Crohn's disease is an inflammatory bowel disease, which usually occurs episodically and can affect the entire digestive tract from the mouth to the anus. Many patients with Crohn's disease receive permanent drug therapy, used to prevent relapses (prophylaxis). Complications of Crohn's disease include bowel obstruction and fistulas, for example in the area of the small intestine. In such cases, surgery may be needed.
What kinds of treatment exist for Crohn's disease?
General measures for Crohn's disease include a balanced diet and not using nicotine. Taking certain nutrients, such as dietary supplements, can also be beneficial. Particularly heavy flare-ups can require the use of liquid food or artificial nutrition using infusion.
Drug therapy is used to prevent relapses of Crohn's disease. Medications can also be used to prolong phases with low symptom occurrence (remission maintenance). In addition, there are drugs for treatment with acute relapse: So-called glucocorticoids such as prednisolone or budesonide and other drugs are used to suppress the immune system.
Surgery is often necessary when complications (such as the formation of stenoses [narrowing]) occur. Unlike ulcerative colitis, Crohn's disease cannot be cured by surgery. In addition, complications such as delayed wound healing can increasingly occur with inflammatory bowel diseases. Operations are therefore only carried out rarely and after the risks have been carefully weighed up.
Medications save many patients from hospital stays, complications, and operations. Severe episodes of illness are treated in the hospital.
How is treatment tailored to the patient?
The therapy is adapted to the course of the disease, the age, and the risk factors of the person concerned. The more severe the course of the disease and the more complications occur, the stronger the therapy must be. If the patient feels better, the treating doctor can carefully reduce the medication. If necessary, the doctor can also switch to better tolerated drugs with fewer side effects. This strategy is also called the “top-down strategy”.
With a mild course of the disease, better tolerated medication can be enough right from the start. If this is not the case, so-called “aggressive” drugs are used. This procedure is also called the “bottom-up strategy”.
The severity of a relapse depends on how far the inflammation has spread. Milder flare-ups are often limited to the last section of the small intestine (terminal ileum) and the right half of the large intestine (colon). Only mild to moderate symptoms of the inflammation appear here. If the course of Crohn's disease is more severe, other sections of the intestine are also affected. Foci of inflammation may also appear outside the small and large intestine.
Important information about Crohn's disease at a glance
- Crohn's disease cannot be cured, but in most cases it can be treated well.
- A distinction is made between the treatment of acute relapses and the long-term therapy for the prevention of relapses (prophylaxis).
- The treating physician adapts the treatment individually to the course of the disease. There is no general approach.
- Drug treatment relies on anti-inflammatory drugs and those that suppress the immune system.
- Refraining from nicotine and adapting one’s diet can have a positive influence on the course of the disease.
- A purely alternative medical treatment without conventional medical therapy is not useful and may lead to serious complications.
What does acute therapy for Crohn's disease look like?
Glucocorticoids (cortisone preparations) are initially used to treat acute episodes. Some of these glucocorticoids work throughout the body (systemic effect). Others start locally on the wall of the intestine (topical effect).
These glucocorticoids are used in the therapy of Crohn's disease:
- Prednisolone is often used with Crohn's disease. Patients take it as a tablet (orally) or receive it as an infusion (intravenously). Prednisolone is taken up in the digestive tract when taken orally. The drug has anti-inflammatory effects throughout the body. However, side effects can occur when ingested. Water retention, food cravings, high blood pressure, and influences on hormonal balance are possible. Prednisolone is mainly used for severe episodes of illness.
- Budesonide is another glucocorticoid. It causes fewer side effects and is mainly used for mild flare-ups. The drug acts mainly as tablets locally in the intestine. Eighty percent of the given dose is broken down by the liver. What remains in the blood afterwards is then distributed in the body. Budesonide can also be used as a foam over the anus (rectally). It is then absorbed into the body in even smaller amounts and acts almost only locally.
After the symptoms have improved, the glucocorticoid dose is slowly reduced (tapering). If the acute flare-up cannot be treated with glucocorticoids or there is no improvement, other immunosuppressive drugs are needed. Otherwise, these are also used in long-term therapy.
Who needs long-term therapy?
When inflammation symptoms subside after acute therapy, the doctor and patient jointly decide whether long-term therapy is necessary to maintain remission. So far, there are no sufficient studies to define which patients benefit from therapy for remission maintenance and relapse prevention. The decision for or against long-term therapy should be made individually with the attending doctor. One is likely to need long-term therapy if they:
- have early onset of the disease in childhood, adolescence or young adulthood (severe episodes can affect one’s growth and development),
- use nicotine,
- experience rapid succession of batches, or
- find inflammation symptoms reappear when tapering off steroids.
How long does therapy for Crohn's disease last?
Medications that suppress the immune system (immunosuppressants) are used for long-term therapy. These include, for example, azathioprine, 6-mercaptopurine, and antibodies that intervene in regulatory mechanisms of the immune system. These antibodies include Infliximab (Remicade®) or Adalimumab, for example, and are administered at regular intervals with a syringe or as an infusion.
Immunosuppressants favor infections, can increase the risk of cancer, and can cause side effects such as intolerance or changes in laboratory parameters. Glucocorticoids should not be used in long-term therapy because they have many side effects in the long term and are not beneficial for maintaining remission.
Can Crohn's disease be treated without medication?
Very mild flare-ups do not necessarily require medication. In such cases, you should pay attention to a light, well-tolerated diet (light food) and physical rest. Many patients also take pain relievers. However, if the inflammation increases, if there is no improvement, or if additional intestinal sections are affected, anti-inflammatory therapy with medication is necessary.
Adequate therapy for a Crohn's disease relapse is important. Otherwise, abscesses (pus accumulation), fistulas, or stenoses may form.
What role does nutrition play in treating Crohn's disease?
Adequate and balanced nutrition is very important for Crohn's disease patients. Flare-ups are often accompanied by a lack of appetite and indigestion. The disease can also weaken the body through the person being underweight and under-supplied with nutrients. In children, the disease can limit growth.
Adequate nutrition is also very important during a flare-up. If the patient is unable to eat enough food, a feeding tube can be used.
Those affected often cannot tolerate lactose (lactose intolerance). Lactose is a certain type of sugar that is found in dairy products. If you suspect you are lactose intolerant, this should be clarified by a doctor. If proven, avoiding dairy products can also have a positive effect on the course of Crohn's disease. If you don't want to do without dairy products, lactose-free products are an option.
What new therapies are there?
There are some new findings regarding therapeutic options against the formation of fistulas at the intestinal exit. Inflammation can form connections from the intestinal wall to the outside. These pose a risk of abscesses and infections. In addition, fistulas sometimes prevent patients from controlling bowel movements (incontinence). Surgery is not always successful because the procedure is complicated and new fistulas may quickly form.
A new drug (Darvadstrocel) appears promising to treat fistulas at the intestinal exit. It contains stem cells from the adipose tissue of healthy people and is introduced into the fistula ducts. In one study, fistula tracts healed better even without surgery. The European Medicines Agency has advocated approval of the preparation.
Can Crohn's disease be treated with alternative medicine?
For Crohn's disease, conventional medical measures such as anti-inflammatory drug therapy and, if necessary, surgical interventions are very important. Purely alternative medical treatment is expressly discouraged. However, alternative treatment options can also be considered.
Crohn's disease is an incurable disease, but it can still be treated well in many cases by relapse therapy and long-term therapy. However, if left untreated, complications such as abscesses or intestinal obstructions are common and can be life-threatening.
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