Injection therapy

The administration of injections may be necessary in the following situations in Crohn’s disease: If Crohn’s patients develop vitamin B12 deficiency-related anemia, vitamin B12 must be replaced. This is best done by injecting into the fatty tissue directly under the skin (subcutaneous injections), by injecting into a muscle (intramuscular injections) or directly into the bloodstream (intravenous injections). This bypasses the intestine, through which vitamin B12 is normally absorbed. Various drugs are used to treat a relapse, which are also given as injections. These include: MTX, which is injected weekly under the skin, the artificially produced antibodies adalimumab (Humira®), infliximab (Remicade®) and ustekinumab (Stelara®), which can be given as injections under the skin by the patient himself or as infusions by the doctor.

Infusion therapy

Infusion is the administration of large quantities of fluid into the body.The fluid is given directly into the bloodstream. For this purpose, an indwelling venous cannula, i.e. an access into a peripheral vein, e.g. in the crook of the arm or on the forearm, must be placed.

The infusion bag with the fluid is connected to this access via a plastic tube. Infusion via a central vein, e.g. in the neck, is also possible. The infusion can be used for the pure administration of liquid or for the administration of certain electrolytes, nutrients or drugs.

Drugs that can be administered as infusions as part of Crohn’s therapy are the following: 1. antibodies such as adalimumab, infliximab and vedolizumab. These active ingredients are contained in drugs called Humira®, Remicade® and Entyvio®. 2. immunosuppressants such as methotrexate. The active ingredient methotrexate is contained in drugs with the names MTX®, Lanatrel® and Metex®, for example.

Nutrition

There are no specific dietary guidelines for Crohn’s disease. However, an individually tailored diet can significantly improve well-being. It is important to know that food is tolerated differently during periods without symptoms than during an acute attack.

During an acute episode, when the intestinal mucosa is inflamed and diarrhea persists, fibre and too much fat should be avoided. Dietary fibers are vegetable food components that cannot be digested in the small intestine. Fruit, vegetables, wholemeal products and pulses, such as beans, peas or lentils, are rich in dietary fiber.

In addition, strong stimuli such as fatty, spicy, sweet, sour, very hot or very cold should be avoided. Since the body loses a lot of water through diarrhoea, it is important to drink a sufficient amount. Still water and herbal teas are best suited for this.

Sweet juices, carbonic acid, coffee, black tea and alcohol are unfavorable. High-caloric drinkable food can also be used if the energy and nutrient supply is not sufficient due to the limited food intake during a relapse. Another option is to feed via an access in the blood vessel to relieve the intestine.

This is called parenteral nutrition. In the remission phase, i.e. the recovery phase after a relapse, however, dietary fiber is recommended. For example: finely ground whole grain products, fruit and vegetables in pureed form, cooked or steamed vegetables, oat flakes and rice.

Less well-tolerated by most of those affected: Bananas, sweets, yeast pastries, wheat, corn and eggs. Overall, the diet should not be too one-sided for fear of intolerance. If deficiencies occur due to poor nutrient absorption by the damaged intestine, these substances must be replaced.

These include, for example, certain vitamins, zinc, calcium or protein. Such a deficiency can also exist if a person is visually well nourished. A control by a doctor is therefore important.

In addition, a diagnosis of intolerances and allergies is recommended so as not to put additional strain on the intestines. For example, about 30% of Crohn’s patients suffer from lactose intolerance. This means that they lack an enzyme that breaks down lactose.

These people should fall back on lactose-free dairy products. Besides nutrition, nicotine plays an extremely important role. Studies show that giving up smoking has a positive effect on the course of the disease. There are fewer relapses and the drugs can work better. In addition, sport, exercise and a good approach to stress can also have a positive effect.