Controlling Crohn's with Diet, Treating the Symptoms

by Food and Drug Administration (FDA)

(Page 2 of 2)

Treating the Symptoms

Since there is no cure for Crohn's disease, the goals of treatment are to control inflammation, relieve symptoms, and correct nutritional deficiencies. Treatment depends on which part and how much of the intestine is affected.

Most people with Crohn's disease are first treated with drugs containing 5-aminosalicylates (5-ASA), which help control inflammation. Sulfasalazine (azulfidine) was traditionally the drug of choice until later evidence showed that newer ASA-containing medications were more effective at higher doses and presented fewer side effects.

Corticosteroids such as prednisone can control inflammation as well. These drugs are the most effective for active Crohn's disease, rather than for remission maintenance, but they can cause serious side effects, including greater susceptibility to infection, weight gain, increased blood sugar levels, thinning of the bones, elevated blood pressure, and personality disorder. Both corticosteroids and 5-ASAs are not approved specifically for Crohn's disease. Use of approved drugs for unapproved indications is commonly referred to as "off-label."

Drugs that suppress the immune system are reserved for patients who do not respond to less toxic forms of therapy because "they carry an increased chance of infection," says Kaminstein. The most commonly prescribed, Purinethol (mercaptopurine) and Imuran (azathioprine), also not specifically FDA-approved for this indication, work by blocking the immune reaction that contributes to inflammation, and are particularly effective for maintaining long periods of remission.

Antibiotics such as Flagyl (metronidazole), which are effective against many types of bacteria, are often prescribed "off-label" to help relieve symptoms of Crohn's disease, especially when it affects the large intestine or causes abscesses and fistulas around the anus. Other "off-label" medication use includes antidiarrheal drugs such as Lomotil (diphenoxylate) and Imodium (loperamide), which may relieve cramps and diarrhea.

Many Crohn's disease patients require surgery to relieve chronic symptoms that do not respond to drug treatment or, like Gray, to correct complications such as an abscess that has begun to perforate. The bowel is cut above and below the diseased area and reconnected. But since Crohn's disease often recurs after surgery, it is very important, according to Kaminstein, for the individual and doctor to consider carefully the benefits, risks and costs of surgery compared with other treatments. He says surgery should be used only after attempts at other forms of therapy have failed.

"It's been 14 years since my last bowel surgery," says Gray, who has had four resections in 23 years. Presently in remission, she is being maintained on low-dose prednisone and 4,000 milligrams of mesalamine (5-ASA) daily. She also receives a monthly injection of vitamin B-12 (cyanocobalamin) since her entire ileum was removed. According to Kaminstein, B-12 is absorbed by receptors located in the last 100 centimeters of the ileum, and removal can lead to B-12 deficiency within five years.

Patients may have areas of narrowing in the small intestine (strictures) that can cause obstruction. These can be surgically widened or stretched to relieve the obstruction.

Some people have long periods of remission, sometimes for years, when they are free of symptoms. However, CCFA says the disease can recur at various times over a person's lifetime. This changing pattern of the disease means a person cannot always tell when treatment has helped.

Controlling Crohn's with Diet

No special diet has been proven effective for preventing or treating Crohn's disease, but during a severe attack, Kaminstein says it is important to eat well to replace lost nutrients. And while there are a number of theories as to the role of "antigens" or other products in the diet that may cause IBD flare-ups, "we do know that we can sometimes decrease symptoms of Crohn's disease by placing the bowel at rest," he says. "In other words, by avoiding certain foods."

Renée Gordon of Montgomery Village, Md., agrees. She says that after 30 years of living with Crohn's disease, she knows exactly what foods trigger her symptoms or make them worse.

"I don't eat rich or spicy foods or those with sauces," she explains. "A bland diet is just the one thing that makes me feel great."

Kaminstein adds that fats may not be digested or absorbed in some Crohn's sufferers who have had a large portion of the small intestine removed. This can increase diarrhea and cramps.

But Kaminstein also warns that IBD patients should not restrict themselves from eating one food or another "unless they find it repeatedly bothers them," and have consulted with their physicians. In some cases, he recommends patients seek the advice of a registered dietitian or nutritionist, who can suggest changes that will conform to their overall nutritional needs.

"Arbitrarily removing certain food groups from the diet can only impair nutrition and should be avoided."

People with Crohn's disease may feel well and be free of symptoms for substantial periods, but there is no way to predict when symptoms may return. Maintenance of remission, according to Kaminstein, involves appropriate medical treatment, monitoring patients for adverse effects and disease complications, and screening for cancer, which can occur in some instances. People with long-term IBD (more than eight to ten years), for example, face a somewhat higher risk of getting colon cancer.

But although there may be long-term needs for medicine and even periods of hospitalization, most individuals, like Gordon, are able to hold productive jobs and function successfully at home and in society.

About the Author

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