What Triggers a Worsening of Crohn's Disease?
Crohn's disease is characterized by periods of having symptoms, which can last for days, weeks or months, interspersed with periods of remission when no symptoms are present. Remissions can last days, weeks, or even years.
Factors that worsen Crohn's disease include:
- Infections (including the common cold)
- Cigarette smoking
- Certain anti-inflammatory drugs (such as aspirin and ibuprofen)
How Is Crohn's Disease Treated?
Though treatments cannot cure Crohn's disease, they can help most people lead normal lives.
Crohn's disease is treated primarily with medications, including:
- Anti-inflammatory drugs, such as salicylates. Examples include Azulfidine, Dipentum, and Pentasa. Side effects include gastrointestinal upset, headache, nausea, diarrhea, or rash.
- Corticosteroids, a more powerful type of anti-inflammatory drug. Examples include prednisone or Solu-Medrol, and Entocort. Side effects, if taken for long periods of time, can be severe and may include bone thinning, muscle loss, skin problems, and increased risk of infection. Entocort has fewer side effects.
- Immune system modifiers such as Imuran or methotrexate. It can take up to six months for these drugs to work. These drugs are associated with increased risk of infections that can be life-threatening.
- Antibiotics such as Flagyl, Cipro, and others. Flagyl can cause a metallic taste in the mouth, nausea, and tingling or numbness of the hands and feet. Cipro can cause nausea and has been associated with rupture of the Achilles tendon.
- Antidiarrheal drugs.
- Biologic therapies, such as Remicade, Humira, and Cimzia. Remicade neutralizes the activity of a substance called tumor necrosis factor alpha (TNF-alpha). This substance is overproduced by people with Crohn's and plays an important role in causing the inflammation associated with Crohn's disease. The drug is given intravenously (through the vein). Side effects include life-threatening infection, infusion reaction, headache, stomach upset, fatigue, fever, pain, dizziness, rash, and itching.
Response to therapy is evaluated within several weeks of starting treatment. Treatment is continued until remission is obtained (at which time, the health care provider may consider maintenance therapy). No improvement calls for more aggressive therapy. Nutritional supplements may also be recommended by your doctor.
Surgery is eventually required in about two-thirds to three-quarters of people with Crohn's disease. Surgery is done to treat complications of the disease -- such as fistulas, abscesses, hemorrhage, and intestinal obstructions -- or to treat people who do not respond to medications.
In most cases, the diseased part of the bowel is removed and the two healthy ends of bowel are joined together (anastomosis). This surgery can allow many people to remain symptom-free for years, but it is not a cure since Crohn's disease often recurs at the site of the anastomosis.
Unfortunately, too many resection surgeries can lead to a condition called short gut syndrome where there isn't enough bowel left to adequately absorb nutrients.
An ileostomy may also be required if the rectum is diseased and cannot be utilized for an anastomosis. This is a connection of the intestine to the skin overlying the abdominal wall. The result is an opening in the skin from which waste products can be excreted into a specially designed pouch.