TREATMENT FOR CROHN'S DISEASE

Long term drug therapy with 5-ASAs (Pentasa, Asacol or Dipentum) is useful to suppress low grade inflammation, especially in the colon. 5-ASAs are less effective in severe acute flare-ups. While most research has found that 5-ASA are not helpful in preventing post-operative recurrence, Mesalasine (a subgroup of these drugs), is recommended after ileocolonic resections. Although Crohn’s disease generally causes rumbling and mild symptoms, from time to time it can flare up and cause serious illness. Initially, drugs are prescribed to reduce inflammation, subdue the body’s immune system and fight infection. Food and fluid may be given by a drip directly into the bloodstream in severe cases. 

The antimetabolites azathioprine and 6-mercaptopurine are effective treatments, especially when Crohn’s disease involves the colon. By suppressing the immune system, they significantly improve the person's condition and allow a decrease in steroid requirements. Often, they also allow the holes that may have developed in the bowel to heal. However, these drugs usually need to be taken for three to six months before the full benefits are experienced. Side effects can be serious and so the patient requires regular tests while on this medication. Cyclosporine, which shows promise for quicker therapeutic action, is under study.

Broad-spectrum antibiotics (eg, metronidazole) may be of benefit in reducing disease activity in some patients but they are most effective for complications due to infection (eg, abscess, infected fistula).

The most recent approach to treating Crohn’s disease is with the anti-inflammatory drugs adalimumab (Humira) and infliximab (Remicade). These drugs make use of manufactured antibodies – the molecules we all have as part of our immune system – to effectively target treatment to a particular mediator (tumour necrosis factor-alpha) involved in the inflammation of Crohn’s disease. They are used in moderate to severe Crohn’s disease and in patients who have fistulae. The drugs are injected a number of times over a course of a few weeks, depending on your condition. There are a number of side effects which may mean the treatment has to be stopped: these include hypersensitivity, itching, infections, headache, difficulty breathing and pain in the bones or muscles, amongst others.

Vitamins, either injected or in tablet form, may be used to correct nutritional imbalances that can occur as a result of poor absorption of food and fluid from the bowel.

Some patients with bowel blockages or small holes in the bowel have improved, over the short term, on hyperalimentation (giving a total food solution through a vein). An elemental diet (a total food solution given through a tube which is fed into the stomach through the nose) is used occasionally. Some children have achieved increased rates of growth with this type of treatment. These measures may be useful before an operation or in addition to other types of treatment.

Surgery is usually necessary when the bowel persistently becomes blocked or when there are abscesses or small holes in the bowel wall. Surgical removal of the part of the bowel that is badly affected may relieve symptoms indefinitely but it does not cure the disease. Recurrence rate after surgery, usually where the bowel has been joined, is 60 to 95%. Ultimately a further operation is required in nearly 50% of cases. Surgery is not performed unless specific complications or failure of medical therapy make it necessary. When operations have been performed, however, most patients consider their quality of life has been improved. Established chronic Crohn’s disease is characterised by lifelong recurrences. Growth retardation commonly results when the disease occurs during the developmental years. The disease rarely spreads without surgical manipulation of the bowel. People with long-standing Crohn’s disease of the small intestine carry an increased risk of small bowel cancer, and those with Crohn’s colitis (Crohn’s disease that is only found in the colon) have a long term risk of colon cancer.

Symptoms of Crohn’s disease are generally treated with oral steroid medications. These drugs not only reduce inflammation in the body, but restore appetite, reduce fever and diarrhoea, and relieve abdominal pain and tenderness. Doctors try to avoid prescribing steroids on a long term basis because they have unpleasant side effects. These can include uncontrolled weight gain, swelling of the face, sugar in the urine, raised blood pressure or difficulty sleeping. However, for some people the disease cannot be controlled without steroids. The dosage is therefore reduced to the lowest possible level. Never stop taking steroids without consulting your doctor.