Crohn’s is a lifelong condition requiring continued management and monitoring. It’s for this reason that you should feel comfortable when talking to your gastroenterologist. You’re a part of your own care team, and your appointments should leave you feeling empowered. Finding a doctor who is the right fit for you is an important step in successful disease management.
It’s important to ask questions. Keep a journal for recording questions as they arise, and bring it with you to each appointment. The more knowledge you have, the better equipped you’ll be to manage your condition, and the more insight you’ll gain into your doctor’s treatment approach.
1. What are my treatment options?
Your doctor should be able to give you information about the treatment options available for Crohn’s disease. Crohn’s is not curable, so the goal of treatment is to put the condition into remission by reducing inflammation. This can be done several ways:
There are medications you can take to treat Crohn’s:
- Aminosalicylates (5-ASA) decrease inflammation in the lining of the colon.
- Corticosteroids suppress the overall immune system.
- Immunomodulators reduce inflammation by suppressing the immune system.
- Antibiotics treat infections like abscesses.
- Biologic therapies target and reduce the inflammation response.
Each medication has advantages and side effects your doctor can explain.
Food and Crohn’s disease have a complicated relationship. Certain dietary items can trigger flares, making them items to avoid. Examples include dairy, fat, and fiber. In severe cases, treatment may include temporary bowel rest. This approach generally requires taking a break from some or all foods, and receiving nutrients through intravenous fluids.
Intestinal inflammation can interfere with nutrient absorption. That’s why malnutrition is a complication of Crohn’s. Your doctor can give you strategies for dealing with the Crohn’s dietary puzzle.
Sometimes, surgery is required to treat Crohn’s. This is done to repair or remove diseased sections of the gastrointestinal tract, or to treat an emergency such as a bowel obstruction. Ask your doctor for the criteria you should meet before surgery is an option.
2. What can you tell me about biologics?
Biologics are the latest treatment innovation for Crohn’s. They are medications made from living cells, and they work by targeting the inflammation process. Some of them target tumor necrosis factor (TNF) to reduce the inflammation it creates. Others block the movement of inflammation particles to inflamed areas of the body, like the gut, giving these areas time to rest and recover.
Biologics come with side effects, primarily relating to suppressed immunity. Ask your doctor about the pros and cons of this treatment approach to see if it’s a good fit for you.
3. Do you favor a top-down or step-up treatment approach?
Typically, biologics are used in a “step-up” approach, which means they’re taken after conventional treatment approaches don’t produce anticipated results. Sometimes, however, doctors opt for what’s known as a “top-down” strategy in which biologics are introduced sooner with the hope of preventing damage to the intestinal walls.
Your doctor can discuss with you the merits of risking infection with biologics to prevent intestinal damage, or taking a more conservative approach and starting with topical steroids and working your way up.
4. How do you manage remission?
Managing remission involves monitoring your condition and protecting you from new flares. Ask your doctor what kind of regular assessments you will have, ranging from clinical observation to blood and stool tests.
Traditionally, doctors have relied on symptoms alone to tell if you’re in remission. Sometimes symptoms don’t match the level of Crohn’s activity, and more testing provides better information.
Ask your doctor about continuing with medication during remission. This is the most frequently recommended approach. The goal is to protect you from experiencing new flares. Your doctor will likely advise you to stay on the same medication that put you in remission, and to continue taking it as long as you encounter no adverse effects.
5. Can alternative treatments help?
Research is yet to demonstrate that alternative therapies can effectively replace conventional treatment. If you do decide to try things like fish oil, probiotics, or herbal supplements, check with your doctor first to make sure that they don’t interfere with your medication. Also, complementary approaches shouldn’t replace your medication.
6. What lifestyle advice do you have?
Lifestyle has a tangible impact on any condition, and Crohn’s is no exception. Ask your doctor about stress reduction, exercise, and other helpful changes you can make such as quitting smoking.
The success of your treatment hinges on your involvement and the relationship you have with your doctor. Ask questions and try to learn as much as you can. The more you know about Crohn’s and your doctor’s treatment strategies, the more able you will be to effectively manage your disease.