Treatment Of Crohn’s Disease – You Should Know This

Treatment of Crohn’s disease aims to prevent new outbreaks and control those who are already there. Due to the fact that the cause of Crohn’s disease is unknown, no cure has been established. However, relieving and reducing the symptoms is manageable.

There are several types of treatment for Crohn’s disease:

• Medication
• Dietary treatment
• Surgical treatment
• Other

Pharmacological treatment

Of the various options, medication is the primary one when it comes to treating Crohn’s disease.

The most common pharmacological groups for the treatment of the disease are the following:

• Antibiotics
• 5-ASA
• Glucocorticoids
• Immunosuppressive
• Biological therapies

Antibiotics

Doctors prescribe this group of medications to treat excessive bacterial growth in the small intestine. Complications from Crohn’s – restrictions, fistulas or previous surgeries – as well as anal or perianal infections, cause this unusual bacterial growth.

The most common forms of antibiotics to treat Crohn’s disease are the following:

• Metronidazole
• Ciprofloxacin
• Ampicillin
• Sulfonamides

Common side effects are:

• Nausea
• Metallic taste in the mouth
• Side effects when mixed with alcohol

5-Aminosalicylic acid compounds

5-ASA, or 5-Aminosalicylic acid, is a group of non-steroidal anti-inflammatory drugs (NSAIDs) that reduce intestinal inflammation in cases of Crohn’s disease.

The most common 5-ASAs are sulfasalazine and mesalazine. Both are oral drugs that are also available as suppositories or enemas. They are a good alternative for patients who do not respond to steroids.

The most common side effects are:

• Nausea
• Diarrhea
• Headache

Glucocorticoids

Glucocorticoids are a hormonal treatment for Crohn’s disease, which help reduce inflammation. Doctors prescribe glucocorticoids in the acute phases of the disease, but when these are under control, their use is discontinued due to the possible side effects of the treatment.

The most commonly used are the following:

• Budesonide : This drug is used to treat the effects of terminal ileum due to its targeted effect.
• Prednisolone : Used in more severe cases.

These drugs often lead to the following side effects:

• Fluid accumulation
• Osteoporosis
• Gastritis
• Acne
• Cataracts

Steroids have an after-effect, which makes it important to gradually reduce the dose as opposed to suddenly stopping treatment.

Immunosuppressive drugs

Immunosuppressive drugs weaken the immune system to prevent an inflammatory reaction. This helps reduce inflammation in the long run. These drugs are used to prevent new outbreaks, and also when corticosteroids do not work.

Among this group of drugs, the most commonly used are the following:

• Azathioprine
• 6-mercaptopurine : Although its primary use is to treat leukemia, this drug acts as an immunosuppressive agent for patients with Crohn’s disease. Unfortunately, it has side effects like those listed here:
  • Nausea
  • Exhaustion
  • Infertility
• Methotrexate : If this medicine is prescribed, you must stop treatment completely for 3 months before trying to conceive. Both men and women risk teratogenic deficiencies in the embryo during use.

Unfortunately, the consequence of using such drugs is a  risk of several infections, because they work to suppress the immune system.

Biological therapies

In this case, anti-TNF-α monoclonal antibodies eliminate TF (Tumor Necrosis Factor), a protein that causes inflammation.

These antibodies are paired with immunosuppressive drugs if they are not potent enough, or in cases where treatment or surgery fails.

The most commonly used biological drugs to treat Crohn’s disease are:

• Inflixima : prescribed as an  infusion. It can cause allergic reactions.
• Adalimumab : is prescribed as an injection every two weeks.
• Certolizumab.

Dietary treatment

Diet is an important factor in patients with Crohn’s disease, because they tend to suffer from loss of appetite or inability to absorb nutrients in the intestines.

These patients should be especially concerned about eating a balanced diet, just like people without Crohn’s disease, especially because of the additional complications associated with the disease.

A balanced diet consists of obtaining 50-55% of all nutrients through carbohydrates, 30-35% through lipids or fats, 12-15% through proteins and certain amounts of fiber (low amounts), as well as vitamins and minerals according to the needs of each patient. Patients should eat several times a day and drink plenty of water.

Despite following a balanced diet, people suffering from Crohn’s disease can develop severe malnutrition. In such cases, one may require specialized diet products or hospital visits for parenteral nutrition.

There are several foods that often cause side effects, so it is best to avoid them altogether. Among them are the following:

• Casein: A protein found in dairy products
• Gluten
• Wheat
• Grain
• Yeast
• Some types of fruits and vegetables

The diets that have had the most success in controlling the symptoms of Crohn’s disease are gluten-free and FODMAP-restrictive diets (diets low on fast carbohydrates that are poorly absorbed in the small intestine).

Vitamin and dietary supplements can be taken to relieve the symptoms during outbreaks of the disease, or to induce remission. In particular, vitamin D supplements show a strong link to Crohn’s disease.

Calcium supplements are controversial due to the risk of arterial calcification and heart attack.

Surgical treatment

The main argument in surgery for the treatment of Crohn’s disease is to restore health and well-being when complications occur, and to avoid expanding pharmacological treatment that shows little improvement.

Surgery is not a definitive cure for the disease, but it is necessary in case of perforation, abscesses, bleeding, lack of medical treatment, intestinal obstruction or fistulas.

The operation consists of removing the inflamed part of the digestive tract, and reconnecting the remaining sections.

Other options for treating Crohn’s disease

Instead of other treatments used to treat the symptoms of the disease, the options consist in healthy habits for patients. In the list we find:

• To quit smoking
• Rest : Reducing emotional stress with rest helps relieve outbreaks, and is just as useful as pharmacological treatment.

Despite the fact that Crohn’s disease is a chronic disease with severe episodes, patients should participate in normal daily activities as much as possible.