June 06, 2009
Crohn’s Disease: Advanced Treatments
Written By: Sara Wykes, Health Editor, 3/14/2008
Reviewed By: Paul Auerbach, MD, MS, FACEP
Crohn’s Disease: Advanced Treatments
Crohn’s is a chronic inflammatory disease of the bowel and treatment is focused on reducing inflammation. Treatment options include medications, nutritional supplements and surgery—either alone or in combination. Complementary and alternative treatments are used to help relieve symptoms in conjunction with other therapies. Treating Crohn’s disease effectively is complex - goals of therapy are to alleviate symptoms and to prevent flare-ups. It is important to develop a strong partnership with your gastroenterologist and nutritionist.
Medications: Aminosalicylates (sulfasalazine, mesalamine, balsalazide, and olsalazine) are given orally or rectally to reduce inflammation in the intestine. Corticosteroids (prednisone, methylprednisolone, hydrocortisone) reduce inflammation and are used short-term for acute flareups. Budesonide, one of a new class of nonsystemic steroids, targets the intestine rather than the whole body. Immunomodulators (azathioprine, 6-mercaptopurine, cyclosporine A, tacrolimus, methotrexate ), usually associated with organ transplants and used to decrease the risk of rejection. Increasingly, they’re being used to treat autoimmune diseases and used to treat people with Crohn’s disease. Usually prescribed for moderate to severe cases, immunomodulators are also used when fistulas develop or corticosteroids are no longer effective. Crohn’s is not caused by an infection, but antibiotics (metronidazole and ciprofloxacin) may help minimize symptoms and heal fistulas and abscesses. Biologics (infliximab (Remicade), adalimumab (Humira) are genetically engineered drugs that combat inflammation by neutralizing proteins in the immune system like tumor necrosis factor (TNF), which can cause inflammation. The advantage in using biologics is that they act selectively rather than suppressing the entire immune system.
Nutritional Support: Nutritional support for people with Crohn’s is a complex endeavor. Malnutrition is a common complication of the illness. Children need to increase their intake of calories and protein by as much as 150% of the recommended amounts for their age and height. It’s also important to increase fluids, proteins (especially fatty fish like tuna and salmon), complex carbohydrates, and potassium-rich foods like bananas, orange juice, potatoes and avocados. Supplements like fish oils, probiotics and liquid nutritional support (Ensure) may help, so be sure to consult your health professionals for the best plan for you or your child.
Complementary and Alternative Therapies: Moderate, regular exercise and stress management techniques like meditation, relaxation practices and cognitive therapy may help reduce the severity of symptoms.
Surgery: Most people with Crohn’s disease eventually need some type of surgery. Half of all children diagnosed with Crohn’s need surgery within 5 years. Surgery is used to remove damaged portions of the digestive tract or scar tissue or repair fistulas. Strictureplasty involves insertion of a ballon to widen narrow segments of intestine without having to remove any portion. Resection of the colon is done to remove damaged intestine. Subtotal colectomy removes part of the colon. Proctocolectomy removes the entire colon. An ileostomy is the creation of a stoma through which feces is passed and collected in a bag which must be emptied several times per day. Emergency surgery is sometimes required for bowel perforations, obstructions, intestinal bleeding, or severe fistulas.
