This is my third and final series of articles on Crohn’s Disease. If you missed any, you can get the full article at www.whelehans.ie or ask one of our staff for a copy.
Treatment for Crohn’s may be medical, surgical or a combination of both. For mild Crohn’s, no drug treatment may be needed. Dietary therapy may be another option for some. Treatment will depend on the type of Crohn’s.
Medication used treat Crohn’s disease
Drug treatment for Crohn’s aims to reduce symptoms and control flare-ups, and then to prevent a relapse once the disease is under control. This can mean taking medication on an on-going basis, sometimes for many years.
- Aminosalicylates such as mesalazine (brand names include Asacol®, Pentasa® and Salafalk®) and sulphasalazine (Salazopyrin®)
- Corticosteroids, often just called steroids, such as prednisolone, hydrocortisone and budesonide (Entocort®)
- Immuno-suppressants such as azathioprine (Imuran®), methotrexate and tacrolimus
- Biological or ‘anti-TNF’ drugs such as infliximab (Remicade®) and adalimumab (Humira®).
Biological therapies are generally reserved for people with severe symptoms of Crohn's disease, especially if corticosteroids and immuno-suppressants are unsuitable or ineffective.
Control and reduce symptoms such as pain, diarrhoea and constipation. They include
- Anti-diarrhoeal such as loperamide (Imodium®) and cholestyramine (Questran®)
- Bulking agents such as ispaghula husk (Fybogel®)
- Painkillers such as paracetamol.
Surgical treatment for Crohn’s
Recent advances such as the development of biological drugs have produced better results for Crohn’s disease meaning surgery is less often needed. There have also been changes in surgery for Crohn’s. For example, extensive re-sections (removal of sections of intestine) are now less common. About seven out of 10 people with Crohn’s will still need surgery at some point in their lives. Surgery is sometimes the only option when other treatments cannot sufficiently control symptoms. Occasionally, an urgent operation is required, for example a severe blockage in the intestines or a hole or tear in the bowel.
Dietary treatment for Crohn’s disease
Enteral nutrition involves a liquid diet replacement usually for a few weeks. These feeds contain all the essential nutrients in a simple form that the body can absorb with little or no digestion. They come in a range of flavours. An alternative may be to take the feed overnight through a naso-gastric tube (a fine tube passed through the nose down into the stomach).
Enteral nutrition is widely used for children with Crohn’s disease to help growth and avoid use of steroids. There is less evidence for the effectiveness of enteral nutrition in adults. Research has shown it to be less effective than steroids.
Does a change in diet help?
No clear evidence indicates that any food or food additive directly causes or improves Crohn’s. The most important thing is to eat a nutritious and balanced diet to help maintain weight and strength, and to drink sufficient fluids to prevent dehydration. Some people find certain foods trigger or worsen symptoms and that reducing or adjusting the amount of fibre or cutting out wheat or dairy products may help. If the patient has a stricture, avoiding ‘hard to digest’ or ‘lumpy’ foods that might cause a blockage is advised. Such foods might include nuts and seeds, fruit and vegetable skins, and tough meat or gristle. Small, frequent meals or snacks, and chewing food thoroughly may help.
If the bowel is not absorbing nutrients properly, some people find a low-fat diet reduces diarrhoea. Avoiding carbonated drinks can help prevent symptoms. Many with Crohn’s lack certain vitamins and minerals, such as iron, calcium, vitamin D or vitamin B12, especially if they have a poor appetite or active diarrhoea or blood loss. Some of the drugs used for Crohn’s can also lead to deficiencies, for example sulphasalazine can affect the body’s ability to absorb folates, and steroids can cause calcium loss. In these cases, a supplement may be useful, but should be discussed with the doctor, pharmacist, dietitian or nutritionist. If tests show a serious deficiency, a course of supplements or enteral nutrition may be advised.
Are complementary and alternative approaches helpful?
There are few reliable scientific studies to show effectiveness of complementary and alternative medicines. A recent review concluded that fish oils were probably not effective at keeping people with Crohn’s in remission, as although some studies found symptoms improved, two larger studies showed no benefit of omega 3’s. A small study on acupuncture for active Crohn’s showed very slight improvement, but not enough to be significant. Other research has suggested the herbal medicine wormwood may help with steroid reduction, but more research is needed. There is ongoing research into the use of probiotics for inflammatory bowel disease but so far have not been found helpful for Crohn’s.
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended
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