Crohn's disease

Alternative Names

Treatment

Medicines that may be prescribed include:

• Aminosalicylates (5-ASAs) are medicines that help control mild to moderate inflammation. Some forms of the drug are taken by mouth; others must be given rectally.
• Corticosteroids (prednisone and methylprednisolone) are used to treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum.
• Immunomodulators such as azathioprine or 6-mercaptopurine help reduce the need for corticosteroids and can help heal some fistulas.
• Antibiotics may be prescribed for abscesses or fistulas.
• Biologic therapy is used to treat patients with severe Crohn's disease that does not respond to any other types of medication. Infliximab (Remicade) and adalimumab (Humira) are approved for Crohn's disease. They belong to a class of drugs called monoclonal antibodies, which help block an immune system chemical that promotes inflammation. Infliximab is also approved for patients with fistulous disease.

If medicines do not work, a type of surgery called bowel resection may be needed to remove a damaged or diseased part of the intestine or to drain an abscess. A procedure called anastomosis is done to connect the remaining two ends of the bowel. According to the Crohn's and Colitis Foundation of America, two-thirds to three-quarters of patients with Crohn's disease will need bowel surgery at some time. However, unlike ulcerative colitis, surgical removal of a diseased portion of the intestine does not cure the condition.

Some persons with Crohn's disease may need surgery to remove the entire large intestine (colon) with or without the rectum.

Removal of the entire large intestine is called a colectomy. The small intestine is connected to the rectum.

Removal of both the colon and rectum is called a proctocolectomy. Since the body still needs a way to move stool and waste through the body after an proctocolectomy, a new pathway must be created. The surgeon will attach the end of the small intestine to an opening in the abdominal wall. A pouch is attached to the opening and worn outside the body. Waste products empty into the pouch. You must empty the pouch several times a day. The pouch can be worn discreetly under clothing, so no one will know you have it.

No specific diet has been shown to improve or worsen the bowel inflammation in Crohn's disease. However, eating a healthy amount of calories, vitamins, and protein is important to avoid malnutrition and weight loss. Foods that worsen diarrhea should be avoided. Specific food problems may vary from person to person.

People who have blockage of the intestines may need to avoid raw fruits and vegetables. Those who have difficulty digesting lactose (milk sugar) need to avoid milk products.

Support Groups

The Crohn's and Colitis Foundation of America offers support groups throughout the United States. See http://www.ccfa.org/chapters/

Outlook (Prognosis)

There is no cure for Crohn's disease. The condition is marked by periods of improvement followed by flare ups of symptoms.

You have a higher risk for small bowel and colon cancer if you have Crohn's disease. Dietary and lifestyle modifications are important. Some evidence suggests that low-fat and high-fiber diets may reduce your risk of colon cancer. Ask your doctor if this may be best for you.

Possible Complications

• Fistulas in the following areas:
  • Bladder
  • Vagina
  • Skin
• Bowel obstructions
• Abscess
• Nutritional deficiencies (particularly vitamin B12 deficiency)
• Complications of corticosteroid therapy
• Inflammation of the joints
• Erythema nodosum
• Pyoderma gangrenosum
• Lesions in the eye
• Impaired growth and sexual development in children

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

• You have symptoms of Crohn's disease
• You are already diagnosed with Crohn's disease and your symptoms get worse or do not improve with treatment
• You already diagnosed with Crohn's disease and you develop new symptoms

References

US Food and Drug Administration. FDA Approves New Treatment For Crohn's Disease. Rockville, MD: National Press Office; February 27, 2007: Report P07-30.

Sandborn WJ, Hanauer SB, Rutgeerts PJ, et al. Adalimumab for Maintenance Treatment of Crohn's Disease: Results of the CLASSIC II Trial. Gut. 2007 Feb 13 [Epub ahead of print].

Hawk ET, Levin B. Colorectal cancer prevention. J Clin Oncol. 2005;23:378-388.