By Dr Ananya Mandal, MD
There is at present no cure for Crohn’s disease. However, there are medications that can improve the symptoms.
There are several surgical methods that may help in improving the symptoms of the condition.
Aims of treatment of Crohn’s disease
The aim of treatment of Crohn’s disease is to treat the active disease in order to relieve the symptoms. Maintenance therapy aims at preventing recurrence of symptoms.
Medications for Crohn’s disease
Some of the medications that are used include:-
Corticosteroids are hormonal medications that help in reducing the inflammation. These agents are used to treat active Crohn's disease but are not usually used for long term purposes due to their risk of side effects.
Budesonide and prednisolone are the two steroid agents that are used to treat Crohn’s disease.
Budesonide is usually the first steroid medication that is used. Another alternative is Prednisolone.
Some of the side effects include acne, gastritis, swelling of face, edema, insomnia, increased vulnerability to infections, osteoporosis, cataracts, muscle cramps, depressed, mood swings etc.
Steroids cannot be stopped abruptly. The dose has to be reduced gradually before stopping the drug completely.
One of the agents included in this group is Sulfasalazine. This agent reduces inflammation within the colon. It may be used as an alternative to steroid medications in Crohn’s disease. Side effects include nausea, diarrhea, and headaches.
These are agents that suppress the immune system and help to reduce inflammation on a long-term basis.
Agents in this group include Azathioprine, Mercaptopurine etc. Azathioprine may be given as pills or as injections. They suppress the immune system and may lead to increased vulnerability to infections as a side effect. There might be an increased risk of bleeding as well.
Mercaptopurine is originally a drug used in treatment of leukemia. In Crohn’s disease it acts as an immunosuppressant. Some of the side effects with use of Mercaptopurine include nausea, loss of appetite, fatigue, infertility etc.
These agents target the actual pathology of the disease rather than the symptoms alone.
Agents include Infliximab and Adalimumab. These belong to the class of monoclonal antibodies. These agents are recommended only in severe cases of Crohn’s disease that have not responded to other treatments or surgery.
Infliximab targets the tumour necrosis factor (TNF) antibodies that lead to inflammation associated with Crohn’s disease. It is administered as an infusion. Two doses are given two weeks apart.
If there is no response then treatment is stopped. If there is a response, the treatment is continued for further 6 weeks after the initial dose, followed by infusions every 8 weeks.
Infliximab may cause allergic reactions including skin rash, joint pain, fever etc. It may also cause increased vulnerability to infections.
Adalimumab works in a similar way as infliximab. Adalimumab is given by injection once every two weeks.
These may be prescribed to treat bacterial overgrowth in the small intestine caused by complications of Crohn’s disease including stricture, fistulas, or prior surgery. Antibiotics used include ampicillin, sulfonamides, cephalosporins, tetracycline or metronidazole.
Surgery for Crohn’s disease
In Crohn’s disease certain areas of the gut that are affected and the other parts that are unaffected.
With progression of the disease there are invariably complications like stricture and obstruction of the affected parts of the colon.
Around 60-75% of people with Crohn’s disease will need to have surgery when their disease progresses with complications. Surgery involves removal of the inflamed section of the digestive system and reattachment of the remaining part.
Dietary modifications may be required in some cases of Crohn’s disease. Fluid replacements are recommended for diarrhea.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)