The treatment of Crohn's disease is sequential: to treat acute disease, and then to maintain remission. Treatment initially involves the use of medications to treat any infection and to reduce inflammation. This usually involves the use of aminosalicylate anti-inflammatory drugs and corticosteroids, and may include antibiotics. Surgery may be required for complications such as obstructions or abcesses, or if the disease does not respond to drugs within a reasonable time. Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining in between). ... In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... Remission is the state of absence of disease activity in patients with known chronic illness. ... “Surgeon” redirects here. ...

Once remission is induced, the goal of treatment becomes maintenance of remission, avoiding the return of active disease, or "flares". Because of side-effects, the prolonged use of corticosteroids must be avoided. Although some people are able to maintain remission with aminosalicylates alone, many require immunosuppressive drugs. ^[1]

Aminosalicylate anti-inflammatory drugs

5-aminosalicylates (5-ASA) include the following: Mesalazine (BP), also known as Mesalamine (USAN) or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug used to treat inflammation of the digestive tract (Crohns disease) and mild to moderate ulcerative colitis. ...

• Mesalazine or mesalamine, which is marketed in the forms Asacol, Pentasa, Salofalk, Dipentum and Rowasa.
• Sulfasalazine, which is converted to 5-ASA and sulfapyridine by intestinal bacteria. The sulfapyridine may have some therapeutic effect in addition to the 5-ASA, although this is not entirely clear.

5-ASA compounds have been shown to be useful in the treatment of mild-to-moderate Crohn's disease.^[2] They are usually considered to be first line therapy for disease in the ileum and right side of the colon particularly due to their low side effect profile.^[3]NO DONT TOUCH ME THERE!!! Mesalazine (INN, BAN), also known as Mesalamine (USAN) or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug used to treat inflammation of the digestive tract (Crohns disease) and mild to moderate ulcerative colitis. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Grays Fig. ...

Corticosteroid anti-inflammatory drugs

Steroid enemas can be used for treatment of rectal disease symptoms

Corticosteroids are a class of anti-inflammatory drug that are used primarily for treatment of moderate to severe flares of Crohn's disease. They are used more sparingly due to the availability of effective treatments with less side-effects.^[4] The side effects of corticosteroids include Cushing's syndrome, mania, insomnia, hypertension, high blood glucose, osteoporosis, and avascular necrosis of long bones. These should not be confused with the anabolic steroids used to enhance athletic performance. Image File history File links Size of this preview: 253 × 599 pixelsFull resolution (610 × 1444 pixel, file size: 119 KB, MIME type: image/jpeg) Image of Cortifoam enema -- Samir धर्म 14:08, 3 June 2006 (UTC) I, the creator of this work, hereby grant the permission to copy, distribute and/or... Image File history File links Size of this preview: 253 × 599 pixelsFull resolution (610 × 1444 pixel, file size: 119 KB, MIME type: image/jpeg) Image of Cortifoam enema -- Samir धर्म 14:08, 3 June 2006 (UTC) I, the creator of this work, hereby grant the permission to copy, distribute and/or... It has been suggested that Clyster be merged into this article or section. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Mania is a severe medical condition characterized by extremely elevated mood, energy, and thought patterns. ... This article is about the sleeping disorder. ... For other forms of hypertension, see Hypertension (disambiguation). ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. ... Crystal structure of human sex hormone-binding globulin, transporting 5-alpha-dihydrotestosterone. ...

The most commonly prescribed oral steroid is prednisone, which is typically dosed at 0.5 mg/kg for induction of remission.^[5] Intravenous steroids are used for cases refractory to oral steroids, or where oral steroids cannot be taken.^[4] These are administered in the hospital setting. Because corticosteroids reduce the ability to fight infection, care must be used to ensure that there isn't an active infection, particularly an intra-abdominal abscess before the initiation of steroids. This article or section does not adequately cite its references or sources. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Look up Abscess in Wiktionary, the free dictionary. ...

Budesonide is an oral corticosteroid with limited absorption and high level of first-pass metabolism, meaning that less quantities of steroid enter into the bloodstream. It has been shown to be useful in the treatment of mild-to-moderate Crohn's disease^[6] and for maintenance of remission in Crohn's disease.^[7] Formulated as Entocort, budesonide is released in the ileum and right colon, and is therefore has a topical effect against disease in that area.^[6] Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. ... A few of the metabolic pathways in a cell. ... Grays Fig. ...

Budesonide is also useful when used in combination with antibiotics for active Crohn's disease.^[8] Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. ... Staphylococcus aureus - Antibiotics test plate. ...

Steroid enemas can also be used for disease of the lower colon and rectum, in order to treat symptoms. Hydrocortisone and budesonide liquid and foam enemas are being marketed for these reasons. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. ...

Mercaptopurine immunosuppressing drugs

Azathioprine, shown here in tablet form, is a first line steroid-sparing immunosuppressant

Azathioprine and 6-mercaptopurine (6-MP) are the most used immunosuppressants for maintenance therapy of Crohn's disease. They are purine anti-metabolites, meaning that they interfere with the synthesis of purines required for inflammatory cells. They have a duration of action of months, making it unwieldy to use them for induction of remission. Both drugs are dosed at 1.5 to 2.5 mg/kg, with literature supporting the use of higher doses.^[9] Image File history File links Metadata Size of this preview: 800 × 600 pixelsFull resolution (2272 × 1704 pixel, file size: 705 KB, MIME type: image/jpeg) Better picture of azathioprine tablets, taken by myself -- Samir धर्म 11:00, 7 June 2006 (UTC) I, the creator of this work, hereby grant the permission... Image File history File links Metadata Size of this preview: 800 × 600 pixelsFull resolution (2272 × 1704 pixel, file size: 705 KB, MIME type: image/jpeg) Better picture of azathioprine tablets, taken by myself -- Samir धर्म 11:00, 7 June 2006 (UTC) I, the creator of this work, hereby grant the permission... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Mercaptopurine (also called 6-MP or by its brand name Purinethol®) is an immunosuppressive drug used to treat leukemia. ... Purine is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ... White Blood Cells is also the name of a White Stripes album. ...

Azathioprine and 6-MP have been found to be useful for the following indications:

• For maintenance therapy for people who are dependent on steroids.^[10]
• Fistulizing disease.^[11]
• Induction of remission in steroid refractory disease.^[12]
• Maintenance of remission after surgery for Crohn's disease.^[13]

Infliximab

Main article: Infliximab, Biological therapy for inflammatory bowel disease

Infliximab, marketed as Remicade, is a mouse-human chimeric antibody that targets tumour necrosis factor, a cytokine in the inflammatory response. It is administered intravenously and dosed per weight. Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... The anti-tumor necrosis factor α monoclonal antibody infliximab is a mainstay of the biological therapy for inflammatory bowel disease Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. ... Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... A Chimera (or chimeric protein) is a human-engineered or in vivo mutated protein that is encoded by a nucleotide sequence made by a splicing together of two or more complete or partial genes or cDNA. The pieces used may be from different species. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... Cytokines are a group of proteins and peptides that are used in organisms as signaling compounds. ...

Infliximab has found utility as follows:

• Maintenance of remission for people with Crohn's disease.^[14]
• Induction of remission for people with Crohn's disease.^[14]
• Maintenance for fistulizing Crohn's disease.^[15]

Side effects of infliximab include hypersensitivity and allergic reactions, risk of re-activation of tuberculosis, serum sickness, and risk of multiple sclerosis.^[16] Serious side effect include lymphoma and severe infections. Hypersensitivity refers to undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system. ... An allergy is an abnormal, acquired sensitivity to a given substance, including pollen, drugs, or numerous environmental triggers. ... Tuberculosis (abbreviated as TB for tubercle bacillus) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. ... Serum sickness is a reaction to an antiserum derived from an animal source. ... This article is about lymphoma in humans. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ...

Surgery

Surgery is generally reserved for complications of Crohn's disease, or when disease that resists treatment with drugs is confined to one location that can be removed.^[17] Surgery is often used to manage complications of Crohn's disease, including fistulae, small bowel obstruction, colon cancer, small intestine cancer and fibrostenotic strictures, when strictureplasty (expansion of the stricture) is sometimes performed. Otherwise, and for other complications, resection and anastomosis - the removal of the affected section of intestine and the rejoining of the healthy sections - is the surgery usually performed for Crohn's disease (e.g., ileocolonic resection). Neither type of surgery cures Crohn's disease, as recurrence often reappears in previously unaffected areas of the intestine.^[18] In medicine, a fistula (pl. ... Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ... Diagram of the stomach, colon, and rectum Colorectal cancer includes cancerous growths in the colon, rectum and appendix. ... Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Strictureplasty is a surgical procedure performed in response to scar tissue that has built up in the intestinal wall from inflammatory bowel conditions such as Crohns disease. ... Resection is a method of orientation (direction or position finding) using a compass and topographic map. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ...

Small intestine transplants are experimental as of yet, and are usually only done when there is a risk of short bowel syndrome due to repeated resection surgeries. “Transplant” redirects here. ... Short bowel syndrome is a malabsorption disorder caused by either the surgical removal of the small intestine or the loss of its absorptive function due to diseases. ...

Diet and lifestyle

There is no evidence that diet causes or cures Crohn's disease. If a person with Crohn's finds that certain foods increase or decrease the symptoms, then they may adjust their diet accordingly. A food diary is recommended to see what positive or negatives foods have [2]. Fish oil has been found to be effective in reducing the chance of relapse in less severe cases.^[19] People with lactose intolerance due to small bowel disease may benefit from avoiding lactose-containing foods. Many diets have been proposed for treatment of Crohn's disease, and many do improve symptoms, but none have been proven to actually cure Crohn's disease.^[20] A low residue diet may be used to reduce the volume of stools excreted daily. Stress is not proven to aggravate or induce the symptoms of Crohn’s disease. If sufferers observe that Stress Management is a successful method of suppressing the illness in their bodies, then they may manage stress as they see fit. Conversely, stress is likely to be caused by the flaring up of the disease and this would make day to day life more difficult. Smoking has also been noted to have an association with Crohn's, and smokers with Crohn's are encouraged to quit. In nutrition, the diet is the sum of food consumed by a person or other organism. ... Fish Oil is oil derived from fishes. ... Lactose is a disaccharide that consists of β-D-galactose and β-D-glucose molecules bonded through a β1-4 glycosidic linkage. ... A Low residue diet is a diet which is designed to reduce the volume of stools excreted daily. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... A cluttered environment with too many tasks can lead to stress. ...

Because the terminal ileum is the most common site of involvement and is the site for vitamin B₁₂ absorption, people with Crohn's disease are at risk for B₁₂ deficiency and may need supplementation. In cases with extensive small intestine involvement, the fat soluble vitamins A, D, E and K can be deficient. Folate deficiency is a risk when being treated with methotrexate. Cyanocobalamin is a compound that is metabolized to a vitamin in the B complex commonly known as vitamin B12 (or B12 for short). ... Retinol, the animal form of vitamin A, is a yellow fat-soluble, antioxidant vitamin important in vision and bone growth. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Tocopherol, or vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... Naphthoquinone, or more precisely 1,4-naphthoquinone, is an organic compound. ... Signs of folic acid deficiency are often subtle. ...

Complementary and alternative medicine

More than half of Crohn's disease sufferers have tried complementary or alternative therapy.^[21] These include diets, probiotics, fish oil and other herbal and nutritional supplements. The benefit of these medications is uncertain. Probiotics are dietary supplements containing potentially beneficial bacteria. ... Dioscorides’ Materia Medica, c. ...

Traditional Chinese medicine can be used to help manage the symptoms of Crohn's disease.^[22] Traditional Chinese medicine shop in Tsim Sha Tsui, Hong Kong. ...

Helminthic therapy has been shown to achieve remission for 73% of patients, patients who were otherwise non-refractive to traditional therapies. The research subjects remained on their traditional therapies for the duration of the study, so at this time this therapy is an adjunct to existing treatments. Due to the unconventional nature of this therapy, despite its efficacy, it is not widely used. Helminthic therapy is currently considered the most promising alternative treatment amongst those suffering from Crohns_disease and Ulcerative colitis. ...

Other medications

• Methotrexate is a folate anti-metabolite drug which is also used for chemotherapy. It is useful in maintenance of remission for those no longer taking corticosteroids.^[23]
• Metronidazole and ciprofloxacin are antibiotics which are used to treat Crohn's that have colonic or perianal involvement, although this use is non-Food and Drug Administration (FDA) approved.^[24] They are also used for treatment of complications, including abscesses and other infections accompanying Crohn's disease.^[4]
• Thalidomide has shown response in reversing endoscopic evidence of disease.^[25]

Methotrexate (rINN) (IPA: ), abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug used in treatment of cancer and autoimmune diseases. ... Folic acid (the anion form is called folate) is a B-complex vitamin (once called vitamin M) that is important in preventing neural tube defects (NTDs) in the developing human fetus. ... Chemotherapy is the use of chemical substances to treat disease. ... Metronidazole (INN) (IPA: ) is a nitroimidazole anti-infective drug used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobic bacteria and protozoa. ... Ciprofloxacin is the generic international name for the synthetic antibiotic manufactured and sold by Bayer Pharmaceutical under the brand names Cipro and Ciproxin (and other brand names in other markets, e. ... hi “FDA” redirects here. ... // Thalidomide is a sedative, hypnotic, and anti-inflammatory medication. ... Endoscopic images of a duodenal ulcer A flexible endoscope. ...

Research on medications in progress

Egg of Trichuris spp. whipworm. Trichuris suis or pig whipworm has been investigated for treatment of Crohn's disease.

Many clinical trials have been recently completed or are ongoing for new therapies for Crohn's disease. They include the following: Image File history File links Trichuris_egg. ... Image File history File links Trichuris_egg. ... Binomial name Trichuris trichiura (Linnaeus, 1771) The human Whipworm (Trichuris trichiura or Trichocephalus trichiuris), is a roundworm, which causes trichuriasis when it infects a human large intestine. ... In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ...

• Sargramostim, or granulocyte-monocyte colony stimulating factor (GM-CSF) has been shown to substabtially improve health-related quality of life in pilot studies, measured by an increase in score of a 32-item IBD questionnaire. ^[26] A recent Phase II trial showed that Sargramostim significantly decreased CD severity (48% compared to 26% placebo group) and improved quality of life (40% versus 19% for placebo).^[27]
• Adalimumab, like infliximab is an antibody that targets tumour necrosis factor.^[28]
• Certolizumab is a PEGylated Fab fragment of a humanized anti-TNF alpha monoclonal antibody that was found to have efficacy over placebo in one large trial.^[29]
• Natalizumab is an anti-integrin monoclonal antibody that shown utility as induction and maintenance treatment for moderate to severe Crohn's disease.^[30] However, it has been associated with progressive multifocal leukoencephalopathy, a usually fatal viral infection of the brain, that may limit its use.^[31]

• Trichuris suis is a pig whipworm that been shown in one study to improve Crohn's disease symptoms.^[32]
• Autologous stem cell transplant has also been evaluated .^[33]
• Rifabutin, clarithromycin and clofazimine are antibiotics designed to attack mycobacterium avium subsp. paratuberculosis, which may be a cause of Chron's disease. This treatment, called Myoconda, is being tested by Giaconda.
• Necator Americanus is a helminth that, like pig whip worm, is being studied for efficacy in the treatment of Crohn's having already been proven effective (66% remission rate) against asthma. ^[34]

Granulocyte macrophage colony-stimulating factor, often abbreviated to GM-CSF, is a protein secreted by macrophages that stimulates stem cells to produce granulocytes (neutrophils, eosinophils, and basophils) and macrophages. ... Adalimumab (Humira®) is the third TNF antagonist (after infliximab and etanercept) to be approved in the US. Like infliximab and etanercept, adalimumab binds to TNFα, preventing it from activating TNF receptors; adalimumab was constructed from a fully human monoclonal antibody, while infliximab is a mouse-human chimeric antibody and etanercept... Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ... Polyethylene glycol (PEG) and polyethylene oxide (PEO) are polymers composed of repeating subunits of identical structure, called monomers, and are the most commercially important polyethers. ... Each antibody binds to a specific antigen; an interaction similar to a lock and key. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell. ... For other uses, see Placebo (disambiguation). ... Natalizumab is a drug co-marketed by Biogen Idec and Élan as Tysabri. ... An integrin, or integrin receptor, is an integral membrane protein in the plasma membrane of cells. ... Progressive multifocal leukoencephalopathy (PML), also known as progressive multifocal leukoencephalitis, is a rare and usually fatal viral disease that is characterized by progressive damage (-pathy) or inflammation (-itis) of the white matter (leuko-) of the brain (-encephalo-) at multiple locations (multifocal). ... In animals, the brain or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for behaviour. ... Binomial name Trichuris trichiura (Linnaeus, 1771) The human Whipworm (Trichuris trichiura or Trichocephalus trichiuris), is a roundworm, which causes trichuriasis when it infects a human large intestine. ... Bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ... Trinomial name Mycobacterium avium paratuberculosis Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria. ... Giaconda is an Australian biotechnology company headquartered in Sydney. ... Species Species N. americanus and A. duodenale The hookworm is a parasitic worm (nematode) that lives in the small intestine of its host, which may be a mammal such as a dog, cat, or human. ... A worm is an elongated soft-bodied invertebrate animal. ...

See also

Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining in between). ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... The anti-tumor necrosis factor α monoclonal antibody infliximab is a mainstay of the biological therapy for inflammatory bowel disease Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. ... The Crohns Disease Activity Index or CDAI is a research tool used to quantify the symptoms of patients with Crohns disease. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... An anal abscess is a abscess adjacent to the anus, characterized by extremely painful bowel movements. ... Erythema nodosum is a form of inflammation of the subcutaneous fatty tissue. ... In medicine, a fistula (pl. ... H&E section of non-caseasting granuloma seen in the colon of a patient with Crohns disease In medicine (anatomical pathology), a granuloma is a group of epithelioid macrophages surrounded by a lymphocyte cuff. ... Grays Fig. ... Crohns disease is a chronic inflammatory disease of the alimentary tract and it can involve any part of it - from the mouth to the anus. ... Malabsorption is the state of impaired absorption of nutrients in the small intestine. ... Proctitis (Noun) Inflammation of the rectum. ... Protein losing enteropathy refers to any condition of the gastrointestinal tract that results in a net loss of protein from the body. ... Pyoderma gangrenosum is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs (Jackson and Callen, 2005). ... In medicine, sacroiliitis is an inflammation of the sacroiliac joint. ... Short bowel syndrome is a malabsorption disorder caused by either the surgical removal of the small intestine or the loss of its absorptive function due to diseases. ... Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Giovanni Battista Morgagni (February 25, 1682 - December 6, 1771), Italian anatomist, was born on at ForIi. ... Burrill Bernard Crohn (born June 13, 1884 in New York; died 1983 in Connecticut) was an American gastroenterologist and one of the first to describe the disease of which he is the namesake, Crohns disease. ... The Crohns and Colitis Foundation of America is a United States medical research charity dedicated to the curing of Crohns disease and Ulcerative colitis. ... The National Society for Colitis and Crohn’s Disease is a British medical research charity dedicated to the curing of Crohns disease. ... The following is a list of notable people diagnosed with Crohns disease. ...

References