Treatment Of Crohn’s Disease

Treatment of Crohn’s disease aims to prevent new outbreaks and control those that do arise. Being a disease of unknown origin, there is no definitive cure, but the symptoms can be alleviated and alleviated.

Treatments for this disease are classified into:

• Pharmacological
• Dietary
• Surgical
• Others

Pharmacotherapy

Drug-based treatment of Crohn’s disease is the priority among the different alternatives.

The most common drug groups for the treatment of Crohn’s disease are:

• Antibiotics
• 5-ASA
• Glucocorticoids
• Immunosuppressants
• Biological therapies

Antibiotics

This group of drugs are prescribed to treat excessive bacterial growth in the small intestine. This unusual proliferation is caused by complications of Crohn’s disease (restrictions, fistulas, or previous surgery) or when there is anal or perianal involvement.

Among the antibiotics, the most used for the treatment of Crohn’s disease are:

• Metronidazole
• Ciprofloxacin
• Ampicillin
• Sulfamides

They have side effects such as:

• Sickness
• Metallic taste
• Interactions with alcohol

5-Aminosalicylates

The 5-ASAs or 5-aminosalicylates make up a group of non-steroidal anti-inflammatory drugs ( NSAIDs ) that are used in Crohn’s disease to reduce inflammation within the colon.

The most common are sulfasalazine and mesalazine. Both drugs are administered orally, although they also exist in the form of suppository and enemas. They are a good alternative for patients who do not respond adequately to steroids.

The most characteristic side effects are:

• Sickness
• Diarrhea
• Headache

Glucocorticoids

It is a hormonal treatment that helps reduce inflammation. They are used in acute phases of the disease, but once controlled, they are no longer administered due to their possible adverse effects.

The most used are:

• Bubdesonide : used to affect the terminal ileum due to its more specific action.
• Prednisone : of choice in more serious cases.

The adverse effects of this group of drugs are:

• Fluid retention
• Osteoporosis
• Gastritis
• Acne
• waterfalls

It must be taken into account that steroids have a rebound effect, so the dose has to be gradually reduced, not stopping the treatment suddenly.

Immunosuppressants

These drugs suppress the immune system by preventing the inflammatory reaction, thus helping to reduce inflammation in the long term. They are chosen in the event that the corticosteroids have no effect and to avoid new outbreaks.

The most commonly used drugs within this group are the following:

• Azathioprine
• 6-mercaptopurine : this drug, although its main use is for the treatment of leukemia,  in Crohn’s disease it acts as an immunosuppressant. As a drawback, it presents some characteristic adverse effects, among which we highlight:
  • Sickness
  • Fatigue
  • Infertility

• Methotrexate : if this drug is administered, treatment should be interrupted 3 months before attempting conception, in both men and women, as it can cause genetic defects in the embryo (teratogenic).

The adverse effect of this group of drugs is that, by suppressing the immune system, it can lead to an increased vulnerability to infections.

Biological therapies

These are monoclonal anti-TNF α antibodies that eliminate TNF (Tumor Necrosis Factor, a molecule that enhances inflammation).

They are used in combination with immunosuppressants if these are not enough or in cases in which treatment or surgery has not responded.

The most widely used biological drugs for the treatment of Crohn’s disease are:

• Infliximab : given as an infusion. May cause allergic reactions.
• Adalimumab : given by injection once every two weeks.
• Certolizumab.

Dietary treatment

Diet is an important factor in Crohn’s patients, as these patients often suffer from poor appetite and poor absorption.

The diet of these patients must be balanced, as in healthy people, but more emphasis should be placed on patients due to their additional complications associated with the disease.

A balanced diet consists of:

• Obtain 50-55% of the total nutrients in carbohydrates
• 30-35% lipids or fats
• 12-15% protein
• Determined amounts of fiber (low amounts), vitamins and minerals depending on the patient’s situation.
• You should eat several meals a day and drink water frequently.

Foods to avoid

In these patients, foods rich in fiber and spicy should be avoided, as well as carbonated, caffeinated or alcoholic beverages.

Despite following the indications of a balanced diet, these people can develop severe malnutrition, requiring specialized food or intravenous nutrition in a hospital.

There are a number of foods that produce adverse effects most often, so their consumption should be avoided. Among them we find:

• Casein: protein present in dairy
• Gluten
• Wheat
• Corn
• Yeast
• Some fruits and vegetables

What is the proper diet?

With all this, the diets that have shown the best efficacy in controlling symptoms have been the gluten-free diet and the diet low in FODMAP (short-chain carbohydrates and related alcohols that are poorly absorbed in the small intestine).

Vitamin supplements can be taken to alleviate symptoms during flare-ups or induce remission, specifically vitamin D, which appears to be closely related to Crohn’s disease.

Calcium supplementation is being questioned due to its relationship with arterial calcifications and myocardial infarctions.

Surgical treatment

The main objective of surgery as a treatment for Crohn’s disease is to regain the state of health and well-being when the disease develops with complications and not to prolong a pharmacological treatment that is not useful.

Surgery does not definitively cure the disease, but it is necessary in cases of perforation, abscess, hemorrhage, failure of medical treatment, intestinal obstruction or fistulas.

This operation consists of the removal of the inflamed section of the digestive system and the reattachment of the remaining partition.

Other alternatives in the treatment of Crohn’s disease

It is not that there are more treatments aimed at alleviating the symptoms of the disease, but there are healthy habits for these patients. Within them we find:

• Give up smoking
• Rest : reducing emotional tension with rest helps to remit minor flare-ups as effectively as with drug treatment.

Despite the fact that it is a chronic disease, with severe episodes, patients can carry out activities of daily living normally.