Treatment For Crohn's Disease

Unfortunately at this point in time Crohn's disease is one of the diseases, which can not be cured, but can only be controlled. Sulfasalazine (brand names: Salazopyrin, Azulfidine) is a medication, which has improved management of Crohn's disease tremendously. It has anti-inflammatory effects and is useful in mild to moderate cases of Crohn's to tone down the amount of inflammation and to maintain remissions for longer.

The main metabolite is mesalamine or 5-amino-salicylic acid (brand names: Rowasa, Asacol, Mesasal, Pentasa, Quintasa and Salofalk), which is especially useful for those patients who are allergic to Salazopyrin. 5-amino-salicylic acid has been shown to prevent recurrence of Crohn's disease following surgery.

It also has been shown to induce and maintain remissions of acute flare-ups of Crohn's. Occasionally the physician will be forced to use corticosteroids by mouth for a short period of time. Long-term use has too many side effects including suppression of the adrenal glands. Occasionally antibiotics such as metronidazole (Flagyl, Metric 21) have been useful in improving Crohn's disease, particularly when perianal lesions are involved. The therapy for each case needs to be tailored according to the physical findings. The physician will customize your treatment accordingly.

For more resistant cases the physician might have to resort to immuno modulating drugs, such as azathioprine (Imuran) or mercaptopurine (brand name: Purinethol) as is described in Ref.12.

Immunosuppressive therapy with Tacrolimus or cyclosporine, which are normally used in patients with organ transplants, have been shown to be effective against Crohn's. These are useful in cases where fistulas do not close.

Biologic therapy is the latest, but also most expensive option. Infliximab is an antibody that blocks tumor necrosis factor (TNF), which has been found to be an important cause of Crohn's. It is administered initially as a series of 3 intravenous injections. For maintenance it has to be given every 8 weeks. This has been shown to induce remission and is also useful in maintaining control of the disease.

For severe cases a period of intravenous hyperalimentation might get the Crohn's disease more under control and improve the nutritional status. Finally, surgery remains reserved only for the cases with structural complications, where physicians are forced to reopen blocked passages, close fistulas, take care of abscesses etc. With any surgery great care is taken that bowel is not needlessly removed. This would only worsen the malabsorption syndrome.

Hormone treatment:

In some patients hormone deficiencies have been determined by blood tests. When Crohn's disease developed with menopause in women, estrogen and progesterone can be low. If bio-identical hormone replacement is given by way of creams remarkable improvements of the inflammatory bowel can be achieved. Similarly low thyroid hormone can also contribute to this illness and replacement with thyroid hormones will lead to further improvement of the bowel condition. In other patients low growth hormone has been detected by way of measuring its close working partner, somatomedin C, and low-dose growth hormone injections can overcome this deficiency. The advantage of natural hormone therapy is that the body already has the hormone receptors in place, which fit bio-identical hormones. Drugs often have serious side-effects, which limit their application. However, it is wise to use whatever makes the patient better, so this likely would be a combination of several treatment methods.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

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Last Modified: Feb. 28, 2012