Management of Crohns Disease

Brian Schmid DMD

Authors: Doug Knutson MD, Greg Greenberg MD and Holly Cronau MD
Journal: American Family Physician
Date: August 2003, vol 68 Number 4
Main Topic: Overview of Crohns Disease
Summary: Crohns is an inflammatory disorder of the alimentary canal. The incidence peaks in the 20's and 40's. Etiology is unknown but is related to enviromental, genetic, immunologic and infectious causes. It is more common in whites than blacks, in women than in men and in Jewish vs. non. Smokers are also more affected. Symptomas include chronic or nocturnal diarrhea, abdominal pain, bowel obstruction, weight loss, fever and night sweats. Differential includes: acute appendicitis, small bowel obstruction, ulcerative colitis, irritable bowel syndrome, malabsorption syndromes, infectious or ischemic colitis, neoplasia, hemorrhoids and diverticular disease.
Therapy includes easing flareups and maintain remission. Mild to moderate disease: treated with salicylate preparation and/or antibiotics. Success of these treatments is dependent on the location of the inflammation and different formulations target specific sites of the alimentary canal. Metronidazole is used but caution must be maintained due its connection with peripheral neuropathy. Ciprofloxacin is also used.
Moderate to severe disease: Steroid treatment is indicated. Azathioprine (Imuran) and mercaptopurine (Purinethol) are often used. Infliximab, an antibody to human tumor necrosis factor alpha, is used in patients who do not respond to these drugs. Steroid therapy continues until symptoms go into remission, often taking months. Side effects such as diabetes mellitus, adrenal suppression and osteoporosis limit their long term use. Budesonide is also becoming a popular alternative and is comparable to prednisolone. Immunosuppressants can be used in addition to steroids. Infliximab is used when other courses have failed.
Severe Disease: Parenteral steroids are called for. Abdominal CT followed by surgical intervention may be necessary, although not curative.
Stress has been associated with Crohns flareups. Patient may be taking vitamin supplements due counteract malabsorption. Frequent colonic monitoring may be necessary depending on severity of disease.
Summary: Great overview of a horrible disease.