Crohn’s disease therapy
The goal of Crohn’s disease therapy is to reduce the relapses and alleviate the symptoms. The therapy of relapses is based on the severity of the relapse. There is still no cure for Crohn’s disease.
However, if the therapy is optimally adjusted, life expectancy in Crohn’s disease is hardly or not at all limited. Episodes are classified according to the CDAI (Crohn’s Disease Activity Index) (the number at the bottom indicates the respective evaluation factor): A CDAI > 150 indicates an episode that should be treated. The therapy of an acute episode (CDAI > 150), in which only the small intestine is affected, consists of the administration of steroids (e.g. prednisolone).
Besides the desired immunosuppression, adverse effects include diabetes mellitus and increased blood glucose levels.
- Number of soft chairs in the last week x2
- Degree of abdominal pain x5
- General condition over 1 week x7
- Other Crohn’s disease associated symptoms x20
- Symptomatic diarrhea treatment in the last week x20
- Tactile resistance resistance in the abdomen x10
- Haematocrit (proportion of red blood cells to the amount of fluid in the blood) x6
- Weight (1- (weight/standard weight)) x10
If there is involvement of the colon during an acute flare, steroids plus salazosulfapyridine (SASP) or 5-aminosalicylic acid (5- ASA:mesalazine) are given. SASP and 5- ASA have an inhibitory effect on inflammatory processes.
Fistulas occurring in Crohn’s disease are treated with antibiotics (metronidazole). It is contraindicated in the first trimester of pregnancy and during lactation. If this therapy fails, the problem must be addressed surgically.
Exanthema (skin rashes), nausea and vomiting may occur as side effects. Diarrhea is usually treated with loperamide, but care must be taken to avoid constipation. The active ingredient loperamide inhibits intestinal movements (peristalsis), stool frequency and increases the absorption of water and electrolytes.
Vitamins, trace elements and liquid are also added to prevent deficiency situations. If surgical therapy remains the only form of treatment for Crohn’s disease, the bowel is usually obstructed (ileus), which hinders the passage of stool. In cases of perforation, i.e. intestinal wall rupture, or accumulation of pus within the abdominal cavity, surgery must be performed just as urgently. The strategy of surgical therapy is to preserve as much of the intestine as possible, i.e. to remove as little intestine as possible. In case of malnutrition and reduced general condition, tube feeding should be considered.
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