Treatment of Crohn's Disease

Alsmost 25% of cases of Crohn's disease recover without any specific treatment - this is particularly likely if the disease developed very acutely. For those people who suffer recurrent attacks, changes in diet and lifestyle may help to control the symptoms and also extend the time between flare-ups. Medication may also be prescribed to reduce the inflammation that triggers the symptoms, and to relieve those symptoms if they do occur. However, in a small proportion of cases, surgery may be needed.

Self Help

Although there is no evidence that diet causes Crohn's disease, certain food can aggravate the symptoms, particularly during a flare-up. The following foods should be avoided:

• Dairy foods
• Fatty foods such as butter, margarine, cream, mayonnaise, nuts, avocados, ice cream, fried foods, chocolate and red meat (they tend to make diarrhoea worse).
• Gassy foods such as beans, cabbage and broccoli, spicy food, raw fruit juices and fruits (especially citrus fruits).
• Alcohol (stimulates the intestine, which can worsen the effect of diarrhoea).
• Carbonated drinks (may produce gas and abdominal pain).
• Caffeine (for example, tea, coffee and chocolate) tends to make diarrhoea worse.

Patients may also need to experiment with the amount of fibre their system can handle; too much roughage can make diarrhoea, gas and pain worse. Raw crunchy fruit and vegetables such as apples and carrots should normally be avoided, as should foods in the Brassica family, such as broccoli, cabbage and cauliflower.

Crohn's disease sufferers often find that eating five or six small meals a day makes them feel better than eating two or three larger ones. Drinking plenty of fluids (water is best) can also help.

It may also be useful to take multi-vitamins, partly because of the limited diet sufferers have to stick to, and partly because of the loss of ability to absorb nutrients effectively. Iron, folic acid and vitamin B12 are particularly useful as they will help to combat anaemia. In severe cases, patients may need monthly injections of vitamin B12 for life.

Stress can make the symptoms of Crohn's disease much worse and may trigger flare-ups. The stomach secretes more acids when the body is under stress and empties more slowly. Stress may also cause changes in intestinal tissue and slow or speed the passage of intestinal contents. Patients are advised to learn how to manage stress more effectively, for example by regular exercise, deep breathing techniques, meditation or yoga.

Medication

Medication may be used to control the inflammation that causes the symptoms of Crohn's disease, which not only leads to symptom relief, but may also lead to long-term remission. Acute inflammation is often treated with corticosteroid drugs or compounds known as aminosalicylates (for example, sulfasalazine or mesalazine) to try and control the inflammatory process. These drugs are usually applied directly (by enema or as a foam); however, if this technique is not effective at controlling symptoms, the drug may be taken orally as tablets, capsules or granules.

Drugs that influence the immune system may be useful where the disease frequently flares up and is difficult to control. Some researchers believe that damage to the digestive tissues may be caused by the body's immune response to an invading bacterium or virus or even to its own tissue, and drugs that target the immune system suppress this response, thus reducing inflammation.

In addition to controlling inflammation, some drugs may be prescribed to relieve the signs and symptoms. These include:

• Antibiotics to combat any infection and heal fistulas and abscesses.
• Anti-diarrheals such as loperamide (Imodium) can be used to treat severe diarrhoea, whilst milder cases may be treated with methylcellulose (Citrucel) or psyllium powder (Metamucil).
• Pain relievers such as paracetamol may be used to combat mild pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen should not be used as they may make symptoms worse.

Surgery

In a number of cases, surgery may be necessary to remove a damaged portion of the bowel, to close fistulas, drain abscesses or to remove scar tissue. Procedures may include:

• ileostomy - where the end of the small intestine (the ileum) is brought out onto the surface of the skin, and waste is collected at this point into a bag
• strictureplasty - a procedure that widens a segment of the intestine that has become too narrow
• ileocolonic resection - where the damaged portion of the digestive tract is removed, and the healthy sections reconnected

At best, surgery can provide years of remission, and at worst it may simply provide a temporary improvement in symptoms. However, surgery often prompts a flare-up of the disorder, and repeated operations, usually at the same site, may be required. 50% of people who undergo surgery need a second procedure and some may require a third operation.