Treatment goals include:
• Inducing remission (relieving symptoms and improving general wellbeing)
• Achieving complete mucosal healing (mucosa is the lining of the gut affected by the inflammatory processes of the disease)
• Maintaining remission and preventing relapse.
Glucocorticoid (steroid) preparations are often required to treat an acute disease flare. There are two main types of steroids:
• Topical steroids (budesonide) which have a local anti-inflammatory effect in the colon
• Systemic steroids (prednisolone) show systemic anti-inflammatory effect throughout the body but are also known to cause many undesirable side effects
Budesonide is a well tolerated steroid treatment which works locally, at the site of inflammation in the gut. Budesonide formulations are designed to release the active drug in the lower small bowel (ileo-caecal region), which is the most common site of inflammation in Crohn’s disease (approx. 65% of patients). After producing the anti-inflammatory effect in the bowel, budesonide is absorbed and transported directly to the liver, where 90% of it is metabolized (broken down). Very little budesonide passes through the liver into the blood stream (about 10%), meaning that the patient is less likely to experience steroid side effects. This explains why patients taking budesonide report less side effects less frequently than those treated with conventional steroids.
According to European and National Guidelines, budesonide is the preferred first line treatment in mild to moderate ileo-caecal Crohn’s disease.
If remission cannot be induced by steroids (topical or systemic), the doctor may prescribe agents that suppress the immune system (immunosuppressants), such as azathioprine or methotrexate. Immunosuppressants support the anti-inflammatory effects of the corticosteroids and can help reduce their use. Finally, when no other agents successfully induce remission, biologics or biosimilar durgs may be tried (anti-TNF-α monoclonal antibodies).
Treatment with different drugs may postpone a new flare of disease, but cannot, in most cases, completely prevent disease recurrence.
Patients with Crohn’s disease may require surgery if complications such as fistula formation or stenosis occur. The principle surgical approach in these cases is one of bowel preservation, since surgical removal of inflamed bowel, unlike in some ulcerative colitis patients, does not lead to cure and inflammation may recur elsewhere in the gastrointestinal tract.
Patients with Crohn’s disease are subject to a number of deficiency syndromes. The absorption of nutrients including vitamins, minerals and proteins may be affected and these nutrients should be substituted using suitable food supplements.
During an acute flare, it may be necessary to supplement the essential nutrients by means of an intravenous infusions. In most cases, however, a special diet is not required. Due to a danger of malnutrition patients should make sure they are receiving a balanced diet.