Drug Therapy continued...
The U.S. Food and Drug Administration has approved the drug infliximab
(brand name, Remicade) for the treatment of moderate to severe Crohn's disease
that does not respond to standard therapies (mesalamine substances,
corticosteroids, immunosuppressive agents) and for the treatment of open,
draining fistulas. Infliximab, the first treatment approved specifically for
Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a
protein produced by the immune system that may cause the inflammation
associated with Crohn's disease. Anti-TNF removes TNF from the bloodstream
before it reaches the intestines, thereby preventing inflammation.
Investigators will continue to study patients taking infliximab to determine
its long-term safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in the small intestine
caused by stricture, fistulas, or prior surgery. For this common problem, the
doctor may prescribe one or more of the following antibiotics: ampicillin,
sulfonamide, cephalosporin, tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the inflammation
subsides, but additional medication may also be necessary. Several
antidiarrheal agents could be used, including diphenoxylate, loperamide, and
codeine. Patients who are dehydrated because of diarrhea will be treated with
fluids and electrolytes.
The U.S. Government does not endorse or favor any specific commercial
product or company. Brand names appearing in this publication are used only
because they are considered essential in the context of the information
The doctor may recommend nutritional supplements, especially for children
whose growth has been slowed. Special high-calorie liquid formulas are
sometimes used for this purpose. A small number of patients may need periods of
feeding by vein. This can help patients who need extra nutrition temporarily,
those whose intestines need to rest, or those whose intestines cannot absorb
enough nutrition from food.
Surgery to remove part of the intestine can help Crohn's disease but cannot
cure it. The inflammation tends to return next to the area of intestine that
has been removed. Many Crohn's disease patients require surgery, either to
relieve symptoms that do not respond to medical therapy or to correct
complications such as blockage, perforation, abscess, or bleeding in the
Some people who have Crohn's disease in the large intestine need to have
their entire colon removed in an operation called colectomy. A small opening is
made in the front of the abdominal wall, and the tip of the ileum is brought to
the skin's surface. This opening, called a stoma, is where waste exits the
body. The stoma is about the size of a quarter and is usually located in the
right lower part of the abdomen near the beltline. A pouch is worn over the
opening to collect waste, and the patient empties the pouch as needed. The
majority of colectomy patients go on to live normal, active lives.