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. (See For More
Information for the names of such organizations.)
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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Can diet control Crohn's disease?
No special diet has been proven effective for preventing or
treating this disease. Some people find their symptoms are made
worse by milk, alcohol, hot spices, or fiber. People are
encouraged to follow a nutritious diet and avoid any foods that
seem to worsen symptoms. But there are no consistent rules.
People should take vitamin supplements only on their doctor's
advice.
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Is pregnancy safe for women with Crohn's disease?
Research has shown that the course of pregnancy and delivery
is usually not impaired in women with Crohn's disease. Even so,
women with Crohn's disease should discuss the matter with their
doctors before pregnancy. Most children born to women with
Crohn's disease are unaffected. Children who do get the disease
are sometimes more severely affected than adults, with slowed
growth and delayed sexual development in some cases.
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