There’s no clear-cut path to treating Crohn’s disease. That’s because the chronic inflammatory bowel disease varies greatly from person to person.
Symptoms can range from mild to severe, says Edward Levine, MD, a gastroenterologist and associate clinical professor at the Ohio State University Wexner Medical Center in Columbus. The response to treatment can also vary just as widely. For these reasons, there’s a lot of confusion out there about Crohn’s disease treatments. To make the best decisions about your care, it’s important to know what's fact and what's fiction when it comes to Crohn’s treatments. Start here.
“There are a number of medications and lifestyle changes that can benefit someone with Crohn’s, but there is no known cure," says Dana J. Lukin, MD, PhD, an assistant professor at the Albert Einstein College of Medicine and director of the Einstein-Montefiore Program for Inflammatory Bowel Diseases in the Bronx, New York.
About 70 percent of people with Crohn's will need surgery when medications no longer control symptoms, such as bleeding, nausea, weight loss, fever, and fatigue, or when they develop a fistula, fissure, or intestinal obstruction, according to the CCFA. Surgery typically involves removing the affected portion of the bowel. “Surgery does not mean your treatment has failed,” Dr. Levine says. “Surgery is part of your treatment.”
“The sooner a diagnosis is made, the better off you are,” Levine says. “That’s because some treatments, especially the biologic medications, are more effective the earlier you start on them.” Early treatment also helps you minimize the risks of complications, he adds.
“This is one of the hardest concepts for patients to grasp,” Levine says. Perhaps that’s because taking a medication every day can feel like a drag, especially when you’re in remission and symptom-free. But Crohn’s is a progressive condition, and its progress is more rapid in some patients than others. “If you stop taking your medication, it can lead to relapses in weeks or months in many patients," Levine says. "You could get worse, and the risks of complications go back to where they were before you started on medication.” If you’re having issues with a Crohn’s medication, always talk to your doctor about making an adjustment before you stop taking it.
While there’s no “Crohn’s diet” that works for everyone, it can help to tailor what you eat to your specific needs, according to the CCFA. Keeping a food diary can help you see which foods tend to aggravate your condition—that way, you can steer clear of them. During flares, it may help to eat smaller meals throughout the day and skip fatty, greasy foods as well as foods that are high in fiber. If your doctor tells you that you have a narrowing in the part of your digestive tract called the ileum—which occurs in about two-thirds of people with small bowel Crohn’s disease—a low-fiber, low-residue diet may minimize your symptoms, says the CCFA. This diet excludes high-fiber foods such as raw fruits, vegetables, nuts, and seeds.
There are two goals of treatment, says Saleem Desai, MD, a gastroenterologist with Providence Health in Northridge, California. One is to achieve remission—meaning you have no symptoms—and one is to maintain that remission and prevent flares. Your doctor may give you steroids to treat an acute flare because they're fast acting; most people feel better within a few days. However, whenever possible, steroids should not be used to maintain remission because of their long-term side effects, such as high blood pressure, high blood sugar, weakened bones, mood swings, insomnia, and weight gain. Talk to your doctor about when it’s safe to taper off steroids.
Babies born to pregnant women who took medications for their inflammatory bowel disease did not have a higher-than-average rate of congenital anomalies or infections, according to a study of more than 1,100 women published in August 2012 in Gastroenterology and Hepatology. It’s important to talk to your doctor about continuing your medications, especially in the first and second trimester, Dr. Lukin says. “Patients whose Crohn’s is not well controlled going into pregnancy may be at higher risk of complications," he notes. "It is important that a woman with IBD see a high-risk obstetrician and that her treatment plan is individualized to her needs.”
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06 May 2016