Treatment of Crohn's disease: drugs, biological therapy and more

The main goals of Crohn's disease treatment include:

• maintenance of a long-term resting period - remission
• reduction of discomfort resulting from disease activity
• avoid the need for surgery and hospitalisation
• healing of fistulas
• healing of ulcers
• improving quality of life

Therapy is highly individualised, taking into account the location of the inflammation, the severity of the condition and associated complications.

Conservative therapy

• Aminosalicylates

A drug called sulfasalazine (5-aminosalicylic acid) is used when the colon is affected. It is ineffective for inflammation in the small intestine and has a range of side effects, so it is used less and less in practice.

Mesalazine is used instead. Mesalazine is also effective in small bowel disease and is also effective in preventing colorectal cancer.

• Antibiotic treatment

Antibiotics are mainly used for septic complications, bacterial multiplication and diseases in the anal region. Of the preparations, ciprofloxacin is mainly used.

• Corticotherapy

Glucocorticoids are very effective in controlling inflammation, but their use is associated with many side effects. Corticosteroids are not very effective in maintaining quiescence and do not maintain remission even for 12 months.

• Immunotherapy

Immunotherapy is an effective treatment, especially in maintaining remission of the disease. Its effect is seen only with the passage of time, so it is necessary to start treatment with other drugs in the active stage.

Known agents include azathioprine, which is associated with a risk of lymphoid tissue cancer, and methotrexate, whose toxicity is manifested by nausea, vomiting and diarrhoea.

• Biological treatment

Biological therapy refers to drugs that are natural, i.e. biological in nature, and can dampen the inflammatory response. For example, infliximab (IFX) and adalimumab (ADA) are used.

Biological therapy is suitable for patients who have a severe disease course, perianal fistulas, do not respond to corticosteroids, are under 17 years of age, have an adverse disease course, and have extra-skeletal symptoms, especially joint or skin involvement.

• Probiotic treatment

Suitable cultures for the treatment of Crohn's disease are species of Lactobacillus, Bifidobacterium, Sacchromyces bouladrii, E. coli Nissle and mixtures of probiotic cultures of lactobacilli and bifidobacteria.

The combination of Sacchromyces bouladrii with mesalazine has an excellent effect on maintaining long-term remission of the disease.

Probiotics: When to take them? How to choose the right ones + For children and infants

• Prebiotics

Prebiotics are oligosaccharides that the human body cannot digest. They are fermented in the colon into fatty acids, which promote the growth of prebiotic microbial flora, lower pH and have an anti-inflammatory effect. They are very beneficial for humans. Examples of such suitable prebiotics include inulin.

• Faecal microbial therapy (FMT)

This is a faecal transplant. Stool is taken from a healthy person and donated to a recipient with a colonic disease.

It has been used successfully in the past to treat diarrhoea caused by Clostridium difficile. It is currently being investigated for its potential in Crohn's disease and ulcerative colitis, which has a very promising future.

Surgical treatment

Surgery is the definitive treatment for Crohn's disease. It is used when conservative treatment fails and life-threatening complications occur.

Nowadays, endoscopic diagnostics are at a high level and pharmacotherapy is relatively affordable. Surgical treatment is therefore on the decline. In the past, up to 40% of patients had to undergo bowel surgery.

The most common surgical interventions are bowel resection with the creation of shunts, bypasses or stomas, which are artificial intestinal outlets. If a surgical solution is necessary, the laparoscopic approach is preferred to the classical open surgery.