Learn more about Crohn’s disease.
Standard medical treatment
The main goal of treatment is to prevent inflammation. Examples of medicines indicated for Crohn’s disease are as follows:
• Steroids: These reduce total body inflammation, but have numerous side effects including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects include high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and an increased chance of infection. For example, prednisone is often used to elicit remission over 3-4 months.
• Aminosalicylates: These drugs suppress inflammation in the intestine and joints. Examples include mesalazine, olsalazine, sulphalazine and balsalazide.
• Immunosuppressants: These suppress the immune system and reduce levels of inflammation. They’re often used in people who relapse when they come off steroids. Examples include azathioprine, mercaptopurine, methotrexate, mycophenolate mofetil, ciclosporin and tacrolimus.
• Antibiotics: These kill bacteria in irritated areas of the bowel. They may also be indicated when abscesses and fistulas are present. Examples include metronidazole and ciprofloxacin.
• Biologics: These are monoclonal antibodies that target the immune system – specifically tumour necrosis factor (TNF). These medications block the effect of TNF and are, for this reason, also called anti-TNF drugs. TNF is a substance made by immune system cells that causes inflammation. TNF inhibitors have potentially very serious side effects. They’re generally prescribed for moderate to severe Crohn’s disease that isn’t responding to other therapies. Infliximab (Remicade) and adalimumab (Humira) are two TNF inhibitors.
• Anti-diarrhoeal medications: For example, lopermide may be helpful when diarrhoea is present without infection. Anti-diarrhoeal medications work by slowing down the contractions (muscle movements) in the gut, so food moves more slowly.
• Bile salt binders such as colestyramine bind to bile salts that may enter the colon in excess and cause diarrhoea if the ileum is affected or removed by surgery.
• Laxatives such as Movicol may help relieve constipation by increasing the amount of water in the large bowel and making stools softer and easier to pass.
• Bulking agents such as Fybogel are made from plant fibre and make stools easier to pass. However, they should be avoided if you have a stricture (narrowing of the bowel).
• Painkillers (e.g. paracetamol) can be used for pain management. Steer clear of non-steroidal anti-inflammatory drugs, as these may worsen Crohn’s disease.
• Anti-spasmodics can reduce painful cramps and spasms by relaxing muscles. They’re most commonly recommended for people with IBS-like symptoms. However, caution must be used if there’s a risk of developing an obstruction.
If the symptoms of Crohn’s disease become severe, bowel rest may be indicated. This gives your gut a chance to heal. During this period, only clear liquids are allowed. However, depending on the severity of your symptoms, it could also mean not taking anything by mouth. If this is the case, nutrition will be given through a major central vein (total parental nutrition).
Due to the advancements in standard medical treatment (discovery of biologics etc.) extensive gut resections (removal of large sections of the intestine) are now less common.
However, up to 8 out of 10 people with Crohn’s disease will still need surgery at some point in their lives as a means to better manage their symptoms or if complications are present (e.g. obstruction, fistula).
|Read on: Treating Crohn’s disease | Health24|