Treatment
The treatment of choice for Crohn’s disease is medical treatment with drugs. Surgical interventions have less successful outcomes in general and the disease tends to recur.
The main drugs used to treat Crohn’s disease are aminosalicylates (e.g. 5 amino salicylic acid, sulphasalazine, mesalazine) and corticosteroids. In mild cases these are given by suppository or enemas to act directly on the lower bowel. They are given orally to treat exacerbations and long term to achieve remission. In a more severe episode the person may be admitted to hospital to receive intravenous medication, and to monitor and stabilise their condition. Antibiotics may be needed to treat abscesses and fistulas.
Classes of immunosuppressant drugs including azothiaprine, ciclosporin, mercaptopurine and methotrexate are used to treat cases that fail to respond adequately to aminosalicylates and corticosteroids.
A new class of drugs called tumour necrosis factor alpha (TNF a) inhibitors are currently being used to treat the most severe cases of Crohns disease that fail to respond to the drugs described above. Infliximab is the drug of choice at present and is used to treat flare-ups. The long term efficacy and safety profile of these drugs is unknown and remains under review.
Up to half of people with Crohn’s disease may require a surgical intervention at some time in the course of the illness to treat complications. The results of surgery are variable.
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Amended April 2008
