US Pharm. 2013;38(12):13-14.
Chronic Inflammation of the Digestive Tract
Crohn’s disease is a type of inflammatory bowel disease
that affects the tissues of the gastrointestinal (GI) tract. It is
caused by an immune reaction and may be genetic. People with Crohn’s
disease have a variety of GI symptoms, including abdominal pain,
diarrhea, and weight loss. These symptoms may come and go over a
lifetime, alternating between symptom-free periods and flare-ups.
Treatment of Crohn’s disease is focused on keeping
intestinal tissue healthy and avoiding symptoms. Proper diet, drugs that
prevent or treat inflammation, and surgery to remove inflamed tissue
are important components of therapy.
Type of Inflammatory Bowel Disease
Crohn’s disease is a type of autoimmune disorder in which
the body’s immune system attacks healthy tissues by mistake, causing
inflammation and tissue damage. The cause is unknown, although there may
be genetic and environmental links. Crohn’s disease runs in families
and is seen more often in city dwellers in modernized countries. Smoking
is also a risk factor. High stress levels and a poor diet can make
symptoms worse, but they do not cause Crohn’s disease.
Recognizing the Disorder
Crohn’s disease often begins in one’s teens or young
adulthood, although it can start at any age. It can affect any part of
the GI tract, including the mouth, stomach, small intestine (duodenum,
jejunum, ileum), large intestine (colon), rectum, or a combination of
these. The area of inflamed digestive tract determines the symptoms. The
most common symptoms of Crohn’s disease are nausea and vomiting,
abdominal pain and cramping, fever, poor appetite and weight loss, and
diarrhea. However, not everyone with Crohn’s disease suffers from all of
The diagnosis is made using the information from a
physical exam, a history of symptoms, blood tests, and the results from a
barium enema, upper GI series, CT or MRI of the abdomen, endoscopy,
colonoscopy, or sigmoidoscopy.
Inducing Remission and Avoiding Flare-ups
The treatment for Crohn’s disease focuses on keeping the
intestines healthy while relieving symptoms and avoiding flare-ups.
Therapy includes a well-planned diet, along with medications that stop
inflammation, as well as drugs that prevent flare-ups once symptoms are
It is important to maintain good nutrition, not only to
avoid intestinal symptoms, but also to prevent losing weight. A healthy
diet may mean avoiding irritating foods while consuming the right amount
of protein, carbohydrates, fiber, and fat, as well as vitamins and
minerals. Some people must limit their dairy intake due to problems
digesting these products. In addition, vitamin and mineral supplements
are often prescribed.
Drugs used to stop inflammation (known as inducing remission) allow the intestinal tissue to heal. Medications are also used to avoid future flare-ups (referred to as maintenance therapy).
The type of drug used in a particular patient depends on the severity
and location of the inflamed intestinal tissue. Aminosalicylates
(sulfasalazine, mesalamine, olsalazine, balsalazide) are
anti-inflammatory medications used mostly for maintenance therapy when
the colon is inflamed. Corticosteroids (prednisone and
methylprednisolone) help in acute flare-ups. They are used orally or
rectally. Immunosuppressants and immunomodulators (azathioprine,
6-mercaptopurine, cyclosporine A, tacrolimus) are drugs that stop the
body’s inflammatory response and can be used in acute or maintenance
therapy. Biologics (adalimumab, certolizumab, infliximab, natalizumab)
are another immunosuppressant category of drugs that stop inflammation
from occurring. Finally, some patients will require pain medications
during severe flare-ups.
Eventually, most patients with Crohn’s disease will need
surgery when symptoms are not controlled by drug therapy. The surgery
removes diseased tissue and reconnects the healthy areas of the GI tract
to help improve symptoms. Although surgery does not cure Crohn’s
disease, it does help improve symptoms, often for many years.
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