Management of Crohn's disease
Surgery may be required for complications such as obstructions, fistulae, abscesses, or if the disease does not respond to drugs within a reasonable time.
[1] 5-ASA compounds, such as mesalazine and sulfasalazine, have shown to be of very little efficacy in the treatment of Crohn's disease, either for induction or for maintenance of remission.
[3] Corticosteroids are a class of anti-inflammatory drugs used to treat moderate to severe flares of Crohn's disease.
However, they are used sparingly because they can cause serious side effects,[4] including Cushing's syndrome, mania, insomnia, hypertension, high blood glucose, osteoporosis, and avascular necrosis of long bones.
The most commonly prescribed oral steroid is prednisone, which is typically dosed at 0.5 mg/kg for induction of remission in Crohn's disease.
[citation needed] Another oral corticosteroid, budesonide (trade name Entocort), has limited absorption and a high level of first-pass metabolism, meaning that lower quantities of the drug enter the bloodstream.
[10] A Cochrane systematic review that included 13 randomized controlled trials, concluded that azathioprine and 6-mercaptopurine are not effective for inducing remission when a person has Crohn's disease.
[citation needed] Infliximab (trade name Remicade, among others) is a mouse-human chimeric antibody that targets tumor necrosis factor alpha (TNFα), a cytokine in the inflammatory response.
[citation needed] Natalizumab is an anti-integrin monoclonal antibody that has shown utility as induction and maintenance treatment for moderate to severe Crohn's disease.
[22] A total of 3 large randomized controlled trials have demonstrated that natalizumab is effective in increasing rates of remission[23] and maintaining symptom-free status[24] in patients with Crohn's disease.
Vedolizumab is a gut-selective, Alpha-4 Beta-7 anti-integrin, monoclonal antibody that was approved by the U.S. Food and Drug Administration (FDA) to treat Crohn's disease in 2014.
It is indicated for management of moderate-to-severe, active Crohn's disease patients and it works by inhibiting the trafficking of pro-inflammatory immune cells to the site of inflammation.
People with lactose intolerance due to small bowel disease may benefit from avoiding lactose-containing foods.
The use of oral probiotic supplements to modify the composition and behaviour of the gastrointestinal microbiome has been researched recently to understand whether it may help to improve remission rate in people with Crohn's disease.
However only 2 controlled trials were available in 2020, with no clear overall evidence of higher remission nor lower adverse effects, in people with Crohn's disease receiving probiotic supplementation.
[35] In an experimental idea called helminthic therapy, moderate hookworm infections have been demonstrated to have beneficial effects on hosts who have diseases linked to overactive immune systems.
[38] Evidence has been put forth suggesting that acupuncture can have benefits beyond the placebo effect, improving quality of life, general well-being and a small decrease in blood-bound inflammatory markers.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can cause flares of inflammatory bowel disease in approximately 25% of patients.
[46] Celecoxib (Celebrex), a cox-2 inhibitor, also appears to be safe, at least in short-term studies of patients in remission and on medication for their Crohn's disease.
