in this category. Side effects are an increased susceptibility to infection, nausea and vomiting.
  • Infliximab (Remicade): This drug blocks TNF (tumor necrosis factor) which is an immune system protein. This drug is used in moderate to severe disease. Often used early after the diagnosis of Crohn’s disease has been made. It is also useful in disease associated with fistula formation. Infliximab is sometimes used in combination with azathioprine. People with heart failure, multiple sclerosis or cancer should not take this drug. Infliximab increases the risk of tuberculosis, hepatitis B and other infections.
  • Adalimumab (Humira): Works like infliximab. Often used as a second line when other drugs have failed.
  • Certolizumab pegol (Cimzia): Also works by TNF inhibition. Side effects can be stomach pain, nausea, infections and headache.
  • Methotrexate: Can be used if Crohn’s disease does not respond to other treatments. Side effects can be diarrhea, fatigue, nausea, pneumonia and liver disease including liver cancer.
  • Cyclosporine: This drug is often a second or third line treatment. It is especially effective in healing fistulas. It can have serious side effects like damage to the kidney or liver, infections and seizures.
  • Natalizumab: Also a second or third line drug. It can lead to a serious, life-threatening brain infection (multifocal leukoencephalopathy).

Antibiotics and Crohn’s Disease

Antibiotics are useful in the treatment of Crohn’s disease associated fistulas and drainage. They might also have an indirect immunosuppressive effect by controlling the amount of bacteria in your intestines. Commonly prescribed antibiotics for Crohn’s disease are metronidazole and ciprofloxacin.

Other Medications

There are a variety of other medications that are used to treat the symptoms of Crohn’s disease including antidiarrheal drugs such as psyllium powder (Metamucil) and loperamide (Imodium). In the case of intestinal stricture a laxative might be used to treat constipation.

Nutritional Supplements

The bleeding associated with Crohn’s disease can lead to iron deficiency so iron supplements can help. A qualified nutritionist can also help with diet planning as well as vitamin supplement choice. For example, you might need calcium and Vitamin D to help prevent osteoporosis. Vitamin B12 supplements are also important and might need to be given by injection if you have problems with absorption. In severe cases of Crohn’s disease, you might need feeding by a feeding tube or intravenously.

Surgery and Crohn’s Disease

Unfortunately, for up to 75% of persons with Crohn’s disease, surgery is eventually required. If the narrowing of the intestines becomes too tight, then the only solution is to remove that part of the bowel surgically. In many cases, repeat surgical procedures are needed to treat reoccurrence.

Crohn’s Disease and Colon Cancer

Your doctor will likely advise for close colon cancer screening, including scheduled colonoscopies. This is because Crohn’s disease increases the risk for colon cancer.

Conclusion

Crohn’s disease is a serious problem, but there are many different treatment options. A close patient-doctor relationship is essential to achieve the best treatment results. Research is continually ongoing. If you do not respond to the mainstream drugs mentioned in this article, ask your doctor if you might be eligible to take part in clinical trials of experimental drugs.

Please feel free to check out the rest of The H Doctor website. Here you will find some of the best information online about hemorrhoid treatment and other intestinal health topics.

Have an outstanding day.

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