What is Crohn's Disease? (Part III)

How is Crohn's disease treated?

Currently there is not a cure for Crohn's disease and remission may either not be possible or prolonged if achieved. In cases where remission is possible, relapse can be prevented and symptoms controlled with a combination of medication, lifestyle change and, in some cases, surgery. Once adequately controlled, Crohn's may not significantly restrict day-to-day living. Treatment is only when symptoms are active and involve first treating the acute problem, then maintaining the remission.

Medication

Acute treatment utilizes medication (usually antibiotics) to treat any infection and to reduce inflammation (usually aminosalicylate anti-inflammatory drugs and corticosteroids). Once symptoms are in remission, treatment enters the maintenance with a goal of avoiding the recurrence of symptoms. Prolonged use of corticosteroid has significant side-effects; as a result they are generally not used for long-term treatment. Alternatives include aminosalicylates alone, however, only a small number of patients are able to maintain the treatment, and many require immunosuppressive drugs instead.

Medications used to treat the symptoms of Crohn's disease include 5-amino salicylic acid (5-ASA) formulations, prednisone, and immunomodulators.

Lifestyle changes

Certain lifestyle changes can reduce symptoms, including dietary adjustments, proper hydration, and smoking cessation. Eating frequent small meals instead of big meals may help with a low appetite. Fatigue associated with Crohn's disease can be helped with regular exercise, a healthy diet, and getting enough sleep. Use of a food diary can help with identifying foods that trigger symptoms. Additionally, following a low-fiber diet can be beneficial in controlling symptoms - especially when high-fiber foods tend to make symptoms worse.

Surgery

Crohn's disease cannot be cured surgically, however, it is used when a partial or full-blockage of the intestine occurs. Surgery might also be required for complications such as fistulas and/or abscesses, or if the disease does not respond to drugs. Following the first surgery, Crohn's will usually show up at the site of the resection though it can appear in other areas. In addition, after resection surgery, scar tissue builds up which can cause strictures - a condition that causes the intestines to become too small to allow excrement to pass through easily which can lead to a blockage. For patients with an obstruction resulting from a stricture, there are two (2) treatment options: 1) strictureplasty; and 2) strictureplasty with resection of the affected portion of the bowel. Statistically there is not a difference between strictureplasty alone versus strictureplasty combined with resection in cases of duodenal involvement.

Short bowel syndrome (SBS) can be caused by the surgical removal of the small intestines. In most cases it develops if the person has had one-half or more of their small intestines removed. Diarrhea is the primary symptom of SBS though other symptoms may include cramping, bloating, and heartburn. It can be treated with changes in diet, intravenous feeding, vitamin and mineral supplements and medication. In cases where the terminal ileum has been removed, the patient may develop excessive watery diarrhea. This is due to the inability to reabsorb bile acids following resection of the terminal ileum.