Treatment:

DIET AND NUTRITION

No specific diet has been shown to improve or worsen symptoms in Crohn's disease. Specific food problems may vary from person to person.

You should eat a well-balanced, healthy diet. It is important for you to get enough calories, protein, and essential nutrients from a variety of food groups.

Certain types of foods may worsen diarrhea and gas symptoms. The problem is more likely during periods when symptoms are present. Possible changes you can make to your diet include:

• Eat small amounts of food throughout the day.
• Drink lots of water (drink small amounts often throughout the day).
• Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
• Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
• If your body does not digest dairy foods well, limit dairy products. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
• Avoid foods that you know cause you gas, such as beans, spicy food, cabbage, broccoli, cauliflower, raw fruit juices and fruits -- especially citrus fruits.

People who have a blockage of the intestines may need to avoid raw fruits and vegetables and other high-fiber foods.

Ask your doctor about extra vitamins and minerals you may need:

• Iron supplements (if you are anemic)
• Calcium and vitamin D supplements to help keep your bones strong
• Vitamin B12 to prevent anemia

STRESS

You may feel worried, embarrassed, or even sad and depressed about having a bowel accident. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can cause digestive problems.

Ask your doctor or nurse for tips on how to manage your stress.

MEDICATIONS

You can take medication to treat very bad diarrhea. Loperamide (Imodium) can be bought without a prescription. Always talk to your doctor or nurse before using these drugs.

Other medicines to help with symptoms include:

• Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription. Ask your doctor about these products.
• Always talk to your doctor before using any laxative medicines.
• You may use acetaminophen (Tylenol) for mild pain.
• Drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) may make your symptoms worse.

Your doctor may also give you a prescription for stronger pain medicines.

Medicines that may be prescribed include:

• Aminosalicylates (5-ASAs) are medicines that help control mild to moderate symptoms. 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.
• Medicines such as azathioprine or 6-mercaptopurine quiet the immune system's reaction.
• 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. Medicines in this group include Infliximab (Remicade) and adalimumab (Humira), certolizumab (Cimzia), and natalizumab (Tysabri).

SURGERY

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. However, 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)
• Failure to grow (in children)
• Fistulas (abnormal connections between the intestines and another area of the body)
• Infections (abscesses)
• Narrowing (strictures) of the intestine

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

See also:

• Ileostomy
• Large bowel resection
• Small bowel resection
• Total abdominal colectomy
• Total proctocolectomy with ileostomy

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, such as thinning of the bones
• 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 deficiency (particularly vitamin B12 deficiency)
• Pyoderma gangrenosum

Calling your health care provider:

Call for an appointment with your health care provider if:

• You have very bad abdominal pain
• You cannot control your diarrhea with diet changes and drugs
• You have lost weight, or a child is not gaining weight
• You have rectal bleeding, drainage, or sores
• You have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F without an illness
• You have nausea and vomiting that lasts for more than a day
• You have skin sores or lesions that do not heal
• You have joint pain that prevents you from doing your everyday activities
• You have side effects from any drugs prescribed for your condition