Crohn's Disease - Treatment

The unclear etiology of this pathological condition complicates the treatment of Crohn's disease. The therapy currently used is essentially empirical, and the search for drugs with antibacterial, anti-inflammatory and immunosuppressive effects is based on the widespread theory of the origin of the disease, which recognizes the leading role of intestinal antigens, under the influence of which a change in reactivity and inflammation of the intestine occurs.

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Drugs for the treatment of Crohn's disease

The requirements for drugs were primarily met by corticosteroids, which have been used in the treatment of nonspecific ulcerative colitis and Crohn's disease since 1950. To this day, corticosteroid therapy remains the most effective method of treating acute forms of these diseases.

In addition to corticosteroids, other drugs with antibacterial and anti-inflammatory effects are also used. The following drugs are used in modern medicine to treat Crohn's disease:

1. Sulfasalazine and its analogues (salazopyrine, salazopyridazine, salazodimethoxine). The drug is taken before meals, without chewing and with plenty of water (about 250 ml). Sulfasalazine is taken four times a day in a dosage of one to two grams during an exacerbation. When the patient's condition stabilizes, the dosage is gradually reduced and switched to taking 500 mg four times a day.

Sulfasalazine is an azo compound of 5-aminosalicylic acid and sulfapyridine. Its mechanism of action is still being studied. It was believed that sulfasalazine taken orally, with the participation of intestinal microflora, loses its azo bond and decomposes into 5-aminosalicylic acid and sulfapyridine. Unabsorbed sulfapyridine temporarily suppresses the growth of anaerobic microflora in the intestine, including clostridia and bacteroids. Recently, it has been established that the active ingredient of sulfasalazine is mainly 5-aminosalicylic acid, which inhibits the lipoxygenic pathway of arachidonic acid conversion and thus blocks the synthesis of 5,12-hydroxyeicosatetraenoic acid (OETE), a powerful chemotactic factor. Consequently, the effect of sulfasalazine on the pathological process turned out to be more complex than previously assumed: the drug causes changes in the intestinal microflora, modulates immune responses and blocks inflammatory mediators.

The results of studies that established that the active component of sulfasalazine is 5-aminosalicylic acid served as the basis for the creation of new drugs in which the molecule of 5-aminosalicylic acid is connected by an amino bond to another similar or neutral molecule. An example of such a drug is salofalk, which does not contain sulfapyridine and, therefore, is devoid of its side effects.

The efficacy of 3 forms of the drug was studied: tablets (250 mg 5-aminosalicylic acid in each tablet), suppositories (250 mg 5-ASA) and enemas (4 g 5-ASA in 60 g suspension). The drug in tablets was recommended for the treatment of Crohn's disease and total forms of nonspecific ulcerative colitis. Suppositories and enemas are indicated for distal forms of nonspecific ulcerative colitis and the anal form of Crohn's disease. Positive results were obtained in 93.9% of cases of Crohn's disease and in 91.6% of cases of nonspecific ulcerative colitis. The treatment was ineffective in patients with a long history of the disease with prolonged corticosteroid therapy during previous exacerbations.

Correct use of corticosteroids, sulfasalazine and its analogues makes it possible to suppress the activity of the inflammatory process in nonspecific ulcerative colitis and Crohn's disease in a significant percentage of cases. However, it should be noted that in many patients, treatment with sulfasalazine has to be stopped due to its intolerance. Responsibility for the undesirable side effects of the drug is assigned to sulfapyridine, which is part of it. The constantly existing risk of complications with long-term use of corticosteroids, the side effects accompanying the use of sulfasalazine, dictate the need to study new pathogenetically substantiated methods of treatment.

1. Mesalazine. The drug is available in various forms, the choice of which depends on the location and severity of the disease. In the acute phase of the disease, the drug is taken at a dose of 400-800 mg three times a day for eight to twelve days. To prevent repeated exacerbations - 400-500 mg three times a day for quite a long time. The duration of use of the drug should be regulated by the attending physician. Suppositories in a dosage of 500 mg are used three times a day, suspension - 60 mg per day before bedtime.
2. Prednisolone. The dose of the drug is calculated individually in each case. In the acute stage, 20-30 mg per day (four to six tablets) is usually prescribed. During maintenance treatment, the dosage is reduced to 5-10 mg per day (one to two tablets).
3. Methylprednisolone. Depending on the severity of the disease, the daily dose is on average 0.004-0.048 g.
4. Budenofalk. The recommended daily dose is 3 mg. The drug is taken three times a day half an hour before meals, without chewing. The course of treatment is two months. After two to four weeks, as a rule, a stable positive effect is observed. The drug is discontinued by gradually reducing the dose.
5. Antibacterial drugs (ciprofloxacin, metronidazole).
6. Vitamin preparations of group D.
7. Azathioprine, a heterocyclic derivative of 6-mercaptopurine, is being used as an immunoreactive agent in the treatment of patients with ulcerative colitis and Crohn's disease.

According to some publications, azathioprine reduces the likelihood of relapses of nonspecific ulcerative colitis and makes it possible to reduce the dose of prednisolone in patients who are forced to take it. There are reports of a good effect of azathioprine in the treatment of patients with the colonic form of Crohn's disease complicated by fistulas and other perianal lesions. According to other data, patients who received azathioprine did not feel better than patients who received placebo.

Thus, the efficacy of azathioprine has not yet been convincingly proven.

Antilymphocyte globulin and some immunostimulants (levamisole, BCG) are also recommended for the treatment of patients with nonspecific ulcerative colitis and Crohn's disease. The detection of circulating immune complexes in the blood of patients with Crohn's disease led to an attempt to use plasmapheresis in treatment. Interferon and superoxide dismutase treatment were used. Further accumulation of experimental and clinical materials with subsequent careful processing of the data obtained is required to determine the role of these drugs in the complex of therapeutic measures for nonspecific ulcerative colitis and Crohn's disease.

In the treatment of ulcerative colitis and Crohn's disease, it is important not only to stop the acute attack, but also to prolong the period of remission, thereby making patients less dependent on taking such drugs as corticosteroids. In this regard, the hyperbaric oxygenation (HBO) method is of interest. Only HBO has the ability to eliminate all types of hypoxia (circulatory, hemic, histotoxic). The ability of HBO to have a positive effect on various levels of the body's adaptation systems, pharmacodynamics, pharmacokinetics and toxicity of drugs, noted in a number of scientific reports, also attracts attention.

The property of HBO to affect microorganisms and reduce their toxicogenicity seems to be especially important, since bacteria play a significant role in the pathogenesis of nonspecific ulcerative colitis and Crohn's disease.

Thus, despite the lack of knowledge of the etiology of nonspecific ulcerative colitis and Crohn's disease, the correct use of the above treatment methods, constant monitoring of patients, an individual approach to each patient, and the use of anti-relapse agents instill some optimism in assessing the prospects for clinical management of patients.

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New in the treatment of Crohn's disease

Scientists in the United States of America suggest using conjugated linoleic acid, which is part of the group of linoleic acid isomers present in meat, milk and other dairy products, to treat Crohn's disease. To date, the question of the causes of the disease remains open, and therefore the search for an effective treatment continues. In the course of the studies, a significant improvement in the condition of patients taking conjugated linoleic acid, which has immunomodulatory properties, was noted. Later, a positive effect of probiotic bacteria on the local synthesis of CLA (conjugated linoleic acid) was also established, which, in turn, helps suppress the disease. In the treatment of Crohn's disease, both direct administration of the acid and stimulation of an increase in its level with the help of probiotic bacteria may be appropriate.

Stem cells in the treatment of Crohn's disease

Stem cell transplantation for inflammatory bowel pathologies is considered a highly effective and promising treatment in modern medicine. The mechanism of action during cell transplantation is the elimination of affected immune system cells by using high doses of immunosuppressive agents. After transplantation of hematopoietic stem cells, the immune system improves and is restored, and the disease stops developing. It is believed that mesenchymal stem cells contained in bone marrow cells are also capable of suppressing the pathological activity of immune system cells, getting to the site of inflammation, thereby providing a good therapeutic effect. In addition, these same cells are capable of forming elements contained in the tissues of the intestinal walls. Thus, they have a positive effect on the restoration of the affected segment of the intestine, accelerating the healing process of ulcerative formations.

Surgical treatment of Crohn's disease

Surgical treatment of Crohn's disease is indicated in cases of intestinal obstruction, intestinal distension, bleeding, peritonitis, and the formation of a through defect in the intestinal wall with contents entering the abdominal cavity. In these cases, emergency surgery is indicated. Elective surgery is performed in cases of hidden perforations, fistulas, etc., as well as in cases where the disease does not respond to conservative therapy. In case of such a complication of Crohn's disease as intestinal obstruction, resection of the required segment of the small or large intestine is performed. In the case of development of an interintestinal abscess, resection of the intestine is performed and drainage of the abscess contents is ensured. In case of thickening of the intestinal wall, as well as compression of the intestine, an intestinal fistula may form - a rather dangerous complication requiring surgical intervention. In half of the cases, a perianal abscess is formed when the pathological process is concentrated in the large intestine. In such cases, the abscess is cut and the contents are removed from it.

Treatment of Crohn's disease with folk remedies

In the case of a disease such as Crohn's disease, folk remedies are used as an adjuvant therapy to relieve discomfort in the abdominal area, improve digestion and absorption of nutrients, and speed up the healing of affected areas of the gastrointestinal tract. For flatulence and colic in the intestines, the following infusion is recommended: mix equal parts of chamomile flowers, centaury and sage, pour a glass of boiling water over it, leave for half an hour and strain, then take a tablespoon seven to eight times a day for twelve weeks, gradually reducing the dosage and increasing the interval between doses. Excessive gas formation can be reduced with the help of anise. Pour a glass of boiling water over one teaspoon of this plant, wrap it in a towel, leave for several minutes (five to seven), strain and drink throughout the day.

Crohn's Disease Treatment with Herbs

In case of such pathology as Crohn's disease, herbal treatment should be combined with the main drug treatment. Many herbs and plants can relieve pain and inflammation in the intestines, eliminate bloating and diarrhea, colic in the intestines. In case of Crohn's disease, you can take the following collection: twenty grams of Russian mustard seeds, ten grams of yarrow herb, twenty grams of anise fruits, thirty grams of licorice roots, ten grams of brittle buckthorn bark. The resulting mixture is poured with boiling water (about two hundred and fifty milliliters) and boiled for ten minutes, then filtered and taken one and a half glass in the morning and at night. You can also prepare a collection of caraway fruits, chamomile flowers, valerian roots and mint. These components are mixed in equal parts, a tablespoon of the resulting mixture is poured with a glass of hot boiled water and infused for an hour. Then strain the infusion and take half a glass three times a day. You can also use sage to make infusions and decoctions: pour one spoon of dried leaves with a glass of boiling water and leave for one hour. Take the infusion four to five times a day, half a glass at a time. To make a decoction, boil a spoon of dried sage leaves over low heat for about ten minutes, then let it sit for half an hour and take one tablespoon three times a day.

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Diet for Crohn's disease

The diet for Crohn's disease includes dishes and products cooked by steaming or boiling, in liquid or mashed form, with a moderate salt content. Food should be taken four times a day, preferably at the same time.

For Crohn's disease, the following products are recommended for consumption:

1. Tea or cocoa.
2. Wheat bread, croutons.
3. Lean fish.
4. Low-fat cottage cheese.
5. Acidophilus.
6. Soft-boiled eggs (no more than one per day), omelette.
7. Soup with vermicelli, rice or semolina, low-fat broth.
8. Lean veal, beef, fish.
9. Pureed porridges of rice, buckwheat, oats, pasta, vermicelli.
10. Greens, boiled pumpkin, zucchini.
11. Fruit jelly, puree or jam.
12. Fruit, berry or vegetable juices and drinks, rosehip decoction.

If you have been diagnosed with Crohn's disease, please note that you are prohibited from eating fatty, salty, smoked, pickled, canned foods, as well as sausages, ice cream, soda, mushrooms, legumes, etc.