Crohn Disease (cont.)
Senthil Nachimuthu, MD, BS
Francisco Talavera, PharmD, PhD
Crohn's Disease Treatment
The goals of treatment of Crohn's disease are to reduce the underlying inflammation, which then relieves symptoms, prevents complications, and maintains good nutrition.
Inflammation: Medications used in reducing inflammation in Crohn's disease include anti-inflammatory drugs, corticosteroids, other immunosuppressants, and antibiotics. The types
of medications most widely used in Crohn's disease are the following:
- Aspirin-like anti-inflammatory drugs (mesalamine) reduce
the inflammation. These drugs are used to prevent flares in people with
mild Crohn's disease.
- Corticosteroids reduce inflammation and suppress
the immune system. They can be used in the short term
only. Corticosteroids are indicated in persons with severe systemic
symptoms (for example, fever, nausea, weight loss)
and in those who do not respond to anti-inflammatory agents.
- Antibiotics reduce inflammation indirectly by
- Immunosuppressants suppress the immune system. Some are more effective than steroids, while others have longer duration of effect.
If these drugs are not successful in suppressing inflammation, the alternative is surgery
Symptoms often go away when the inflammation is treated. Symptoms may be treated separately if necessary.
- For symptoms such as diarrhea, cramps, and bloating,
medication is usually enough. Antidiarrheal agents usually relieve mild to
moderately severe symptoms.
- Dietary therapies, such as diets high in fiber, low in fiber,
or low in fat, are helpful in some people over the short term, but are rarely
helpful over the long term.
- Do not take dietary supplements or vitamins without
first discussing it with a health care provider.
- Many people with Crohn's disease are lactose intolerant and should avoid dairy products if they are intolerant of them.
Most complications resolve when the inflammation is treated. Some, however, require additional treatment. A fistula, for example, usually is treated with antibiotics to get rid of the infection. Other medications may be tried to help heal the fistula, but these work in only about 30-40% of cases.
- During this treatment, you may have to stop eating and receive nutritious fluids intravenously for several days. A nasogastric (NG) tube
placed in your stomach through your nose will remove some of the fluids and
gases that collect there. This combination of approaches, called bowel rest,
lets your digestive tract stop working temporarily, which promotes healing.
- Fistulas that bypass a large amount of the intestine (thus causing very severe symptoms) or do not get better with medical treatment may need to be repaired surgically.
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