Medical Treatment

Presently, there is no cure for Crohn's disease. The goal of treatment is to control the disease by (1) minimizing the number and severity of flares, (2) inducing and maintaining remission, and (3) preventing complications. Drug, biologic, and nutritional therapies are the foundations of treatment, but therapy must be tailored for each individual child. The following drugs are most widely used in children with Crohn's disease. Unfortunately, many of these have not been formulated especially for children, and it may take some time to adjust the dose and schedule for each child.

• Aminosalicylates: This is a group of drugs containing 5-aminosalicylic acid (5-ASA). These drugs are related to aspirin and have similar anti-inflammatory effects. They relieve symptoms and maintain remission in many cases with mild or moderate Crohn's disease. They are usually the first choice of treatment because of their relatively mild side effects. Some newer forms of these drugs are designed to work only in the small intestine. This allows the medicine to target only the damaged tissue, avoiding healthy tissues and reducing side effects. Enema and suppository forms are available for children with disease of the lower colon and rectum.
  
  
• Antibiotics: Treatment with certain antibiotics is helpful in some children with mild to moderate Crohn's disease, especially those with disease of the lower colon, rectum, and/or anus.
  
  
• Corticosteroids: These are potent drugs that suppress the immune system and reduce inflammation. They are usually not the first choice of treatment because they have many side effects, including suppression of growth. They are reserved for moderately severe to severe cases of the disease. In children, they are typically given over a short period to control a severe flare. They are usually given in addition to, not instead of, an aminosalicylate. In some cases, only corticosteroids can control the disease. Children with "steroid-dependent" disease must take these drugs regularly in small doses.
  
  
• Immunomodulators: These drugs interfere with the immune system and suppress immune responses. They usually are not the first choice of treatment because of their side effects, but they are preferred to steroids in children and teens with moderately severe or severe disease. They often are used to treat steroid-dependent disease and disease that does not get better with steroids. They can reduce symptoms, maintain remission, and improve growth.

Biologic therapies duplicate or enhance natural processes in the body to fight disease. Scientists are finding ways of harnessing the body's natural immune system to fight the inflammation of Crohn's disease. One important newer therapy fights the action of an immune factor called tumor necrosis factor alpha, which may promote inflammation in Crohn's disease. These agents are used to treat active disease and fistulas. These have typically been given intravenously, although a newer medication can be administered subcutaneously at home. Several clinical trials are currently being performed to test new therapeutic agents for patients with Crohn's disease, including antibodies against certain inflammatory proteins.

Nutritional therapy is another important part of treatment of Crohn's disease. Children who receive appropriate medical therapy and adequate nutrition often experience dramatic reversal of symptoms and increased growth. The exact treatment of nutritional deficiencies depends on the specific situation and should be tailored for each individual child. Your child's health care provider can make recommendations. Parents may want to consult a nutritionist to devise a plan for meeting the child's nutritional needs. A high-calorie, well-balanced diet is the ideal, but many children with Crohn's disease cannot eat enough to supply all of their nutritional needs.

Other options include high-calorie formulas and other supplements; and overnight continuous feeding through a nasogastric tube (which goes through the nose to the stomach), gastrostomy tube (which goes through the skin into the stomach), or, less commonly, vein (intravenous or parenteral feeding). In some cases, overnight continuous feedings can be implemented as an effective treatment of Crohn's disease, resulting in decreased inflammation and less disease activity as well as improved growth.