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Whelehans Pharmacy: Crohn’s Disease Part 3

Tuesday, 15th August, 2017 10:05am

Whelehans Pharmacy: Crohn’s Disease Part 3

Eamonn Brady _Pharmacist_.jpg

Crohn’s Disease Part 3

This is my third and final series of articles on Crohn’s Disease.

Treatment

Treatment for Crohn’s may be medical, surgical or a combination of both. For mild Crohn’s, no drug treatment may be needed. Dietary therapy may be another option for some. Treatment will depend on the type of Crohn’s.


Medication used treat Crohn’s disease

Drug treatment for Crohn’s aims to reduce symptoms and control flare-ups, and then to prevent a relapse once the disease is under control. This can mean taking medication on an on-going basis, sometimes for many years.


Anti-inflammatory drugs

  • Aminosalicylates such as mesalazine (brand names include Asacol®, Pentasa® and Salafalk®) and sulphasalazine (Salazopyrin®)

  • Corticosteroids, often just called steroids, such as prednisolone, hydrocortisone and budesonide (Entocort®)

  • Immuno-suppressants such as azathioprine (Imuran®), methotrexate and tacrolimus

  • Biological or ‘anti-TNF’ drugs such as infliximab (Remicade®) and adalimumab (Humira®).


Biological therapies are generally reserved for people with severe symptoms of Crohn's disease, especially if corticosteroids and immuno-suppressants are unsuitable or ineffective.


Symptomatic drugs

Control and reduce symptoms such as pain, diarrhoea and constipation. They include

  • Anti-diarrhoeal such as loperamide (Imodium®) and cholestyramine (Questran®)

  • Bulking agents such as ispaghula husk (Fybogel®)

  • Painkillers such as paracetamol.


Surgical treatment for Crohn’s

Recent advances such as the development of biological drugs have produced better results for Crohn’s disease meaning surgery is less often needed. There have also been changes in surgery for Crohn’s. For example, extensive re-sections (removal of sections of intestine) are now less common. About seven out of 10 people with Crohn’s will still need surgery at some point in their lives. Surgery is sometimes the only option when other treatments cannot sufficiently control symptoms. Occasionally, an urgent operation is required, for example a severe blockage in the intestines or a hole or tear in the bowel.


Dietary treatment for Crohn’s disease

Enteral nutrition involves a liquid diet replacement usually for a few weeks. These feeds contain all the essential nutrients in a simple form that the body can absorb with little or no digestion. They come in a range of flavours. An alternative may be to take the feed overnight through a naso-gastric tube (a fine tube passed through the nose down into the stomach).

Enteral nutrition is widely used for children with Crohn’s disease to help growth and avoid use of steroids. There is less evidence for the effectiveness of enteral nutrition in adults. Research has shown it to be less effective than steroids.


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