Crohn's disease: treatment

The uncertainty of the etiology of this pathological condition makes it difficult to treat Crohn's disease. Currently used therapy is essentially empirical, and the search for drugs that have antibacterial, anti-inflammatory and immunosuppressive action, are based on the widespread theory of the emergence of the disease, which recognizes the leading role of intestinal antigens, under the influence of which there is a change in reactivity and inflammation of the intestine.

[1], [2], [3], [4], [5]

Drugs for Crohn's Disease

The requirements for the preparations were primarily met by corticosteroids, which were used in the treatment of ulcerative colitis and Crohn's disease since 1950. To date, corticosteroid therapy remains the most effective treatment for acute forms of these diseases.

In addition to corticosteroids, other drugs with antibacterial and anti-inflammatory effects are used. For the treatment of Crohn's disease in modern medicine the following drugs are used:

1. Sulfasalazine and its analogs (salazopyrine, salazopyridazine, salazodimethoxin). The drug is taken before meals, without chewing and washing with a large amount 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 is stabilized, the dosage is gradually reduced and passes to a dose of 500 mg four times a day.

Sulfasalazine is azo compound of 5-aminosalicylic acid and sulfapyridine. Until now, the mechanism of its action has been studied. It was believed that the ingested sulfasalazine, with the participation of the intestinal microflora, loses the azo link and decomposes into 5-aminosalicylic acid and sulfapyridine. Unabsorbed sulfapyridine temporarily inhibits the growth of anaerobic microflora in the intestine, including clostridia and bacteroides. Recently, it has been established that the active principle of sulfasalazine is mainly 5-aminosalicylic acid, which inhibits the lipoxygen pathway of the transformation of arachidonic acid and thus blocks the synthesis of 5,12-hydroxyicatetraenoic acid (HEET), a potent chemotactic factor. Consequently, the effect of sulfasalazine on the pathological process was more complicated than previously thought: the drug causes changes in the intestinal microflora, modulates immune responses and blocks the mediators of the inflammatory process.

The results of studies that established that the active ingredient of sulfasalazine is 5-aminosalicylic acid served as the basis for the development of new drugs in which the 5-aminosalicylic acid molecule is linked through an amino-linkage to another same or neutral molecule. An example of such a preparation is salofalk, which does not contain sulfapyridine and, therefore, is devoid of its side properties.

The effectiveness of the action of 3 forms of the drug was studied: tablets (250 mg of 5-aminosalicylic acid in each tablet), suppositories (250 mg of 5-ASA) and enema (4 g of 5-ASA in 60 g of suspension). The drug in tablets was recommended for the treatment of Crohn's disease and total forms of ulcerative colitis. Suppositories and enemas are shown in the distal forms of ulcerative colitis and 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 ulcerative colitis. Treatment was ineffective in patients who had a long history of the disease with prolonged corticosteroid therapy in previous exacerbations.

Proper use of corticosteroids, sulfasalazine and its analogs makes it possible in a significant percentage of cases to suppress the activity of the inflammatory process with ulcerative colitis and Crohn's disease. However, it should be noted that in many patients the treatment with sulfasalazine has to be discontinued because of its intolerance. Responsibility for undesirable side effects of the drug rests with the sulfapyridine that enters it. The constantly existing danger of complications with prolonged use of corticosteroids, side effects accompanying sulfasalazine, dictate the need for studying new pathogenetically valid 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 from eight to twelve days. To prevent repeated exacerbations, 400-500 mg three times a day for a fairly long time. The period of application of the drug should be regulated by the attending physician. Suppositories in a dosage of 500 mg are used three times a day, a suspension of 60 mg per day at bedtime.
2. Prednisolone. The dose of the drug is calculated in each case individually. In the acute stage, usually prescribed 20-30 mg per day (four to six tablets). With maintenance treatment, the dosage is reduced to 5-10 mg per day (1 to 2 tablets).
3. Methylprednisolone. Depending on the severity of the disease, the daily dose averages 0.004-0.048 g.
4. Budenofalk. The recommended daily dose is 3 mg. The drug is taken three times a day for half an hour before meals, without chewing. The course of treatment is two months. In two or four weeks, as a rule, there is a persistent positive effect. Abolition of the drug is carried out, reducing the dose gradually.
5. Antibacterial drugs (ciprofloxacin, metronidozole).
6. Vitamin preparations of group D.
7. As an immunoreactive agent in the treatment of patients with ulcerative colitis and Crohn's disease, try to use azathioprine, a heterocyclic derivative of 6-mercaptopurine.

According to some publications, azathioprine reduces the likelihood of recurrence of 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 colonic form of Crohn's disease, complicated by fistula and other perianal lesions. According to other data, patients who received azathioprine did not feel better than patients who received a placebo.

Thus, the effectiveness of azathioprine has not yet been conclusively proven.

In the treatment of patients with ulcerative colitis and Crohn's disease, antilymphocytic globulin, some immunostimulants (levamisole, BCG) are also recommended. The detection of circulating immunocomplexes in the blood of patients with Crohn's disease led to an attempt to use plasmapheresis in the treatment. Interferon and superoxide dismutase treatment was performed. To determine the role of these drugs in a complex of therapeutic measures for ulcerative colitis and Crohn's disease, further accumulation of experimental and clinical materials is required, followed by careful processing of the data.

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

The ability of HBO to affect microorganisms and reduce their toxicity is particularly important, since bacteria play a significant role in the pathogenesis of ulcerative colitis and Crohn's disease.

Thus, despite ignorance of the etiology of ulcerative colitis and Crohn's disease, the correct use of the above-mentioned methods of treatment, constant monitoring of patients, an individual approach to each patient, and the use of antiretroviral agents give some optimism in assessing the prospects for clinical management of patients.

[6], [7], [8], [9], [10], [11]

New in the treatment of Crohn's disease

Scientists in the United States of America offer conjugated linoleic acid for the treatment of Crohn's disease, which is part of the group of linoleic acid isomers present in meat, milk and other dairy products. To date, the question of the causes of the origin of the disease remains open, and, consequently, the search for an effective treatment tool continues. In the course of the conducted studies, there was a significant improvement in the condition of patients taking conjugated linoleic acid, which has immunomodulatory properties. Later positive influence of probiotic bacteria on local synthesis of CLA (conjugated linoleic acid) was also established, which, in turn, promotes suppression of the disease. In the treatment of Crohn's disease, it may be expedient to either directly administer the acid, or stimulate an increase in its level with the help of probiotic bacteria.

Stem cells in the treatment of Crohn's disease

Transplantation of stem cells in pathologies of the inflammatory bowel in modern medicine is considered a highly effective and promising treatment. The mechanism of action in cell transplantation is the elimination of the affected cells of the immune system through the use of high doses of immunosuppressive medication. After transplantation of hematopoietic stem cells, the immune system improves and restores its function and the development of the disease stops. There is an opinion that mesenchymal stem cells contained in bone marrow cells are also capable of inhibiting the pathological activity of immune system cells, falling into the site of inflammation, thus providing a good therapeutic effect. In addition, from these cells the elements contained in the tissues of the intestinal walls can form. Thus, they have a positive effect on the restoration of the affected segment of the intestine, accelerate the healing process of ulcerative formations.

Surgical treatment of Crohn's disease

Surgical treatment for Crohn's disease is indicated in case of intestinal obstruction, distention of the intestine, opening of bleeding, peritonitis and the formation of an end-to-end defect in the intestinal wall with the entry of the contents into the abdominal cavity. In these cases, an emergency surgical procedure is indicated. The planned operation is performed with hidden perforations, fistulas, etc., as well as in cases when the disease does not lend itself to conservative therapy. With this complication, Crohn's disease as an intestinal obstruction is performed by resection of the desired segment of the small or large intestine. With the development of the intestinal abscess, resection of the intestine is carried out and the outflow of the contents of the abscess is ensured. With thickening of the intestinal wall, as well as squeezing the intestine, intestinal fistula can form - a rather dangerous complication requiring surgical intervention. Perianal abscess in half of cases is formed at concentration of pathological process in the large intestine. In such cases, the abscess is cut and the contents are removed from it.

Treatment of Crohn's disease by alternative means

In a disease such as Crohn's disease, alternative treatment is used as an adjuvant therapy to relieve discomfort in the abdomen, improve digestive processes and absorb nutrients, and accelerate the healing of affected areas of the gastrointestinal tract. With meteorism and colic in the intestine, the following infusion is recommended: in equal parts, mix the flowers of chamomile medicinal, a thousand centner and sage, pour a glass of boiling water, insist half an hour and decant, then take a tablespoon seven to eight times a day for twelve weeks, dosage and increasing the interval between doses. Reduce excessive gassing can be with the help of anise. One teaspoon of this plant is filled with a glass of boiling water, wrapped with a towel, insisted for several minutes (five to seven), drained and drunk during the day.

Crohn's disease treatment with herbs

With such a pathology as Crohn's disease, herbs should be treated with the basic medication. Many herbs and plants can remove pain and inflammation in the intestines, eliminate bloating and diarrhea, colic in the intestine. With Crohn's disease, you can take the following collection: twenty grams of seeds of Russian mustard, ten grams of yarrow, twenty grams of anise fruit, thirty grams of licorice root, ten grams of bark fragile buckthorn. The resulting mixture is poured with boiling water (about two hundred and fifty milliliters) and boiled for ten minutes, then decant and take one second of the glass from morning to night. You can also prepare a collection of cumin fruit, chamomile flowers, valerian roots and mint. These components are mixed in equal parts, a tablespoon of the resulting mixture is poured into a glass of hot boiled water and insisted for an hour. Then the infusion should be filtered and taken on a half cup three times a day. To prepare infusions and decoctions, you can also use sage: one spoonful of dried leaves is poured a glass of boiling water and insisted for one hour. Infusion use four to five times a day for half a glass. In order to prepare the broth, a spoon of dried sage leaves is simmered for about ten minutes, then insisted for half an hour and taken three times a day for one tablespoon.

[12], [13]

With Crohn's Disease

Diet in Crohn's disease includes dishes and products cooked steamed or boiled, in liquid or crushed form, with a moderate salt content. Take your food four times a day, preferably at the same time.

With Crohn's disease, the following foods are recommended for use:

1. Tea or cocoa.
2. Bread wheaten, crackers.
3. Low-fat fish.
4. Low-fat cottage cheese.
5. Acidophilin.
6. Eggs soft (no more than one per day), scrambled eggs.
7. Soup with vermicelli, rice or semolina, low-fat broth.
8. Low-fat veal, beef, fish.
9. Mashed porridge from rice, buckwheat, oats, pasta, vermicelli.
10. Greens, boiled pumpkin, zucchini.
11. Fruit jelly, mashed potatoes or jam.
12. Fruit and berry or vegetable juices and drinks, decoction from the hips.

If you have been diagnosed with Crohn's disease, please note that you are not allowed to eat fatty, salty, smoked, pickled, canned foods, sausage, ice cream, soda, mushrooms, beans, etc.,