Is It Time to Step Up Your Crohn's Disease Treatment?
Crohn’s disease is a chronic, progressive condition. Its symptoms come and go, and it generally gets worse as time goes on. Unfortunately, there’s no guaranteed cure for Crohn’s disease. But there are treatments that can help you control the disease.
Together with your doctor, you can find a course of treatment that’s right for you. As the disease progresses, however, you may need to adjust your therapy.
There’s no one-size-fits-all approach to treating Crohn’s disease. And because each person is different, your doctor will be on the lookout for a variety of symptoms to figure out whether your treatment is working or whether it’s time to step it up.
Step 1: Assessing Crohn’s disease
Before starting treatment, your doctor needs to know just how serious your condition is. He or she may start by asking about your family history. Your risk for Crohn’s disease is much higher if a family member also has the condition.
From there, the doctor will look for symptoms, such as fever, abdominal pain, weight loss, or joint pain. Lab tests will check your blood for signs of inflammation. If the doctor thinks it’s necessary, you may need an endoscopy, CT scan, or MRI scan.
Step 2: Initial treatment
If your doctor decides you’re a low-risk patient, meaning your disease isn’t yet very advanced or your symptoms are fairly mild, you may start with sulfasalazine, metronidazole, or corticosteroid treatment. These drugs reduce the inflammation in your intestines that causes Crohn’s disease symptoms. In people with mild symptoms, corticosteroids work fast to provide relief. The most common corticosteroids are:
Corticosteroids are a short-term treatment. If your symptoms go away while taking them, your doctor may stop your therapy and monitor your health over the next year to see if they return. He or she may also suggest a type of drug called immunomodulators that may be able to keep your symptoms away for longer.
Step 3: If symptoms return
There is a strong chance that your Crohn’s disease symptoms will come back after your initial treatment. If this happens, there are a few things your doctor may try:
Immunomodulators: These drugs weaken, or suppress, the immune system, which reduces inflammation in the intestines.
Changing drug levels: Your doctor may adjust the dose of a medication you’ve tried before to see if there’s any change in your symptoms.
Step 4: Biologics
If your first round of treatment doesn’t work and your symptoms grow worse, or if your symptoms were already quite serious by the time you were diagnosed with Crohn’s disease, you may need a more intensive treatment. If that’s the case, biologic medicines are often the best way to go.
Biologics are drugs made from living organisms that target the specific enzymes causing inflammation in more serious cases of Crohn’s disease.
Biologic medicines may be prescribed if your Crohn’s disease causes deep ulcers, fistulas, or rectal disease, or if the inflammation has spread to other parts of your body.
Biologics are a newer form of treatment compared to other treatments like corticosteroids. Different biologics target different causes of inflammation. This lets your doctor tailor a treatment to your specific needs.
These drugs can be used both to treat symptoms of Crohn’s disease and to keep those symptoms in remission for longer periods of time. Biologics can be taken by both adults and children.
A variety of side effects can occur with biologic medicines, so be sure to talk with your doctor about what to expect with these treatments.
Step 5: Surgery
Even if your condition is well managed, you may eventually need surgery to help treat the effects of the disease.
Estimates vary on how many people need surgery. According to the National Institutes of Health, as many as 20% of Crohn’s disease patients will need surgery during their lifetimes. The Crohn’s and Colitis Foundation of America, however, puts that figure closer to 70%. Reasons for surgery include:
Medication side effects
Surgery is often performed to remove parts of the small intestine, large intestine, colon, or rectum. While surgery is effective at treating the symptoms of Crohn’s disease, it is not a cure. As many as 60% of patients who have surgery will see their symptoms come back within 10 years.
Talk with your doctor about the many different options available for treating Crohn’s disease to find the best course for you.
There’s no one-size-fits-all approach to treating Crohn’s disease. Your doctor looks for a variety of symptoms to decide if it’s time to adjust your treatment.
If your symptoms are fairly mild, you may start with sulfasalazine, metronidazole, or corticosteroid treatment. These drugs reduce the inflammation in your intestines that causes Crohn’s disease symptoms.
There is a strong chance your symptoms will return after initial treatment. Your doctor can then try immunomodulators, drugs that suppress the immune system to reduce inflammation in the intestines. He or she may also try adjusting the dose of a medication you’ve tried before.
If you need a more intensive treatment, biologic medicines are often the best way to go.
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- AGA Institute Guidelines for the Identification, Assessment and Initial Medical Treatment in Crohn’s Disease: Clinical Decision Support Tool. American Gastroenterological Association. http://campaigns.gastro.org/algorithms/IBDCarePathway/index.html
- Immunomodulators, Crohn’s and Colitis Foundation of America. http://www.ccfa.org/assets/pdfs/immunomodulators.pdf
- Corticosteroids. Crohn’s and Colitis Foundation of America. http://www.ccfa.org/assets/pdfs/steroids.pdf
- Biologic therapies. Crohn’s and Colitis Foundation of America. http://www.ccfa.org/resources/biologic-therapies.html
- Crohn’s treatment options. Crohn’s and Colitis Foundation of America. http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/crohns-treatment-options.html...
- Skroza N, et al. Correlations between psoriasis and inflammatory bowel diseases. BioMed Research International. 2013. doi:10.1155. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736484/pdf/BMRI2013-983902.pdf
- Crohn’s disease. National Digestive Diseases Information Clearinghouse. http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/crohns-disease/Document...