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There is no medication that can cure Crohn's disease. Patients with Crohn's disease typically will experience periods of relapse (worsening of inflammation) followed by periods of remission (lessening of inflammation) lasting months to years. During relapses, symptoms of abdominal pain
, diarrhea, and rectal bleeding
worsen. During remissions, these symptoms improve. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously without any treatment.
Since there is no cure for Crohn's disease, the goals of treatment are to 1) induce remissions, 2) maintain remissions, 3) minimize side effects of treatment, and 4) improve the quality of life. Treatment of Crohn's disease and ulcerative colitis
with medications is similar though not always identical.
Medications for treating Crohn's disease include:
1. anti-inflammatory agents such as 5-ASA compounds and corticosteroids
2. topical antibiotics, and
Selection of treatment regimens depends on disease severity, disease location, and disease-associated complications. Various guidelines recommend that approaches be sequential - initially to induce clinical remission, and then to maintain remissions. Initial evidence of improvement should be seen within 2 to 4 weeks and maximal improvement should be seen in 12 to 16 weeks.
The classic approach to therapy in Crohn's disease has been a "step-up" approach starting with the least toxic agents for mild disease, and increasingly more aggressive treatment for more severe disease, or patients who have not responded to less toxic agents. More recently the field has been moving toward a "top-down" approach (early aggressive management) which might decrease exposure to anti-inflammatory agents and increase exposure to agents that enhance mucosal healing that might prevent future complications.
Dietary changes and supplementation that may help control Crohn's disease:
- Since fiber is poorly digestible, it can worsen the symptoms of intestinal obstruction
. Hence, a low fiber diet may be recommended, especially in those patients with small intestinal disease
- A liquid diet may be of benefit when symptoms are more severe.
- Intravenous nutrition or TPN (total parenteral nutrition
) may be utilized when it is felt that the intestine needs to "rest."
- Supplementation of calcium, folate and vitamin B12 is helpful when malabsorption of these nutrients is apparent.
- The use of anti-diarrheal agents (diphenoxylate and atropine [Lomotil], loperamide [Imodium]) and antispasmotics also can help relieve symptoms of cramps and diarrhea.
You should contact your grandson's treating physician to advise him/her of ongoing symptoms and the need for additional or change in therapy. Due to his continuing bleeding, your grandson is probably experiencing the effects of anemia. Loss of weight is indicative of malabsorption of nutrients. You can try supplementing his nutrition with a high caloric drink such as Ensure. This will also help in giving his bowel time to heal.