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What is the
treatment for Crohn's Disease?
Treatment for Crohn's disease depends on
the location and severity of disease, complications, and response to previous
treatment. The goals of treatment are to control inflammation, correct
nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea,
and rectal bleeding. Treatment may include drugs, nutrition supplements,
surgery, or a combination of these options. At this time, treatment can help
control the disease, but there is no cure.
Some people have long periods of
remission, sometimes years, when they are free of symptoms. However, the disease
usually recurs at various times over a person's lifetime. This changing pattern
of the disease means one cannot always tell when a treatment has helped.
Predicting when a remission may occur or when symptoms will return is not
possible.
Someone with Crohn's disease may need
medical care for a long time, with regular doctor visits to monitor the
condition.
Drug
Therapy
Most people are first treated with drugs
containing mesalamine, a substance that helps control inflammation.
Sulfasalazine is the most commonly used of these drugs. Patients who do not
benefit from it or who cannot tolerate it may be put on other mesalamine-containing
drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa.
Possible side effects of mesalamine preparations include nausea, vomiting,
heartburn, diarrhea, and headache.
Some patients take corticosteroids to
control inflammation. These drugs are the most effective for active Crohn's
disease, but they can cause serious side effects, including greater
susceptibility to infection.
Drugs that suppress the immune system are
also used to treat Crohn's disease. Most commonly prescribed are
6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work
by blocking the immune reaction that contributes to inflammation. These drugs
may cause side effects like nausea, vomiting, and diarrhea and may lower a
person's resistance to infection. When patients are treated with a combination
of corticosteroids and immunosuppressive drugs, the dose of corticosteriods can
eventually be lowered. Some studies suggest that immunosuppressive drugs may
enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has
approved the drug infliximab (brand name, Remicade) for the treatment of
moderate to severe Crohn's disease that does not respond to standard therapies (mesalamine
substances, corticosteroids, immunosuppressive agents) and for the treatment of
open, draining fistulas. Infliximab, the first treatment approved specifically
for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a
protein produced by the immune system that may cause the inflammation associated
with Crohn's disease. Anti-TNF removes TNF from the bloodstream before it
reaches the intestines, thereby preventing inflammation. Investigators will
continue to study patients taking infliximab to determine its long-term safety
and efficacy.
Antibiotics are used to treat bacterial
overgrowth in the small intestine caused by stricture, fistulas, or prior
surgery. For this common problem, the doctor may prescribe one or more of the
following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or
metronidazole.
Diarrhea and crampy abdominal pain are
often relieved when the inflammation subsides, but additional medication may
also be necessary. Several antidiarrheal agents could be used, including
diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of
diarrhea will be treated with fluids and electrolytes.
Nutrition Supplementation
The doctor may recommend nutritional
supplements, especially for children whose growth has been slowed. Special
high-calorie liquid formulas are sometimes used for this purpose. A small number
of patients may need periods of feeding by vein. This can help patients who need
extra nutrition temporarily, those whose intestines need to rest, or those whose
intestines cannot absorb enough nutrition from food.
Surgery
Surgery to remove part of the intestine
can help Crohn's disease but cannot cure it. The inflammation tends to return
next to the area of intestine that has been removed. Many Crohn's disease
patients require surgery, either to relieve symptoms that do not respond to
medical therapy or to correct complications such as blockage, perforation,
abscess, or bleeding in the intestine.
Some people who have Crohn's disease in
the large intestine need to have their entire colon removed in an operation
called colectomy. A small opening is made in the front of the abdominal wall,
and the tip of the ileum is brought to the skin's surface. This opening, called
a stoma, is where waste exits the body. The stoma is about the size of a quarter
and is usually located in the right lower part of the abdomen near the beltline.
A pouch is worn over the opening to collect waste, and the patient empties the
pouch as needed. The majority of colectomy patients go on to live normal, active
lives.
Sometimes only the diseased section of
intestine is removed and no stoma is needed. In this operation, the intestine is
cut above and below the diseased area and reconnected.
Because Crohn's disease often recurs after
surgery, people considering it should carefully weigh its benefits and risks
compared with other treatments. Surgery may not be appropriate for everyone.
People faced with this decision should get as much information as possible from
doctors, nurses who work with colon surgery patients (enterostomal therapists),
and other patients. Patient advocacy organizations can suggest support groups
and other information resources.
People with Crohn's disease may feel well
and be free of symptoms for substantial spans of time when their disease is not
active. Despite the need to take medication for long periods of time and
occasional hospitalizations, most people with Crohn's disease are able to hold
jobs, raise families, and function successfully at home and in society.
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