Treatment for Crohns Disease
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[edit] Treatment for Crohns disease
Unfortunately at this point in time Crohns disease is one of the diseases, which can not be cured, but can only be controlled. Sulfasalazine (brand names: Salazopyrin, Azulfidine) is a medication, which has improved management of Crohns disease tremendously. It has anti-inflammatory effects and is useful in mild to moderate cases of Crohns to tone down the amount of inflammation and to maintain remissions for longer.
The main metabolite is mesalamine or 5-amino-salicylic acid (brand names: Rowasa, Asacol, Mesasal, Pentasa, Quintasa and Salofalk), which is especially useful for those patients who are allergic to Salazopyrin. 5-amino-salicylic acid has been shown to prevent recurrence of Crohns disease following surgery.
It also has been shown to induce and maintain remissions of acute flare-ups of Crohns. Occasionally the physician will be forced to use corticosteroids by mouth for a short period of time. Long-term use has to many side effects including suppression of the adrenal glands. Occasionally antibiotics such as metronidazole (Flagyl, Metric 21) have been useful in improving Crohns disease, particularly when perianal lesions are involved. The therapy for each case needs to be tailored according to the physical findings. The physician will customize your treatment accordingly.
For more resistant cases the physician might have to resort to immuno modulating drugs, such as azathioprine (Imuran) or mercaptopurine (brand name: Purinethol) as is described in Ref.12. For severe cases a period of intravenous hyperalimentation might get the Crohns disease more under control and improve the nutritional status.
Immunosuppressive therapy with Tacrolimus or cyclosporine, which are normally used in patients with organ transplants, have been shown to be effective against Crohns. These are useful in cases where fistulas do not close.
Biologic therapy is the latest, but also most expensive option. Infliximab is an antibody that blocks tumor necrosis factor (TNF), which has been found to be an important cause of Crohns. It is administered initially as a series of 3 intravenous injections. For maintenance it has to be given every 8 weeks. This has been shown to induce remission and is also useful in maintaining control of the disease.
Finally, surgery remains reserved only for the cases with structural complications, where physicians are forced to reopen blocked passages, close fistulas, take care of abscesses etc. With any surgery great care is taken that bowel is not needlessly removed. This would only worsen the malabsorption syndrome.
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