How is Crohn's Disease Treated?

There is no known cure for Crohn's Disease. The route of treatment varies from one patient to another depending upon the location, extent, and severity of the disease. The goal of treatment is to suppress the inflammatory response, allowing the intestine to heal and also to decrease symptoms. Once symptoms are under control the next goal is to decrease the frequency of flare-ups and increase periods of remission, thus improving the quality of life.

Crohn's Disease can be treated with several different types of medication. Classes of medication for treatment include Aminosalicylates (5-ASA compounds), Corticosteroids, Immuno-Modulators, Antibiotics, and Biologic Therapies.

-Aminosalicylates: 5-ASA Compounds are anti-inflammatory drugs including Asacol, Pentasa, Colazal, Rowasa Enemas, and Canasa Enemas. These medications reduce inflammation in the affected areas and are generally used to treat mild to moderate symptoms. Rare side effects include lung and kidney inflammation and therefore should be used with caution in patients who have known kidney disease. Patients that are allergic to aspirin should also avoid 5-ASA Compounds, as they are chemically similar to one another.

-Corticosteroids: These drugs include prednisone, prednisolone, and hydrocortisone and are generally used to treat moderate to severe symptoms, and also to treat patients where 5-ASA drugs have not been effective. Corticosteroids, unlike 5-ASA drugs, do not require direct contact with inflammation. Corticosteroids stimulate an anti-inflammatory reaction throughout the body, including the areas of the intestine that are affected by inflammatory bowel disease. Although Corticosteroids are faster acting than 5-ASA Compounds they are not effective in maintaining remission or preventing flare-ups from occurring. Side effects depend on the dosage administered and the duration that the patient is on the medication. Common side effects include water retention (mainly in the face), increased vulnerability to infections, high blood pressure, cataracts, glaucoma, muscle weakness, depression, personality changes, mood swings, and osteoporosis (thinning of the bones).

Immuno-Modulators: Azathioprine, 6-MP (6-Mercaptopurine), also known as Purinethol, and Methotrexate are used to maintain remission. They are also used when Corticosteroids are not working in a patient with moderate to severe Crohn's Disease. These drugs reduce inflammation by reducing immune cells and by obstructing the production of their protein cells. Side effects differ with each immuno-modulator. Azathioprine and 6-MP can cause inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), and bone marrow toxicity. Pancreatitis is a less common side effect when using Azathioprine and only occurs in about 3%-5% of all patients.

Antibiotics: The most commonly used antibiotic in inflammatory bowel disease is Flagyl. It is an antibiotic that is used to treat infections caused by parasites and bacteria. It is also effective in treating anal fistulas. Side effects of Flagyl include nausea, loss of appetite, headaches, and a metallic taste. Less common side effects include peripheral neuropathy in which permanent nerve damage causes a tingling sensation in the hands and feet.

Biologic Therapies: A new biologic therapy called Remicade (Infliximab) was introduced by the FDA in 1998. It is used in patients who have moderate to severe inflammatory bowel disease and are not responding to conventional therapies. It is administered through intravenous infusion and is used to maintain remission. Patients are observed throughout their infusion for adverse reactions, which may include nausea, chest pain, and shortness of breath. 

When conventional therapies are not effective a patient has the option of surgery.  Sections of the diseased bowel can be removed to reduce symptoms.  Although surgery may improve the quality of life, it is NOT a cure for Crohn's Disease.