Crohn's Disease (cont.)

In most cases, the diseased part of the bowel is removed and the two healthy ends of bowel are joined together (anastomosis). This surgery can allow many people to remain symptom-free for years, but it is not a cure since Crohn's disease often recurs at the site of the anastomosis.

Unfortunately, too many resection surgeries can lead to a condition called short gut syndrome where there isnt enough bowel left to adequately absorb nutrients.

Other surgeries include repair of parts of the intestine that have narrowed (a stricture) or abscessed (infection).

An ileostomy may also be required if the rectum is diseased and cannot be utilized for an anastomosis. This is a connection of the intestine to the skin overlying the abdominal wall. The result is an opening in the skin from which waste products can be excreted into a specially designed pouch.

Treatment By Activity or Location of Disease

Mild-moderate disease (of the ileum or colon):

  • Oral Pentasa (mesalamine) or Azulfidine (sulfasalizine)
  • If you dont respond to those treatments, antibiotic therapy with Flagyl or Cipro is also an option
  • Steroid treatment may be started if there is no response to the above medications.

Moderate-severe disease:

  • Steroid treatment until symptoms resolve and weight gain is sustained (7-28 days).
  • Infection is treated with appropriate antibiotics unless it's an abscess where its treated with drainage.
  • Therapy with Imuran, methotrexate, or Remicade is an alternative for people who do not respond to standard therapy.

Severe-fulminant disease:

People with persistent symptoms despite taking Remicade or steroids or those with symptoms of serious illness should be hospitalized. Treatment includes:

  • Surgery for any abscesses, obstruction or fistulae.
  • Intravenous (by vein) corticosteroids for those who were on oral steroids.
  • Nutritional support using TPN after 5-7 days if the person is unable to maintain nutritional requirements with oral nutrition. Transfusions for severe anemia or blood loss.
  • Antibiotics for treatment of infection.

Perianal disease:

  • Abscesses in the anal or rectal area (perianal or perirectal abscess) require surgical drainage.
  • Fistulas in this area that can also be treated with antibiotics.

Maintenance therapy to prevent relapse:

  • Imuran/mercaptopurine combination after initial treatment with steroids.
  • Pentasa or Imuran/mercaptopurine combination can be given after resection of parts of the intestine to reduce recurrence of disease.

What Role Does Diet Play in Crohn's Disease?

While foods appear to play no role in causing the disease, soft, bland foods may cause less discomfort than spicy or high-fiber foods when the disease is active. Except for restricting milk in lactose intolerant people, most gastroenterologists try to be flexible in planning the diets of their Crohn's disease patients. Ask your doctor to create a dietary plan for you.

Reviewed by The Cleveland Clinic Department of Gastroenterology.
Edited by Louise Chang, MD, WebMD, November 2005.

WebMD Medical Reference

Last Editorial Review: 2/17/2006

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