Crohn's Disease Treatment
Treatment is typically initiated when Crohn's disease is still mild to moderate with 5-ASA preparations taken orally (by mouth) at a dose of 4 grams daily. If the patient's body responds well, maintenance treatment should be continued at the same dose to maintain stability. If this treatment fails, steroid therapy should be immediately switched to treatment.
1. Steroid Therapy
Crohn's disease can be treated with steroids orally or intravenously, depending on the severity of the disease. Given the numerous side effects of prednisone and other steroids, research is ongoing to develop a steroid with fewer side effects. Budesonide is a synthetic steroid. Three large multicenter studies have shown that budesonide (9 mg daily) and prednisone (40 mg daily, in a tapering dose) are equally effective in treating Crohn's disease, but with fewer side effects. When steroids fail to treat Crohn's disease, or when the patient begins to develop a dependency phase, treatment with immunomodulators such as MP-6 (Puri-Nethol) or azathioprine (Imuran) is often switched to. The induction of remission rate is approximately 75% within three months. In addition to their success in initial treatment, these drugs are also effective in reducing steroid dosage, closing fistulas, and maintaining remission.
2. Antibiotics
The effectiveness of antibiotics in treating Crohn's disease has also been proven beyond doubt. Metronidazole (Flagyl) has been proven effective in treating perianal lesions in Crohn's disease of the large intestine and in maintaining remission after surgery. The recommended dose is 20 mg/kg daily. This dose is intolerable for a significant number of patients due to nausea and a metallic taste in the mouth, making treatment with this effective drug difficult. The antibiotic ciprofloxacin has also been proven effective in active disease and in treating perianal wounds.
3. Medications
Most trials investigating the effects and effectiveness of new immune-modulating drugs have been conducted and tested in Crohn's disease. These trials have tested drugs containing protective inflammatory modulators (IL-10) or anti-TNF (anti-TNF). In recent years, a series of publications documenting the therapeutic success of chimeric monoclonal antibodies against tumor necrosis factor (TNF) have attracted attention. Anti-TNF antibodies have biological effects that could be of great importance in the treatment of inflammatory bowel diseases, such as the secretion of modifiers, the recruitment of inflammatory cells, the activation of the coagulation system, and a role in the production of granulomas. Double-blind, controlled trials demonstrate the efficacy of anti-TNF monoclonal antibodies administered once intravenously (5 mg/kg) or as three injections over several weeks. The treatment may achieve remission in patients with steroid-resistant Crohn's disease and seal fistulas. Its effectiveness in maintaining remission has also been demonstrated.
