Crohn’s disease therapy

Medication is essential for Crohn’s disease. Which medication is used depends on whether a flare-up is present and how severe it is. Doctors use the following medications as “anti-inflammatories” during an acute flare-up:

• Corticosteroids (“cortisone”): These are immunosuppressants that suppress the immune system. Doctors use them for acute flare-ups. However, drugs containing cortisone are not suitable for long-term treatment of Crohn’s disease due to the side effects. Prednisolone in tablet form is a commonly used active ingredient. Cortisone can also be administered as an infusion in higher doses. Cortisone can lead to sleep disorders, weight gain, acne and an increase in blood sugar. If taken over a longer period of time, it also causes bone loss (“osteoporosis”). Continuous administration of more than 10 mg for more than two months should be avoided if possible.
• Budenoside is a cortisone-like medication that only works in the intestine because it is broken down very quickly by the liver. Despite having a comparable effect to normal cortisone, it therefore has significantly fewer side effects. The medication is available as a tablet. Enema, foam or suppositories – it works directly at the site of inflammation
• Immunosuppressants of the “thiopurine type”: These are used when mesalazine and cortisone have not produced a sufficient effect. Examples of these active substances are azathioprine and 6-mercaptopurine. These immunosuppressants are not suitable for treating an acute attack of ulcerative colitis, but are suitable for maintaining freedom from symptoms, i.e. for long-term therapy. However, it takes a few months for the medication to take effect. So you need to be a little patient. Possible side effects: Headache, dizziness, inflammation of the liver and pancreas.
• antibodies (biologics) if other medications are not sufficiently successful. Biologics are proteins that are produced by genetic engineering and are very similar to the body’s own substances. They are therefore also known as “biological medicines”. Active substances for the treatment of Crohn’s disease include (in order of approval) infliximab, adalimumab, certolizumab pegol, vedolizumab and ustekinumab. The medication is available as an injection or infusion. They either block inflammatory messengers or, like vedolizumab, prevent inflammatory cells from migrating into the intestine. The time to onset of action varies for the biologics. Infliximab has the fastest effect. Vedolizumab has the slowest effect. However, vedolizumab only works in the intestine and cannot weaken the immune functions in other organs.
• Even after the acute flare-up has subsided, anti-inflammatory medication is often useful (e.g. azathioprine or 6-mercaptopurine or biologics). They extend the time between relapses and prevent the development of new relapses. Many patients take them over a longer period of several years.

Like all medicines, all the medicines mentioned have side effects. Some medications also weaken the body’s defenses. The benefits and risks must be carefully weighed up in each individual case. Blanket treatment for all those affected is not appropriate. If the condition is not mild, it may be helpful to go to an expert center and have the treatment adjusted.

Doctors treat typical symptoms of Crohn’s disease, such as diarrhea, with the active ingredient loperamide. Iron supplements help with iron deficiency, but iron should not be taken in tablet form as it can trigger flare-ups of inflammation in Crohn’s disease.

Psychotherapy for Crohn's disease

Crohn’s disease is a chronic illness that affects not only the body but also the mind. Those affected must learn to cope well with their lifelong companion. Psychotherapy can help with coping with the illness and improve quality of life. Psychological support is also advisable for anxiety and depression.

Surgery is sometimes unavoidable

Sometimes, as the disease progresses, medication and other therapies are not enough and no longer show sufficient success. Then an operation helps. Surgery is also necessary if complications occur, such as intestinal obstruction, intestinal perforation or severe intestinal bleeding. Surgery is also an option for children and adolescents if Crohn’s disease delays growth and development. Surgeons generally only remove the inflamed section of bowel during the operation, i.e. as little bowel tissue as possible. The large-scale removal of parts of the intestine has proven to be unnecessary and has many disadvantages.

Nutrition as a therapy for Crohn's disease

Anyone with Crohn’s disease should pay attention to their diet. Not only to prevent further strain on the inflamed bowel and aggravate symptoms, but also to prevent malnutrition. Seek training from a specially trained nutritionist or seek advice from a doctor who is well versed in nutritional medicine. Nutritional advice is also useful if you also suffer from a food intolerance or food allergy.

There is no special diet for people with Crohn’s disease that is equally good for everyone. Try out which foods you can and cannot tolerate. The following diet is advisable after a flare-up:

• First of all, foods that are easy to digest and do not strain the intestines. Initially carbohydrates are good, later foods containing proteins and fats.
• Then eat light whole foods: examples are dairy products with a low fat content, lean meat, wholemeal bread, rice, potatoes, pasta or vegetables such as carrots, tomatoes or fennel. You can also try fresh fruit and salads.
• Avoid ready-made products because they contain many artificial additives. In addition, not all ingredients are listed on the packaging.
• You should also be careful with foods that contain a lot of sugar (e.g. chocolate, cakes, pies, cookies, soft drinks).

During an acute episode of the disease, artificial feeding via a gastric or intestinal tube is sometimes helpful. However, once the flare-up has subsided, you can gradually return to a normal diet. Gradually get your digestive tract used to a normal diet again.