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Although Crohn's Disease can't be cured, its symptoms can usually be brought under control. The overall effectiveness of treatment for Crohn’s disease depends on the location and severity of the disease, the number of complications it creates, and the person’s response to previous medical treatments for recurring symptoms. The most successful treatments help the disease go into remission and prevent it from flaring up again.
There are several steps in the treatment sequence for Crohn's Disease. The first order of business is to treat the acute symptoms of the disease such as infections, severe inflammation, obstructions and abscesses.
During flare-ups, less digestible foods such as bulky grains, hot spices, alcohol, and dairy products are likely to increase diarrhea and cramping, and should be avoided. In the most severe cases of inflammation, patients may need to be fed intravenously for a brief time through a small tube inserted into the vein of the arm, so they can obtain extra nutrition temporarily, and give their intestines a rest.
Antibiotics are used to kill off the infections in the abscesses or fistulas. Immunomodulators, such as azathioprine or 6-mercaptopurine, can help heal some fistulas as well. Aminosaicylates, which are mild anti-inflammatory medicines, can be taken by mouth or through the rectum to reduce swelling and clear up the intestinal passage. Corticosteroids such as prednisone and methylprednisolone are the most powerful of the anti-inflammatories, and are used only to treat the most painful and chronic inflammations characteristic of moderate to severe Crohn's disease.
In the severest cases of Crohn's disease, where the inflamed tissue does not respond to any of the traditional medications, doctors resort to a technique known as biologic therapy. Two drugs specifically approved for Crohn's Disease, Infliximab (Remicade) and adalimumab (Humira) are monoclonal antibodies, which help block an immune system chemical that promotes inflammation. Infliximab, in particular, is also approved to combat fistula.
Even the strongest medications can be ineffective, however, particularly in the case of extensive bleeding and hemorrhaging, abscessing (another term for infected tissue), fistulas, and the narrowing of the intestine. In these worst-case scenarios, the treatment of last resort is a form of intestinal surgery known as bowel resection. This surgical technique physically removes from the body all the fistulas, abscesses and other obstructions that have not responded to drugs, either by cutting them away or draining them. If a section of the intestine is diseased, the surgeon can cut it out and reconnect the healthy parts on either side.
However, the inflammation of the colon becomes so severe sometimes that Crohn's patients need a colectomy, an operation in which the surgeon removes the entire colon, and then reconnects the abdomen to the end of the small intestine through a small opening called a stoma. Waste leaves the body through the stoma, and collects in a small removable pouch that the patient can remove and empty as needed.
The Crohn's and Colitis Foundation of America reports that two thirds to three quarters of Crohn's patients will at some point in their lives need to go through bowel surgery. That will not be the end of the story, however; not even surgery can cure Crohn's Disease. Inflammation can and does return; the diseased tissue grows right back. People with Crohn’s Disease must often get several operations, because inflammation often reappears in the area next to the remains of the diseased intestinal tissue that was removed in the first surgery. For this reason, surgery may not be the best option for every one with Crohn's, and patients should carefully consider all their options before resorting to surgery.
If treatment is successful enough to induce remission -- the disappearance of symptoms -- then the next step is to maintain remission and avoid the return of disease, also known as flare-ups.
Corticosteroids have severe side effects, including Cushing's syndrome, mania, insomnia, hypertension, high blood glucose, osteoporosis, and avascular necrosis of long bones, so doctors do their best to avoid using them over the long term. Since aminosalicylates alone may not be enough to maintain remission and prevent the return of severe inflammation, many Crohn's patients must begin a regime of immunosuppressive drugs, which are medicines that suppress the immune system.
Some people with Crohn's disease remain symptom-free for years. Most Crohn's sufferers, even if they do have occasional flare-ups, are able to live fulfilling lives in which they work, raise families, and make friends. However, even these long periods of remission are likely to end eventually, because the disease tends to recur. It is difficult to know when treatment has helped, and impossible to predict the timing of a remission or a flare-up. Because of this uncertainty, Crohn’s disease patients require long-term medical care and regular visits to the doctor in order to monitor their condition.
*This article is based on the information at AARP Health Tools, Wikipedia, National Institutes of Health: Crohn's Disease Page |
