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 mouth, stomach, large and small intestines, and rectum — to become irritated. This can cause:
- abdominal pain and cramping
- serious diarrhea
- weight loss
- scattered ulcers throughout the digestive tract
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. Crohn’s can sometimes cause open sores, or ulcers, in the bowel. These sores 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. Treatment for the condition traditionally has been focused on reducing symptoms so you can feel as comfortable and healthy as possible. Treatment is sometimes effective at bringing a person’s Crohn’s disease into long-term remission. Treatment is also focused on new ways to target inflammation at its source.
Most of the time, Crohn’s is treated with therapeutic medications. In some cases, doctors recommend surgery to help ease symptoms. There are two common treatment approaches for Crohn’s disease. One is called the “step-up” treatment. This involves starting with mild drugs and slowly increasing doses as needed. The second method is called the “top-down” approach. This involves starting with stronger drugs and slowly decreasing doses as symptoms improve.
The key to reducing Crohn’s 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 looking for new ways to treat Crohn’s disease symptoms, as well as possible cures. Newer treatments are using medications that block inflammation at the source, rather than after the inflammation has occurred. Researchers are also trying to uncover treatments that are more specific to the intestinal tract. Here’s a look at some current treatment options, as well as new ones being studied.
Corticosteroids, such as prednisone, have long been beneficial for people with Crohn’s disease. However, they are limited to short term use when other treatments aren’t effective. This is because they can have many serious side effects on the entire body. Research suggests that newer corticosteroids, such as budesonide and beclomethasone dipropionate, may be more effective at reducing symptoms, with fewer side effects.
Immune system suppressors
Common immune system suppressors that have been traditionally used to treat Crohn’s disease are azathioprine (Imuran) and mercaptopurine (Purinethol). But research has found that they can cause side effects, including increased risk of infection.
Other drugs in this category also include methotrexate, cyclosporine (Neoral) and tacrolimus (Prograf). Typically, these drugs are no longer used alone but rather in addition to other medications. All of the immune system suppressor drugs require regular blood tests to monitor potential side effects to the blood system, kidney and liver.
TNF inhibitors or “biologics”
These newer drugs are used in people with moderate to severe cases of Crohn’s disease. Depending on an individual’s overall health, not everyone may be a candidate for these medications. TNF inhibitors work by blocking a protein that causes inflammation. 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 may be.
Natalizumab (Tysabri) and vedolizumab (Entyvio)
These drugs are also used to treat people with moderate to severe Crohn’s disease who don’t respond well to other medications. These block inflammation in a different way compared to the TNF inhibitors. They work by keeping inflammatory cells out of tissue. Natalizumab (Tysabri) does carry a risk for a serious brain condition in certain people. It is recommended that individuals be tested for a specific virus before using this medication in order to reduce this risk. Research suggests that vedolizumab works like natalizumab, but so far it does not have the same risk of brain disease. Vedonlizumab seems to work more specifically on the intestinal tract rather than the whole body.
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. This drug works by blocking certain pathways of inflammation. However, in rare instances it can also affect the brain.
This is a new combination antibiotic therapy now being studied. Some research suggests that an infection with a bacteria called Mycobacterium avium paratuberculosis (Map) may contribute to Crohn’s disease as well as other human diseases. This bacteria causes serious intestinal infections in cattle, similar to Crohn’s disease in humans. As a result of this knowledge, several studies are underway to see if people with Crohn’s disease who are given antibiotics to treat this bacteria improve. RHB-104 is an antibiotic cocktail of clarithromycin, rifabutin, and clofazimine. Results of these studies have not yet been published.
Studies are still ongoing to uncover the exact role of the Map bacteria in Crohn’s disease, as not all researchers agree. It seems not all patients with Crohn’s disease have Map and some healthy people with Map do not have Crohn’s disease.
Currently, a vaccine trial in underway in the United Kingdom to study the potential benefit of a Map vaccine for humans.
As our understanding of Crohn’s disease continues to improve, we can expect more effective treatment options in the future. Having a specialist in Crohn’s as part of your medical team is one way to ensure you are receiving accurate information about your disease, as well as any up and coming options for treatment. Working with your doctors and taking your medicines as prescribed are important ways to help you get the best care for your Crohn’s.