Crohn's: New Treatments, Better Understanding

Currently there are many symptomatic treatments for Crohn's, but there is no cure. The cause of the illness isn't known, which makes finding effective treatments or a cure nearly impossible. Current types of treatment include antibiotics, anti-inflammatory drugs, immunomodulators, biologic therapies and in some cases nutritional therapies.

When Remicade TM (infliximab) first came on the market, it brought relief to many Crohn's patients. Infliximab modifies the human immune system. It is an antibody produced in mice after they're infected with a protein called tumor necrosis factor-alpha (TNF-alpha). Antibodies to TNF-alpha are then taken from the mouse, and they become infliximab after being adjusted to be more like human antibodies in order to avoid allergic reactions or rejections in patients. It's given as an IV. Many doctors feel it hasn't been studied enough, and should not be used as a long-term drug.

More recently a similar anti-TNF agent has come on the market: Humira TM (adalimumab). It doesn't use a "middle-mouse" like Remicade does. Instead, it is completely human in origin. It's administered by a shot, or subcutaneous injection, instead of intravenously as with Remicade. It's been in use for some time by rheumatologists treating illnesses like rheumatoid arthritis and ankylosing spondylitis. Like Remicade, it treats the inflammation of the small intestine, and can help to prevent the on-set of a flare. It is commonly used in patients who can no longer tolerate infliximab.

A recent study funded by the National Institutes of Health (NIH) tried the drug naltrexone, used to treat addictions to alcohol and opioid drugs, on Crohn's patients. They found that a daily dose of 4.5 mg for twelve weeks helped reduce symptoms and improve the quality of life of those patients. The researchers admitted that they don't yet know how it works in Crohn's patients, and that more study is needed. It has potential for future treatment, as it has fewer side effects than most other drugs in use, is less expensive than most, and is safer for long-term use.

The most interesting work to me is what is being done in nutritional therapy. Fish oil and flaxseed oil given as supplements seem to fight the intestinal inflammation that causes many of the symptoms of Crohn's. Complex carbohydrates like psyllium cause the bacteria in the lower intestine to produce short-chain fatty acids, which then in turn help the lining of the colon to heal.

Probiotics, or "good bacteria" like those in yogurt (lactobacillus, for example) have been found to be helpful for Crohn's patients. Those who are lactose intolerant can be given supplements of these probiotics, which help to heal the intestinal tract.

One other type of nutritional treatment that may have potential for helping Crohn's patients is the use of minerals and vitamins like those being used as chemoprevention in cancer patients. This is another area where a lot more research is needed, but it's enough to provide some hope.

Social Advances for Crohn's Patients

Every Crohn's patient knows the feeling of an immediate need for a bathroom. Some stores and businesses keep their bathrooms for staff only. Legislation called Ally's Law, also known as the Restroom Access Act, went into effect in Illinois in September of 2005. This act requires businesses to provide restroom access to people with debilitating bowel disorders, including Crohn's and Ulcerative colitis. The legislation originated when a young girl with an inflammatory bowel disease brought a suit against a business that refused her access to a restroom when she desperately needed one. It is her courage and tenacity that got it through the Illinois legislature. This is a major step forward, and the Crohn's and Colitis Foundation of America (CCFA) and other groups are working to make this a national law.

Personally, I'd like to see a modified version of this law in effect in public schools. Many Crohn's patients are teenagers. They shouldn't be forced to raise their hands and ask permission to go to the restroom when they need to go urgently. Teachers need to be educated about inflammatory bowel diseases (IBDs), as do other students. It's hard enough to have frequent bouts of diarrhea without being teased about it. School cafeterias need to understand the dietary needs of Crohn's patients as well, and offer alternates to some of the foods, so that young people with Crohn's can eat with their friends without causing their intestines to flare.

Another positive step for Crohn's patients is the recognition by the Social Security Administration of debilitating bowel disorders, including IBDs like Crohn's disease and Ulcerative colitis, as "disabling illnesses," making patients with these illnesses potential candidates for Social Security Disability benefits. While many Crohn's patients have enough control of their illness with medications, others do not. The potential for disability benefits, and just knowing that it's a possibility, gives hope to many patients who are suffering as they struggle to gain control of their illness.

Crohn's and Ulcerative colitis support groups should be more widely available. The CCFA provides a directory of support groups on its Web site, and there are numerous "lists" for patients with IBDs to correspond with people in similar situations or who have similar problems and/or interest, but not everyone has access to computers, and some elderly people aren't about to leap onto the Internet looking for help. Hospitals and clinics won't act on their own, however. Crohn's patients will have to be their own advocates to start support groups.

A final area where Crohn's patients need to be both activists and advocates is in obtaining support for research into their illness. It's hard to be an activist when you're going through a flare, but it's necessary. There is research going on in both the private and public sectors. But since there is, as of now, no cure for Crohn's, and most of the treatments have horrible side effects, it's clear that more research is needed. We need to contact our Congress members and lobby for funding for research, and also lobby our doctors, especially people whose primary hospital is a teaching hospital, to apply for grants for research. We as Crohn's patients need to be heard, and to do that we need to speak up.

Progress in the treatment and understanding of Crohn's disease has been made over the last few years; drugs like Remicade and Humira have "given life back" to many Crohn's patients whose flares weren't under control. But until there is a cure, it isn't enough.