Treatments for Crohn's disease
Treatments for Crohn's disease:
There is currently no cure for Crohn's disease. The overall treatment goal for people living with the condition is to control symptoms to a degree that allows them to feel better and live as normally and actively as possible. This includes controlling inflammation, ensuring good nutrition, and relieving symptoms, such as abdominal pain and diarrhea. For the best outcome for your individual case of Crohn's disease, it is important to get a referral to a qualified gastroenterologist who is experienced in treating people with Crohn's disease. In conjunction with this specialist, you will develop an individualized treatment plan that best fits your type and severity of Crohn's disease, your goals, and your life style. The plan will also be based on your complete medical history, coexisting complications, such as ulcers, and your response to prior treatments.
The most effect treatment plans include a multifaceted approach. One facet of treatment is the use of medications. After a complete evaluation, your health care provider will decide what medication or combination of medications will work best for you. Prescribed medications may include anti-inflammation drugs that contain mesalamine, an active ingredient that helps control inflammation. The most commonly used drug of this type is sulfasalazine. Anti-inflammation drugs can have side effects that include nausea, vomiting, heartburn, diarrhea, and headache. Crohn's disease may also be treated with corticosteroids, including prednisone. Corticosteroids are very effective in controlling symptoms, but can have serious side effects, such as increased susceptibility to infection. Other medications include infliximab and immune system suppressors, which also decrease inflammation, but can have serious side effects. It is very important that these medications are taken exactly as directed, that you immediately notify your gastroenterologist if you experience any side effects, and that you ensure that all your health care providers, including the dentist, are aware of your medications.
Treatment may also include medications that have an anti-diarrheal effect, such as codeine. Intravenous rehydration and electrolyte replacement may be needed because frequent diarrhea can result in the loss of too much fluid and too many electrolytes, potentially causing severe dehydration and electrolyte imbalances. Complete intravenous nutrition may be needed as a bridge treatment in order to let the GI tract rest. Vitamins and other nutritional supplements may also be ordered, but should only be used as advised by your gastroenterologist. There is currently no evidence that any type of a special diet can improve or correct Crohn's disease.
Many people with Crohn's disease may also need surgery at some point in their lives. Surgery is only considered when the symptoms of Crohn's disease cannot be controlled by medications. Surgery may involve the removal of the diseased section of the intestines or in some cases the complete removal of the large intestine (colectomy). Surgery might also be necessary to address complications of Crohn's disease, such as intestinal obstructions, ulcers, GI bleeding, or pockets of infection (abscesses).
Treatments for Crohn's disease
The list of treatments mentioned in various sources
for Crohn's disease
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
- Diet changes
- Exercise
- Stress reduction
- Antibiotics
- Steroids
- Corticosteroids
- Predisnone
- Immunosuppressives
- Remicade (R) (infliximab) - an anti-TNF drug
- Mesalamine containing drugs
- Sulfasalazine
- 5-ASA agents - such as Asacol, Dipentum, or Pentasa.
- Antidiarrheal drugs - diphenoxylate, loperamide, and codeine
- Fluids - to treat dehydration from diarrhea
- Electrolytes - to treat electrolyte imbalances from diarrhea
- Antibiotics - used to treat secondary infections, not Crohn's disease itself.
- Surgical treatments - aim to reduce symptoms by removing an inflamed part of the digestive system.
- Intestinal surgery - to remove an afflicted part of the intestine
- Colectomy - removal of the colon
- Vitamin A - to prevent vitamin A deficiency
- Vitamin E - possibly used for treatment of related Vitamin E deficiency
- Chronic diarrhea in Crohn diseaseresponds well to antidiarrheal agents such as loperamide (2-4 mg), diphenoxylate with atropine
- Sulfasalazine is mainly useful in colonic disease
- For colon and small bowel inflammation, anti-inflammatory drugs or antibiotics are helpful
- Steroid therapy is indicated in patients with severe systemic symptoms (eg, fever, nausea, weight loss) and in those whose conditiondoes not respond to anti-inflammatory agents
- Treatment may include medicines, nutrition supplements, surgery or a combination of these options. Some people have long periods of remission, when they are free of symptoms
Crohn's disease: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Crohn's disease may include:
Hidden causes of Crohn's disease may be incorrectly diagnosed:
- The exact cause of Crohn disease remains unknown. Current theories implicate the role of genetic, microbial, immunologic, environmental, dietary, vascular, and even psychosocial factors as potential causative agents
- Imbalance between proinflammatory and anti-inflammatory mediators
- Research shows that the inflammation seen in the GI tract of people with Crohn's disease involves several factors: the genes the patient has inherited, the immune system itself, and the environment. Foreign substances, also referred to as antigens, are found in the environment. One possible cause for inflammation may be the body's reaction to these antigens, or that the antigens themselves are the cause for the inflammation. Some scientists think that a protein produced by the immune system, called anti-tumor necrosis factor (TNF), may be a possible cause for the inflammation associated with Crohn's disease
- more causes...»
Crohn's disease: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Crohn's disease:
Curable Types of Crohn's disease
Possibly curable types of Crohn's disease may include:
Crohn's disease: Research Doctors & Specialists
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Crohn's disease:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Crohn's disease include:
- Entocort EC
- Methylprednisolone
- A-Methapred
- Depmedalone-40
- Depmedalone-80
- Depo-Medrol
- Enpak Refill
- Mar-Pred 40
- Medrol
- Medrol Acne Lotion
- Medrol Enpak
- Medrol Veriderm Cream
- Meprolone
- Neo-Medrol Acne Lotion
- Neo-Medrol Veriderm
- Rep-Pred 80
- Solu-Medrol
- Prednisolone
- A&D w/Prednisolone
- Cortalone
- Delta-Cortef
- Duapred
- Fernisonone-P
- Hydelta-TBA
- Hydeltrasol
- Inflamase
- Inflamase Forte
- Key-Pred
- Meticortelone
- Meti-Derm
- Metreton
- Minims Prednisolone
- Mydrapred
- Niscort
- Nor-Pred
- Nova-Pred
- Novoprednisolone
- Optimyd
- Otobione
- Peidaject
- Pediapred
- Polypred
- Predcor
- Pred Forte
- Pred-G
- Pred Mild
- Prelone
- PSP-IV
- Savacort
- Sterane
- TBA Pred
- Prednisone
- Apo-Prednisone
- Aspred-C
- Deltasone
- Liquid Pred
- Meticorten
- Novoprednisone
- Orasone
- Panasol-S
- Paracort
- Prednicen-M
- Prednisone Intensol
- SK-Prednisone
- Sterapred
- Sterapred-DS
- Winpred
- Sulfasalazine
- Alti-Sulfasalazine
- Azaline
- Azulfidine
- Azulfidine EN-Tabs
- PMS Sulfasalazine
- PMS Sulfasalazine E.C
- Salazopyrin
- Salazopyrin EN
- SAS-Enema
- SAS Enteric-500
- SAS-500
- Sulfazine EC
- Budesonide
- Entocort
Unlabeled Drugs and Medications to treat Crohn's disease:
Unlabelled alternative drug treatments for Crohn's disease include:
- Mercaptopurine
- Alti-Mercaptopurine
- Purinethol
- Metronidazole
- Apo-Metronidazole
- Femazole
- Flagyl
- Flagyl ER
- Flagystatin
- Helidac
- Losec Helicopak
- Metizol
- MetroGel
- MetroIV
- Metryl
- Neo-Tric
- Novo-Nidazole
- Protostat
- Rho-Metrostatin
- SK Metronidazole
- Trikacide
- Thalidomide
- Thalomid
Latest treatments for Crohn's disease:
The following are some of the latest treatments for Crohn's disease:
Hospital statistics for Crohn's disease:
These medical statistics relate to hospitals, hospitalization and Crohn's disease:
- 0.17% (21,634) of hospital consultant episodes were for crohn’s disease in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 82% of hospital consultant episodes for crohn’s disease required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 42% of hospital consultant episodes for crohn’s disease were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 58% of hospital consultant episodes for crohn’s disease were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 35% of hospital consultant episodes for crohn’s disease required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Crohn's disease
Research quality ratings and patient incidents/safety measures
for hospitals and medical facilities in specialties related to Crohn's disease:
Hospital & Clinic quality ratings » »
Choosing the Best Treatment Hospital:
More general information, not necessarily in relation to Crohn's disease,
on hospital and medical facility performance and surgical care quality:
Medical news summaries about treatments for Crohn's disease:
The following medical news items
are relevant to treatment of Crohn's disease:
Discussion of treatments for Crohn's disease:
Crohn's Disease: NIDDK (Excerpt)
Treatment for Crohn's disease depends on the
location and severity of disease, complications, and response to previous
treatment. The goals of treatment are to control inflammation, correct
nutritional deficiencies, and relieve symptoms like abdominal pain,
diarrhea, and rectal bleeding. Treatment may include drugs, nutrition
supplements, surgery, or a combination of these options. At this time,
treatment can help control the disease, but there is no cure.
(Source: excerpt from Crohn's Disease: NIDDK)
Crohn's Disease: NIDDK (Excerpt)
Drug Therapy
Most people are first treated with drugs
containing mesalamine, a substance that helps control inflammation.
Sulfasalazine is the most commonly used of these drugs. Patients who do
not benefit from it or who cannot tolerate it may be put on other
mesalamine-containing drugs, generally known as 5-ASA agents, such as
Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine
preparations include nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take corticosteroids to control inflammation. These drugs
are the most effective for active Crohn's disease, but they can cause
serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to treat Crohn's
disease. Most commonly prescribed are 6-mercaptopurine and a related drug,
azathioprine. Immunosuppressive agents work by blocking the immune
reaction that contributes to inflammation. These drugs may cause side
effects like nausea, vomiting, and diarrhea and may lower a person's
resistance to infection. When patients are treated with a combination of
corticosteroids and immunosuppressive drugs, the dose of corticosteriods
can eventually be lowered. Some studies suggest that immunosuppressive
drugs may enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the drug infliximab
(brand name, Remicade) for the treatment of moderate to severe Crohn's
disease that does not respond to standard therapies (mesalamine
substances, corticosteroids, immunosuppressive agents) and for the
treatment of open, draining fistulas. Infliximab, the first treatment
approved specifically for Crohn's disease, is an anti-tumor necrosis
factor (TNF) substance. TNF is a protein produced by the immune system
that may cause the inflammation associated with Crohn's disease. Anti-TNF
removes TNF from the bloodstream before it reaches the intestines, thereby
preventing inflammation. Investigators will continue to study patients
taking infliximab to determine its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small
intestine caused by stricture, fistulas, or prior surgery. For this common
problem, the doctor may prescribe one or more of the following
antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or
metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the
inflammation subsides, but additional medication may also be necessary.
Several antidiarrheal agents could be used, including diphenoxylate,
loperamide, and codeine. Patients who are dehydrated because of diarrhea
will be treated with fluids and electrolytes.
Nutrition Supplementation
The doctor may recommend
nutritional supplements, especially for children whose growth has been
slowed. Special high-calorie liquid formulas are sometimes used for this
purpose. A small number of patients may need periods of feeding by vein.
This can help patients who need extra nutrition temporarily, those whose
intestines need to rest, or those whose intestines cannot absorb enough
nutrition from food.
Surgery
Surgery to remove part of the intestine can help
Crohn's disease but cannot cure it. The inflammation tends to return next
to the area of intestine that has been removed. Many Crohn's disease
patients require surgery, either to relieve symptoms that do not respond
to medical therapy or to correct complications such as blockage,
perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need to
have their entire colon removed in an operation called colectomy. A small
opening is made in the front of the abdominal wall, and the tip of the
ileum is brought to the skin's surface. This opening, called a stoma, is
where waste exits the body. The stoma is about the size of a quarter and
is usually located in the right lower part of the abdomen near the
beltline. A pouch is worn over the opening to collect waste, and the
patient empties the pouch as needed. The majority of colectomy patients go
on to live normal, active lives.
Sometimes only the diseased section of intestine is removed and no
stoma is needed. In this operation, the intestine is cut above and below
the diseased area and reconnected.
Because Crohn's disease often recurs after surgery, people considering
it should carefully weigh its benefits and risks compared with other
treatments. Surgery may not be appropriate for everyone. People faced with
this decision should get as much information as possible from doctors,
nurses who work with colon surgery patients (enterostomal therapists), and
other patients. Patient advocacy organizations can suggest support groups
and other information resources.
(Source: excerpt from Crohn's Disease: NIDDK)
Ileostomy, Colostomy, and Ileoanal Reservoir Surgery: NIDDK (Excerpt)
Sometimes treatment for Crohn's disease,
ulcerative colitis, and familial adenomatous polyposis involves removing
all or part of the intestines. When the intestines are removed, the body
needs a new way for stool to leave the body, so the surgeon creates an
opening in the abdomen for stool to pass through. The surgery to create
the new opening is called ostomy. The opening is called a stoma.
(Source: excerpt from Ileostomy, Colostomy, and Ileoanal Reservoir Surgery: NIDDK)
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Bowel sounds, hyperactive:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
After detecting hyperactive bowel sounds, quickly check the patient's vital signs and ask him about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression, to give I.V. fluids and electrolytes, and prepare the patient for surgery.
If he has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.
GENDER CUE:Homosexual males who report acute diarrhea and who have negative fecal ova and parasite cultures may be infected with chlamydial proctitis not associated with lymphogranuloma venereum. Because rectal cultures will probably be negative, treatment with tetracycline is appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Intestinal obstruction:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Surgery, nasogastric tube, total parenteral nutrition, supportive care (I.V. fluids, bed rest)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Crohn's disease:
Treatment
(Professional Guide to Diseases (Eighth Edition))
To control the inflammatory process, medications, such as 5-aminosalicylate, may be prescribed. Corticosteroids and immunomodulators may be prescribed if 5-aminosalicylate isn’t effective or in patients with severe Crohn’s disease. In debilitated patients, therapy includes total parenteral nutrition to maintain nutritional status while resting the bowel. If abscesses or fistulas occur, antibiotics may be prescribed. Infliximab (an antibody to tumor necrosis factor-alpha, an immune chemical that promotes inflammation) may also be prescribed.
Effective treatment requires important changes in lifestyle: physical rest, restricted diet (specific foods vary from person to person), and elimination of dairy products for lactose intolerance.
Surgery may be necessary to correct bowel perforation, massive hemorrhage, fistulas, or acute intestinal obstruction. Colectomy with ileostomy is necessary in many patients with extensive disease of the large intestine and rectum.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Bowel sounds, hyperactive:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
After detecting hyperactive bowel sounds, quickly check vital signs and ask the patient about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression and to give I.V. fluids and electrolytes, and prepare the patient for surgery.
If the patient has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.
Gender Cue: Homosexual males who report acute diarrhea and who have negative fecal ova and parasite cultures may be infected with chlamydial proctitis not associated with lymphogranuloma venereum. Because rectal cultures will probably be negative, treatment with tetracycline is appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Intestinal obstruction:
Treatment
(Handbook of Diseases)
Initial therapy involves correcting fluid and electrolyte imbalances, resting the bowel by decompressing it to relieve vomiting and distention, maintaining nothing by mouth status, and treating shock and peritonitis. A strangulated obstruction usually necessitates blood replacement as well as I.V. fluid administration. Nasogastric tube suction is necessary to relieve vomiting and abdominal distention.
Close monitoring of the patient’s condition determines the duration of treatment; if the patient fails to improve or if his condition deteriorates, surgery is necessary. Surgery is performed on all patients with large-bowel obstruction.
Total parenteral nutrition may be appropriate if the patient suffers a protein deficit from chronic obstruction, postoperative or paralytic ileus, or infection.
Drug therapy includes an analgesic and a sedative. An antibiotic is given for peritonitis due to bowel strangulation or infarction. A broad-spectrum antibiotic should be given to provide anaerobic and gram-negative coverage.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Crohn's disease:
Treatment
(Handbook of Diseases)
No cure for Crohn’s disease exists; treatment is aimed at restoring and maintaining bowel and nutritional status by suppressing inflammation, and minimizing discomfort caused by pain and diarrhea. In debilitated patients, therapy includes I.M. hyperalimentation to maintain nutrition while resting the bowel.
Mild to moderated disease benefits from sulfasalazine, an antibacterial, and other 5-ASA (5-amino salicylic acid) agents. Drug therapy may include an anti-inflammatory, a corticosteroid, an immunosuppressant (such as azathioprine and mercaptopurine), and an antibacterial. An antispasmodic, such as propantheline and dicyclomine, may be used for abdominal cramping. Metronidazole and aperfloxacin have proved to be effective in some patients.
Effective treatment requires important changes in lifestyle: physical rest, low-residue diet, and elimination of dairy products for lactose intolerance.
Surgery may be necessary on poor response to medical therapy to correct bowel perforation, massive hemorrhage, intra-abdominal abscess, stricture, fistulas, or acute intestinal obstruction. Colectomy with ileostomy is necessary in many patients with extensive disease of the large intestine and rectum.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bowel sounds, hyperactive:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s vital signs. Prepare him for diagnostic tests. These may include endoscopy to view a suspected lesion, barium X-rays, computed tomography scan, or stool analysis.
Monitor intake and output closely. If diarrhea is present, monitor for signs and symptoms of dehydration.
Patient teaching
Explain prescribed dietary changes to the patient. These may range from complete food and fluid restrictions to a liquid or bland diet. Because stress commonly precipitates or aggravates bowel hyperactivity, teach the patient relaxation techniques such as deep breathing. Encourage rest and restrict the patient’s physical activity.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bowel sounds, hyperactive:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After detecting hyperactive bowel sounds, quickly check the patient’s vital signs and ask him about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression, to give I.V. fluids and electrolytes, and prepare the patient for surgery.
If he has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bowel sounds, hyperactive:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for diagnostic tests, such as laboratory studies, imaging studies, endoscopy, barium X-rays, or stool analysis.
▪ If the patient has diarrhea, administer I.V. fluids and electrolytes to replace losses.
▪ Restrict food and fluids to rest the GI tract, as indicated.
▪ If the patient has GI bleeding, restrict food and fluids and administer I.V. fluids, blood, and vasopressors.
Patient teaching
▪ Explain dietary changes, such as food and fluid restrictions, clear liquid diet, or bland diet.
▪ Teach stress reduction and relaxation techniques.
▪ Discuss any activity restrictions.
▪ Explain diagnostic tests and procedures.
▪ Teach the patient about the cause of hyperactive bowel sounds and the treatment plan after a diagnosis is established.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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