Crohn’s Disease: Treatment Options

For now, there is no permanent cure for Crohn’s Disease, an Inflammatory Bowel Disorder (IBD) that causes inflammation within the gastrointestinal tract. Therefore, Crohn’s disease treatment is usually focused on reducing inflammation, symptoms, and complications. However, with an early diagnosis and adequate treatment, most patients are able to experience long-term remission, i.e. periods without symptoms.

1- Anti-Inflammatory Medication:

Some commonly prescribed medication for inflammation reduction includes:

• Corticosteroids: are commonly prescribed for only 3-4 months and reduce intestinal inflammation, provide symptom relief and help induce remission. However, they are utilized only when all other anti-inflammatory options have failed, and may also be used in conjunction with immunosuppressants.
• Oral-5 Amino Salicylates: previously the go-to drug for reducing IBD-induced inflammation, include mesalamine and sulfasalazine. However, despite their previous popularity, they have now been proven to only moderately reduce Crohn’s symptoms.

2- Immunosuppressants:

Reducing inflammation via the immune system, commonly prescribed immunosuppressants include:

• Azathioprine and Mercaptopurine: are the most widely prescribed immune system suppressants for Crohn’s and other IBD treatment. Side effects include nausea, vomiting, liver inflammation and increased chances of infection, which is why close monitoring and regular blood tests are required.
• Infliximab, Adalimumab and Certolizumab Pegol: equalize the immune system protein, ‘Tumour Necrosis Factor’s (TNF) levels, an excess of which is responsible for causing inflammation.
• Natalizumab: aids in inflammation and symptomatic reduction by halting the binding process of integrins (a set of immune cell molecules) with the intestinal lining. However, the medication is administered under strict observation due to the increased risk of multifocal leukoencephalopathy, a rare, progressive virus that causes fatal brain damage. Alternatively, the newly approved Vedolizumab works like natalizumab minus the brain damage.
• Ustekinumab: is primarily used for treating the skin disease, Psoriasis, but can also be used for Crohn’s disease treatment when all other medications fail.

3- Antibiotics:

Certain antibiotics like Ciprofloxacin and Metronidazole aid in reducing drainage of organ materials into other organs caused by fistulas, while also healing the fistulas themselves, in some cases. Moreover, antibiotics may aid in reducing inflammation alongside immunosuppressants and anti-inflammatory medication by targeting the relevant intestinal bacteria.

4- Other Medication:

The following medication may also be prescribed for providing symptomatic relief:

• Anti-diarrheals: like Psyllium powder and Methylcellulose for mild-moderate symptoms and Loperamide for severe symptoms help control diarrhea by bulking up the stool with fibrous content.
• Painkillers: particularly Acetaminophen can help deal with mild pain. Other common painkillers like Naproxen sodium, Paracetamol and Ibuprofen can worsen symptoms and the disease, and are hence not recommended.
• Iron, Calcium, and Vitamin D and B-12 Supplements: may be prescribed in case of severe malnutrition due to loss of nutrients, iron deficiency anemia, osteoporosis, and abnormal or reduced nerve function.

5- Nutrition Therapy:

In addition, or as an alternative to nutrient supplements, malnutrition and diarrhea can also be managed through special diets administered via feeding tubes or direct injection into a vein. This helps provide short-term inflammation relief and is often employed for patients prior to surgery or alongside immunosuppressant therapy.

6- Dietary Adjustments:

• Increase your fluid intake.
• Limiting dairy products, particularly if you are lactose intolerant, may help minimize diarrhea, abdominal pain, and gas.
• Avoid fried foods, butter, margarine, creamy sauces, and other fatty foods to prevent diarrhea if your small intestine is affected.
• If fiber worsens your symptoms, particularly diarrhea and gas, then adopt a low-fiber diet. Moreover, avoid inflammation and constipation-promoting spicy foods, caffeine, and alcohol.

7- Surgery:

Common surgical procedures include removing damaged portions of the GI tract and reconnecting the uninfected sections, closing fistulas, and draining swollen, pus-containing tissues (abscesses) within the GI tract. However, surgery is usually a last resort treatment as the condition often recurs, particularly near the corrected area, and hence requires follow up medication to minimize or prevent recurrence. Yet most Crohn-affected individuals undergo at least one surgical procedure during their lifetime due to progressive intestinal damage.

With a timely diagnosis and the right treatment, the life quality of a large number of patients diagnosed with Crohn’s disease can remain positively unaffected. So, consult your doctor immediately if you experience any of the condition’s telltale signs and diligently follow your treatment plan. You can also book an appointment with a top gastroenterologist in Rawalpindi, Karachi and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT Doctor for your gastric concerns.