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Sunday, May 18, 2008

Treatment Of Crohn's Disease

The symptoms and severity of Crohn's Disease vary among patients. Patients with mild or no symptoms may not need treatment. Patients whose disease is in remission (where symptoms are absent) also may not need treatment. There is no medication that can cure Crohn's Disease. Patients with Crohn's Disease typically will experience periods of relapse (worsening of inflammation) followed by periodsof remission (reduced inflammation) lasting months to years. During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During remissions, these symptoms improve. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously, that is, without any treatment. Since there is no cure for Crohn's Disease, the goals of treatment are to:
  1. Induce remissions
  2. Maintain remissions
  3. Minimize side effects of treatment
  4. Improve the quality of life
Treatment of Crohn's Disease and ulcerative colitis with medications is similar though not always identical. Medications for treating Crohn's Disease include:
  1. Anti-Inflammatory Medications

  2. Immuno-Modulator Medications

  3. Herbal Supplements

Anti-inflammatory Medications For Crohn's Disease

Anti-inflammatory medications that decrease intestinal inflammation are analogous to arthritis medications that decrease joint inflammation. Different types of anti-inflammatory medications used in the treatment of Crohn's Disease are:

  • 5-ASA compounds such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowasa enema, Canasa suppository) that act via direct contact (topically) with the inflamed tissue in order to be effective.
  • Corticosteroids that act systemically (without the need for direct contact with the inflamed tissue) to decrease inflammation throughout the body. Systemic corticosteroids have important and predictable side effects if used long-term.
  • A new class of topical corticosteroid (e.g., budesonide) that acts via direct contact (topically) with the inflamed tissue. This class of corticosteroids has fewer side effects than systemic corticosteroids which are absorbed into the body.
  • ntibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro) that decrease inflammation by an unknown mechanism.
New anti-inflammatory medications are constantly being approved by the FDA to treat inflammation associated with Crohn's Disease. To read about several different types of medications as well as the side effects of these different medications please click on the link below.

Anti-Inflammation Medications

Immuno-modulator Medications

Immuno-modulators are medications that affect the body's immune system. The immune system is composed of immune cells and the proteins that they produce. These cells and proteins serve to protect the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is, in fact, an important mechanism used by the immune system to defend the body.) Normally, the immune system is activated only when the body is exposed to foreign invaders. In patients with Crohn's Disease and ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. Immuno-modulators decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins. Decreasing the activity of the immune system with immuno-modulators increases the risk of infections; however, the benefits of controlling moderate to severe Crohn's Disease usually outweigh the risks of infection due to weakened immunity. Examples of immuno-modulators are 6-mercaptopurine (6-MP), azathioprine, methotrexate, and infliximab.

While there are several benefits to using Immuno-modulators, the question becomes, is the risk worth the reward? With all medications there are several drawbacks and benefits that help your physician determine which one to use. To read more information about the different types of Immuno-modulators used to treat Crohn's Disease please click on the link below.

Immuno-Modulator Medications

Surgery in Crohn's Disease

There is no surgical cure for Crohn's disease. Even when all of the diseased parts of the intestines are removed, inflammation frequently recurs in previously healthy intestines months to years after the surgery. Therefore, surgery in Crohn's disease is used primarily for:

  1. Removal of a diseased segment of the small intestine that is causing obstruction.
  2. Drainage of pus from abdominal and peri-rectal abscesses.
  3. Treatment of severe anal fistulae that do not respond to drugs.
  4. Resection of internal fistulae (such as a fistula between the colon and bladder) that are causing infections.
Usually, after the diseased portions of the intestines are removed surgically, patients can be free of disease and symptoms for some time, often years. Surgery, when successfully performed, can lead to a marked improvement in a patient's quality of life. In many patients, however, Crohn's disease eventually returns, affecting previously healthy intestines. The recurrent disease usually is located at or near the previous site of surgery. In fact, 50% of patients can expect to have a recurrence of symptoms within four years of surgery. Drugs such as Pentasa or 6-MP have been useful in some patients to reduce the chances of relapse of Crohn's disease after surgery.

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