Crohn’s disease therapy

There are several treatment options for Crohn's disease, which doctors often use in combination. This increases their effectiveness and impact. The aim of treatment is always to alleviate symptoms, reduce the number of relapses, extend the time between relapses and prevent complications.

Medication for Crohn's disease

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”): They are among the most effective anti-inflammatory medications during an attack and reduce inflammatory activity.
  • Aminosalicylates: frequently used active ingredients are sulfalazine and mesalazine. They are available in various dosage forms: as tablets, suppositories or enemas.
  • Immunosuppressants: These drugs suppress the activity of the immune system. Examples of active substances are azathioprine and 6-mercaptopurine (6-MP). However, pathogens also have an easier time with a dampened immune system – the risk of infectious diseases increases. Patients are more susceptible to colds, pneumonia, urinary tract infections or fungal infections.
  • Cytostatic drugs: Methotrexate is an active substance that slows down cell growth.
  • Antibiotics, for example for purulent abscesses and fistulas if bacteria are involved (incidentally, antibiotics are ineffective against viruses).
  • 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”. Examples of such antibodies are infliximab, certolizumab or adalimumab. They belong to the group of TNF-alpha blockers. Alternatives are vedolizumab and ustekinumab. The antibodies intervene directly in the inflammatory process in the body, albeit at different points.

Even after the acute flare-up has subsided, anti-inflammatory medication is often useful (e.g. azathioprine or 6-mercaptopurine). 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. These can range from skin rashes and skin inflammation to skin cancer. Some medications also weaken the body’s defenses.

Doctors treat typical symptoms of Crohn’s disease, such as diarrhea, with the active ingredient loperamide, while iron supplements help with iron deficiency.

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. However, doctors always try to delay surgery as much as possible. 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.

In Crohn’s disease, we perform standard laparoscopic surgery, i.e. minimally invasive keyhole surgery. This not only has cosmetic advantages. Patients recover much faster after the operation. They have less pain, spend less time in hospital and can therefore return to work sooner.

Nutrition as a therapy for Crohn's disease

Anyone with Crohn’s disease must pay attention to their diet. Not only to prevent further strain on the inflamed bowel and aggravate symptoms, but also to prevent malnutrition. Seek advice from a specially trained nutritionist (ecotrophologist) or 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.

Extraintestinal diseases

Up to 50 percent of patients with Crohn’s disease may also experience extraintestinal symptoms. The joints are most frequently affected; arthralgia (joint pain) and arthritis (joint inflammation) can occur. In addition, skin changes in the form of erythema nodosum or pyoderma gangraenosum can also occur. It can also lead to rosacea and inflammation of the eye. We work very closely with colleagues from the Department of Rheumatology and the Department of Dermatology at the University Hospital Zurich.

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