What is Crohn’s disease?
Crohn’s disease is a chronic inflammatory bowel disease. It causes the lining of some parts of the digestive system — including the stomach, large and small intestines, and rectum — to become irritated. This can cause:
- abdominal pain and cramping
- serious diarrhea
- weight loss
Crohn’s disease may affect different parts of the digestive system in different people. Bowel inflammation can spread deeply into affected tissues, causing severe pain that’s bad enough to interfere with daily activities. Sometimes, Crohn’s disease can cause open sores, or ulcers, in the bowel. They can be so severe that they break through the intestinal wall, connecting two body parts, creating what is called a fistula. If left untreated, fistulas can be life-threatening.
How is Crohn’s disease usually treated?
Currently, there’s no known cure for Crohn’s disease. Instead, treatment for the condition is focused on reducing symptoms so you can feel as comfortable and healthy as possible. Sometimes treatment is effective at bringing a person’s Crohn’s disease into long-term remission.
Most of the time, Crohn’s disease is treated with therapeutic medications. In some cases, doctors recommend surgery to help ease symptoms. There are two different treatment approaches for Crohn’s disease. One is called the “step-up” treatment. This involves starting with mild drugs and slowly increasing dose as needed. The second method is called the “top-down” approach. This involves starting with stronger drugs and slowly decreasing dose as symptoms improve.
The key to reducing Crohn’s disease symptoms is to reduce bowel inflammation. One or more of the following treatments are usually used:
- anti-inflammatory drugs to reduce bowel irritation
- immune system suppressors to reduce bowel inflammation
- antibiotics to help heal ulcers and fistulas and to reduce the amount of harmful bacteria in the intestines
- fiber supplements
- pain relievers
- iron, calcium, and vitamin D supplements
- vitamin B-12 shots to help reduce risks of malnutrition
- nutritional therapy, such as a special diet plan or liquid diet to help reduce risk of malnutrition
- surgery to remove damaged parts of the digestive system for symptom relief
What’s next in Crohn’s disease treatment?
Researchers are now looking for new ways to treat Crohn’s disease symptoms, as well as possible cures. Here’s a look at some treatments now being studied.
Corticosteroids such as prednisone are usually beneficial for people with Crohn’s disease. However, they are only used in the short term when other treatments aren’t effective. This is because they can have many serious side effects. New research suggests that newer corticosteroids, such as budesonide and beclomethasone diproponate, may be more effective at reducing symptoms, with fewer side effects.
Ongoing studies are looking at the efficacy of AMG 181, a new anti-inflammatory drug, in treating people with Crohn’s disease. Recently published research suggests that AMG 181 can help reduce Crohn’s flare-ups and promote healing after as little as six weeks of treatment.
Immune system suppressors
The most common immune system suppressors used to treat Crohn’s disease are azathioprine (Imuran) and mercaptopurine (Purinethol). But research has found that they may cause side effects, including drug withdrawal.
TNF inhibitors or “biologics”
These drugs are used in people with moderate to severe cases of Crohn’s disease. But people with certain conditions shouldn’t take TNF inhibitors, as they are associated with certain cancers and infections. Some examples include infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia). Researchers have also found that for some people, the longer TNF inhibitors are used, the less effective they can be.
This is a drug usually used to treat cancer, psoriasis, and rheumatoid arthritis, but it is sometimes used to treat people with Crohn’s who don’t respond well to other medications. It can cause some side effects, such as nausea, fatigue, and diarrhea. Long-term use may lead to bone marrow suppression, liver scarring, and cancer. Research suggests it’s most effective when given to patients who don’t respond to azathioprine or mercaptopurine.
Cyclosporine (Gengraf, Neoral, Sandimmune) and tacrolimus (Astagraf XL, Hecoria)
These are very strong drugs used in people whose Crohn’s disease symptoms don’t improve with other treatments. But these drugs cannot be used for long-term control, and they may cause serious side effects such as seizures, liver damage, and life-threatening infections. Research has shown they’re most effective when used as a complementary, rather than primary, treatment.
Natalizumab (Tysabri) and vedolizumab (Entyvio)
These drugs are used to treat people with moderate to severe Crohn’s disease who don’t respond well to other medications. To be prescribed natalizumab, you must be enrolled in a special drug distribution program. This drug can cause a serious brain disease. Research suggests that vedolizumab works like natalizumab, but it hasn’t been found to carry the risk of brain disease.
This is a drug usually used to treat psoriasis, but research suggests that it may be helpful in treating Crohn’s disease when other medications don’t work.
There are also several new antibiotics that are being researched for Crohn’s.
This is an antibiotic now used in place of metronidazole. Research suggests that the two medications may have similar effects in people with Crohn’s. It’s effective in alleviating some people’s symptoms, but in rare cases it can cause serious tendon rupture (especially if a person is also taking corticosteroids).
This is a new combination antibiotic therapy now being studied. Some early research suggests that an infection called Mycobacterium avium paratuberculosis may contribute to Crohn’s disease. As a result, several studies are underway to see if people with Crohn’s disease who are given antibiotics to treat this infection improve. RHB-104 is an antibiotic cocktail of clarithromycin, rifabutin, and clofazimine. Results of these studies have not yet been published.
It’s important only to take medication prescribed to you by your doctor, and in the exact amount you were instructed. That way, you will get the greatest benefit with the fewest risks.