Crohn's disease: Encyclopedia II - Crohn's disease - Treatment

Crohn's disease - Treatment

Crohn's disease - Medication

Steroids are often necessary in initial stages and during flare-ups, although long-term steroid therapy is discouraged because of its well-known side effects. Traditionally, corticosteroids such as prednisone are used because they have the longest medical history of anti-inflammatory use. However, their side-effects are also the most severe, causing insulin resistance and frank diabetes, hypertension (high blood pressure), glaucoma, osteoporosis, severe psychological issues, and many other problems after long-term use.

A well-established group of drugs, especially useful in mild-to-moderate disease, are salicylates - 5-ASA derivates - 5-aminosalicylic acid compounds such as sulfasalazine (Azulfidine ®, Salazopyrin ®), mesalamine (Pentasa®, Asacol®), olsalazine, and balsalazide. Immunomodulating drugs such as azathioprine, 6-mercaptopurine and methotrexate are given mainly in moderate-to-severe cases. Research trials are being conducted on treatment with drugs in the same family as thalidomide. Infliximab (brand name Remicade®) is given in patients with therapy-resistant or fistulating Crohn's. Adalimumab (brand name Humira®) has been used in patients who show allergic reaction or diminished response to infliximab.

Crohn's disease - Surgery

Surgery (resection of parts of the bowel) is avoided, as this does not cure the disease - it can recur at any site in the digestive tract. 50% of all Crohn's patients eventually undergo one or more resections to control highly active disease. Most often, this is of the terminal ileum. In some cases of wide-spread intractable Crohn's colitis, removal of the colon and rectum (protocolectomy) is required. In these cases, the patient is left with an ileostomy.

According to the Crohn's and Colitis Foundation of America, patients who have had a resection have a 20% chance of recurrence of Crohn's after two years, increasing to approximately 50% after five years. Patients who've had a proctocolectomy with ileostomy have a recurrence rate of less than 20%. Crohn's most commonly recurs at the site of the anastomosis or ileostomy.

Crohn's disease - Dietary

Paying close attention to diet can help reduce the number and severity of flare-ups for many sufferers. Patients are encouraged to follow a nutritious diet and limit any foods that seem to worsen symptoms. Individual reactions vary. Some foods commonly avoided by Crohn's patients are:

• Dairy foods. Some people are lactose intolerant (unable to digest the sugar lactose, found in milk products). Taking lactase tablets or specially prepared dairy products may help. Note: Many lactose-intolerant patients are still able to eat yogurt with active cultures, which may even be helpful
• Foods high in fiber, but because a high-fiber diet has other benefits, these foods might be avoided only during flare-ups.
• Foods associated with inflammation (alcohol, hot spices, and caffeine).
• Saturated fats, found in meat and dairy products. However some fats such as in fish oil may actually be helpful.
• Products containing corn or gluten (those made from wheat, oats, barley, or triticale).
• Common allergenic foods, such as soy, eggs, peanuts, tomatoes.
• Gas-producing foods such as cabbage family vegetables (broccoli, cabbage, cauliflower and brussels sprouts), dried peas and lentils, onions and chives, peppers and carbonated drinks
• Foods that may irritate the intestine (particularly the cabbage family vegetables).
• Simple sugars,
• Dried fruits or high-sugar fruits, such as grapes, watermelon, or pineapple.
• Sorbitol (an artificial sweetener)

And some foods may also be beneficial:

• Fluids to keep the body hydrated and prevent constipation
• Fruits may be protective
• A high protein diet with lean meats

Other advice:

• Trying small frequent meals may also help.
• There have also been some suggestions that prebiotics such as psyllium may help in the healing process. Furthermore, probiotics (live culture) may also be helpful in aiding recovery of the intestines.

Crohn's disease - Helminthic therapy Current research

Helminthic therapy is a promising new treatment for Crohn's disease and Ulcerative Colitis which has shown great results in clinical trials. It argues that the absence of intestinal worms (due primarily to higher hygiene standards) from the human intestinal tract may cause the immune system, which is not evolutionary adapted to this condition, to over-react causing inflammation and other negative effects, and that reintroducing helminths through ingesting eggs of a certain species (which is not dangerous to humans) can help downregulate and normalize immune responses.

It is interesting to note that both the helminthic therapy and the fecal bacteriotherapy induce a characteristic TH2 white cell response in the diseased areas which seems to be the key in achieving and maintaining remission, and may prove to be of key significance in further research. If the theories behind these new treatments prove correct, they could also very elegantly explain the similarities, differences and reasons behind Crohn's disease and ulcerative colitis (one being induced by lack of certain helminth parasites in the bowel, the other by lack of certain bacteria).

Adapted from the Wikipedia article "Treatment", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki