Crohn's disease treatments
As there is no cure for Crohn's disease, medical treatment aims to control your symptoms and bring on a remission of the disease. Ideally, medical treatment of Crohn's disease should prevent complications developing and prevent nutritional deficiencies developing due to nutrients not being absorbed properly from your food by your gut.
Treatment will depend on how severe your condition is, whether your disease is active at present and where in your bowel it’s located. Medications are generally prescribed to bring active disease episodes to an end and induce a remission.
There are several different types of treatments, and some work better than others for different stages of the disease.
Steroids
Corticosteroids are usually given to treat active disease. They are not generally used for maintenance therapy. A short, sharp course of steroids to bring active disease under control can then be followed by some kind of maintenance therapy.
Steroids are very potent anti-inflammatory medicines and appear to be the most effective medicines for treating active Crohn's disease. Studies indicate up to 70 per cent of people with active Crohn's disease benefit from them. However, a major problem with using them is that people taking high doses of steroids for a long time tend to develop side-effects, such as a round face, mood changes, wasting of the muscles and high blood pressure.
Doctors have tried to get around this problem by developing formulations of steroids that are applied to and absorbed at the actual site of the disease, rather than taken by mouth and transported to the disease site in the bloodstream (which means more of the body is exposed to the medication and there is a higher chance of side effects). These locally acting steroids can only be used for areas of the bowel that are easy to access, such as the rectum.
Steroids are prescribed both as tablets to be taken by mouth and also as rectal suppositories, foam and enemas. Steroid medications include prednisolone (brand names Predsol; Panafcortelone), hydrocortisone (Colifoam Rectal Foam) and budesonide (Entocort). In severe exacerbations of Crohn's disease, intravenous steroids may be administered in hospital.
Aminosalicylates
These medications are similar to aspirin and include mesalazine (brand name Mesasal) and sulfasalazine (Salazopyrin, Pyralin). These medications are available as delayed-release tablets with a special coating (enteric coated; EN) that only disintegrates when the tablet is in the terminal ileum and colon sections of your bowel, thus avoiding some side effects. The aminosalicylate medications are often given during an acute attack, but can also be used as maintenance treatment. Doctors estimate that 30 to 40 per cent of people with active Crohn's disease respond well to these medications.
Immunosuppressants or immune modifiers
These include azathioprine (Imuran), mercaptopurine, and methotrexate, which can be used as maintenance treatment for people who have frequent disease flare-ups and/or would otherwise need intensive treatment with steroids. These medicines may take several weeks or even a couple of months to work.
Tumour necrosis factor inhibitors or anti-TNF agents
Tumour necrosis factor-alpha is a protein that occurs naturally in the body and it is involved in inflammation of the bowel. In Crohn's disease TNF-alpha is produced in abnormally large quantities, resulting in bowel inflammation and damage to the bowel wall.
Medications known as tumour necrosis factor inhibitors block the TNF-alpha, and so reduce bowel inflammation. Remicade is the Australian brand name for infliximab, which is one of these agents.
Infliximab has been tested in clinical trials of people with Crohn's disease and found to be highly effective for treating active Crohn's disease. Infliximab is indicated in Australia for use in people with moderate to severe Crohn's disease that is unresponsive to other treatments, and also for people with fistulae unresponsive to other forms of therapy. It is given by infusion via a drip into a vein.
Crohn's disease sufferers who have had infliximab often see a reduction in bowel inflammation, with fewer signs and symptoms, and improved healing of the bowel tissues.
Adalimumab (brand name Humira), another TNF-alpha blocker, has also been approved for the treatment of people with moderate to severe Crohn’s disease who have had an inadequate response to conventional therapies, or who have lost response to or are intolerant of infliximab.
Antibiotics
Antibiotics, including metronidazole (Flagyl), may be used to control infection and reduce disease activity.
Medicines to control diarrhoea and pain are also often prescribed.
If your disease is severe, you may need to be admitted to hospital where you will be given medications intravenously.
Surgery
For people with severe disease which isn’t controlled by medication, or if there is a bowel obstruction or other complication, surgery may be needed. Often this involves an operation to cut out the diseased section of bowel and join the 2 ends of unaffected bowel together (anastomosis). However, although this usually stops the symptoms, the disease often recurs and many people need a repeat operation.
Nutritional supplements
Because Crohn's disease results in parts of the gastrointestinal tract being diseased and also results in diarrhoea and loss of appetite, people with the disease do not have good absorption of nutrients, vitamins and minerals from the foods they eat. For this reason, people with Crohn's disease may have to take nutritional supplements and/or have vitamin injections.
How can I help myself?
Eating a healthy balanced diet is important, particularly as it’s important for a person with Crohn's disease to maintain a good weight. If you find that certain foods make your diarrhoea worse, it makes sense to avoid these. Some people with Crohn's disease aren’t able to absorb particular nutrients from their food, so may need to take vitamin or mineral supplements.
Always discuss any supplements you are planning to take with your doctor.
The outlook
Although Crohn's disease is a serious condition, it is not fatal and many people who have it still lead productive lives and feel well and free of symptoms in between flare-ups of the disease.
Last Reviewed: 30 March 2009
- 1. Therapeutic Guidelines (eTG). Crohn's disease. In: Gastroenterology guidelines [updated 2006, Sep; accessed 2009, Apr 6]. Available from: http://www.etg.hcn.net.au/
2. Von Roon, AC, Reese GE, Orchard TR, Tekkis PP. Crohn's disease. In: BMJ Clinical Evidence 2007;11:416
3. eMIMS Prescribing Information, April 2009
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