Treatment:

Crohn� ' s disease cannot be cured, but appropriate treatment can help suppress the inflammatory response and manage symptoms. A treatment plan for Crohn� ' s disease includes:

• Diet and nutrition
• Medications
• Surgery

Diet and Nutrition

Malnutrition is very common in Crohn's disease. Patients with Crohn's disease experience reduced appetite and weight loss. In addition, diarrhea and poor absorption of nutrients can deplete the body of fluid and necessary vitamins and minerals.

Patients should strive to eat a well-balanced healthy diet and focus on getting enough calories, protein, and essential nutrients from a variety of food groups. These include protein sources such as meat, chicken, fish or soy; dairy products such as milk, yogurt, and cheese (if the patient is not lactose-intolerant); and fruits and vegetables.

Depending on your nutritional status, your doctor may recommend that you take a multivitamin or iron supplement. Although other types of dietary supplements, such as probiotics (“healthy bacteria” like lactobacilli) and omega-3 fatty acids, have been investigated for Crohn� ' s disease, there is no conclusive evidence that they are effective in controlling symptoms or preventing disease relapses.

Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. While people vary in their individual sensitivity to foods, general guidelines for dietary management during active disease include:

• Eat small amounts of food throughout the day.
• Stay hydrated by drinking lots of water (frequent consumption of small amounts throughout the day).
• Eat soft, bland foods and avoid spicy foods.
• Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
• Avoid fatty greasy or fried foods and sauces (butter, margarine, and heavy cream).
• Limit milk products if you are lactose intolerant (or consider taking a lactase supplement to improve tolerance). Otherwise, dairy products are a good source of protein and calcium.
• Avoid or limit alcohol and caffeine consumption.

In cases of severe malnutrition, particularly for children, patients may need enteral nutrition. Enteral nutrition uses a feeding tube that is inserted either through the nose and down through the throat or directly through the abdominal wall into the gastrointestinal tract. It is the preferred method for feeding patients with malnutrition who cannot tolerate eating by mouth. Enteral nutrition can be effective for helping maintain remission.

Medications

The goal of drug therapy for Crohn� ' s disease is to:

• Resolve symptoms (induce remission)
• Prevent disease flare-ups (maintain remission). The main drugs used for maintenance are azathioprine, methotrexate, infliximab, and adalimumab.

Depending on the severity of the condition, different types of drugs are used. The main medications for Crohn� ' s disease include:

• Aminosalicylates (5-ASAs) are anti-inflammatory drugs, which are usually used to treat mild-to-moderate disease. The standard aminosalicylate used for Crohn� ' s disease is sulfazine (Azulfidine).
• Corticosteroids are used to treat moderate-to-severe disease. Common corticosteroids include prednisone (Deltasone) and methylprednisone (Medrol). Budesonide (Entocort) is a newer type of steroid. Because corticosteroids can have severe side effects, they are usually used short-term to induce remission, but NOT for maintenance therapy.
• Immunosuppressives, also called immunomodulators or immune modifiers, block actions in the immune system that are involved with the inflammatory response. Standard immunosuppressives include azathioprine (Imuran, Azasan), 6-mercaptopurine (6-MP), and methotrexate (Rheumatrex). These drugs are used for long-term maintenance therapy and to help decrease corticosteroid dosages.
• Biologic drugs are generally used to treat moderate-to-severe disease. They include infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia), and natalizumab (Tysabri). Infliximab, adalimumab, and certolizumab target the inflammatory immune factor known as tumor necrosis factor (TNF).

Other types of drugs may also be used to treat specific conditions and symptoms. Antibiotics, usually ciprofloxacin or metronidazole, may be used to treat fistulas. Anti-diarrheal medications such as loperamide (Imodium) may be given to help control diarrhea.

Drug therapy for Crohn� ' s disease is considered successful if it can push the disease into remission (and keep it there) without causing significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed, and symptoms, such as diarrhea, abdominal cramps, and tenesmus (painful defecation), are normal or close to normal.

Surgery

Most patients with Crohn� ' s disease eventually require some type of surgery. However, surgery cannot cure Crohn's disease. Problems with fistulas and abscesses may occur after surgeries. New disease usually recurs in other areas of the intestine. Surgery may be helpful for relieving symptoms and to correct intestinal blockage, bowel perforation, fistulas, or bleeding.

Basic types of surgery used for Crohn� ' s disease include:

• Strictureplasty is used to help open up strictures, narrowed areas of intestine.
• Resection is used to remove damaged sections of the bowel. The surgeon reattaches the cut ends of the intestine in a procedure called an anastomosis. Repeat resections may be needed if the disease recurs at a different site near the anastomosis.
• Colectomy (removal of the colon) or proctocolectomy (removal of the colon and rectum) may be peformed in cases of severe Crohn� ' s disease. After a proctocolectomy is completed, the surgeon performs an ileostomy in which the surgeon connects the end of the small intestine (ileum) to a small opening in the abdomen (called a stoma). Patients who have had a proctolectomy and ileostomy need to wear a pouch over the stoma to collect waste. Patients who have had a colectomy can continue to pass stool naturally.
• Other surgical procedures include repairing fistulas that have not been helped by medication and draining abscesses.