Therapy of the acute attack

Crohn’s disease is a chronic inflammatory disease that progresses in phases. Periods without symptoms alternate with acute phases of the disease. In acute phases, the disease is active and sections of the gastrointestinal tract are inflamed.

An acute episode should always be accompanied by a physician in order to contain the inflammation as quickly as possible. The therapy takes place on several levels. In addition to drug therapy, nutrition must also be adjusted.

The aim of drug therapy is to relieve symptoms such as pain and cramps and also to contain the inflammation. In the case of a weak flare, the administration of mesalazine may be sufficient. The drug acts locally in the intestine and inhibits the inflammation there.

In a more severe episode mesalazine is not sufficient and the administration of cortisone is necessary. There are different dosage forms of cortisone. Firstly, cortisone is given only locally (Budesonide® tablets), so that the active ingredient acts directly on the intestinal mucosa.

This is achieved, for example, by means of specially coated tablets that are swallowed and only dissolve from the small intestine onwards. Even enemas containing cortisone and foam preparations (Budensonid® foam), which are introduced from the rectum, are only effective locally and mainly reach the large intestine. If the local administration of cortisone is not sufficient, cortisone must be given systemically (prednisolone), i.e. via the bloodstream, and thus reaches the entire body in addition to the intestine.

Systemic cortisone therapy is sufficient in most cases. As a last step, the therapy can be supplemented with immunosuppressive drugs, i.e. drugs that suppress the immune system. Examples of immunosuppressive drugs are: Humira®, azathioprine and methotrexate (MTX).As far as nutrition is concerned, a sufficient water supply is very important, because the body loses a lot of water during an acute episode of diarrhea.

In addition, a good calorie intake is important because the body needs the energy to regenerate. This should be supplied by easily digestible food in order not to put additional strain on the gastrointestinal tract. Examples are white bread and pureed vegetable soups.