Treatment:

Medicines that may be prescribed include:

• Aminosalicylates (5-ASAs) are medicines that help control mild to moderate inflammation. Some forms of the drug are taken by mouth; others must be given rectally.
• Corticosteroids (prednisone and methylprednisolone) are used to treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum.
• Immunomodulators such as azathioprine or 6-mercaptopurine help reduce the need for corticosteroids and can help heal some fistulas.
• Antibiotics may be prescribed for abscesses or fistulas.
• Biologic therapy is used to treat patients with severe Crohn's disease that does not respond to any other types of medication. Infliximab (Remicade) and adalimumab (Humira) are approved for Crohn's disease. They belong to a class of drugs called monoclonal antibodies, which help block an immune system chemical that promotes inflammation. Infliximab is also approved for patients with fistulous disease. Other related drugs are being studied.

If medicines do not work, a type of surgery called bowel resection may be needed to remove a damaged or diseased part of the intestine or to drain an abscess. A procedure called anastomosis is done to connect the remaining two ends of the bowel.

According to the Crohn's and Colitis Foundation of America, two-thirds to three-quarters of patients with Crohn's disease will need bowel surgery at some time. However, unlike ulcerative colitis, surgically removing the diseased portion of the intestine does not cure the condition.

Patients who have Crohn's disease that does not respond to medications may need surgery, especially when there are complications such as:

• Bleeding (hemorrhage)
• Fistulas
• Infections (abscesses)
• Narrowing (strictures)

Some patients may need surgery to remove the entire large intestine (colon), with or without the rectum.

No specific diet has been shown to improve or worsen the bowel inflammation in Crohn's disease. However, eating a healthy amount of calories, vitamins, and protein is important to avoid malnutrition and weight loss. Avoid foods that worsen diarrhea. Specific food problems may vary from person to person.

People who have a blockage of the intestines may need to avoid raw fruits and vegetables. Those who have difficulty digesting milk sugar (lactose) may need to avoid milk products.

Support Groups:

The Crohn's and Colitis Foundation of America offers support groups throughout the United States. See http://www.ccfa.org/chapters/

Expectations (prognosis):

There is no cure for Crohn's disease. The condition is marked by periods of improvement followed by flare-ups of symptoms.

It is very important to stay on medications long-term to try to keep the disease symptoms from returning. If you stop or change your medications for any reason, let your doctor know right away.

You have a higher risk for small bowel and colon cancer if you have Crohn's disease.

Complications:

• Abscess
• Bowel obstructions
• Complications of corticosteroid therapy
• Erythema nodosum
• Fistulas in the following areas:
  • Bladder
  • Skin
  • Vagina
• Impaired growth and sexual development in children
• Inflammation of the joints
• Lesions in the eye
• Nutritional deficiencies (particularly vitamin B12 deficiency)
• Pyoderma gangrenosum

Calling your health care provider:

Call for an appointment with your health care provider if:

• You have symptoms of Crohn's disease
• You are already diagnosed with Crohn's disease and your symptoms get worse or do not improve with treatment
• You are already diagnosed with Crohn's disease and you develop new symptoms