Crohn's disease is a chronic condition for which there is currently no cure. It is characterised by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is relatively low. However, Crohn's disease is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer.
Medication
Acute treatment uses medications to treat any infection (normally antibiotics) and to reduce inflammation (normally aminosalicylate anti-inflammatory drugs and corticosteroids). When symptoms are in remission, treatment enters maintenance with a goal of avoiding the recurrence of symptoms. Prolonged use of corticosteroids has significant side-effects; as a result they are generally not used for long-term treatment. Alternatives include aminosalicylates alone, though only a minority are able to maintain the treatment, and many require immunosuppressive drugs., certolizumab and natalizumab. Hydrocortisone should be used in severe attacks of Crohn's disease.
Lifestyle changes
Certain lifestyle changes can reduce symptoms, including dietary adjustments, proper hydration and smoking cessation. Eating small meals frequently instead of big meals may also help with a low appetite. To manage symptoms have a balanced diet with proper portion control. Fatigue can be helped with regular exercise, a healthy diet and enough sleep. A food diary may help with identifying foods that trigger symptoms. Some patients should follow a low fiber diet to control symptoms especially if fiberous foods cause symptoms. For patients with an obstruction due to a stricture, two options for treatment are strictureplasty and resection of that portion of bowel. There is no statistical significance between strictureplasty alone versus strictureplasty and resection in cases of duodenal involvement. In these cases, re-operation rates were 31% and 27%, respectively, indicating that strictureplasty is a safe and effective treatment for selected patients with duodenal involvement.
Short bowel syndrome (SBS, also short gut syndrome or simply short gut) can be caused by the surgical removal of the small intestines. It usually develops if a person has had half or more of their small intestines removed. Diarrhea is the main symptom of short bowel syndrome though other symptoms may include cramping, bloating and heartburn. Short bowel syndrome is treated with changes in diet, intravenous feeding, vitamin and mineral supplements and treatment with medications. Another complication following surgery for Crohn's disease where the terminal ileum has been removed is the development of excessive watery diarrhea. This is due to an inability to reabsorb bile acids after resection of the terminal ileum.
In some cases of SBS, intestinal transplant surgery may be considered; though the number of transplant centres offering this procedure is quite small and it comes with a high risk due to the chance of infection and rejection of the transplanted intestine.
Prospective treatments
Researchers at University College London have questioned the wisdom of suppressing the immune system in Crohn's, as the problem may be an under-active rather than an over-active immune system: their study found that Crohn's patients showed an abnormally low response to an introduced infection, marked by a poor flow of blood to the wound, and the response improved when the patients were given sildenafil citrate.
Recent studies using helminthic therapy or hookworms to treat Crohn's Disease and other (non-viral) auto-immune diseases seem to yield promising results.
Complementary and alternative medicine
More than half of Crohn's disease sufferers have tried complementary or alternative therapy. These include diets, probiotics, fish oil and other herbal and nutritional supplements. The benefit of these medications is uncertain.
- Acupuncture is used to treat inflammatory bowel disease in China, and is being used more frequently in Western society. However, there is little evidence that acupuncture has benefits beyond the placebo effect, improving quality of life, general well-being and a small decrease in blood-bound inflammatory markers.
- Metronidazole and ciprofloxacin are antibiotics which are used to treat Crohn's that have colonic or perianal involvement, although this use has not been approved by the Food and Drug Administration. They are also used for treatment of complications, including abscesses and other infections accompanying Crohn's disease.
- Cannabis may be used to treat Crohn's Disease with its anti-inflammatory properties. Cannabis and cannabis-derived drugs may also help to heal the gut lining.
Further Reading
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