Medications

The primary goal of drug therapy is to reduce inflammation in the intestine. Drugs are effective in reducing the inflammation and accompanying symptoms in up to 80% of patients. Unfortunately, relapses are still frequent, and researchers continue to look for the optimal treatments that will both control symptoms and prevent relapse.

Drugs Used for Crohn's Disease. The drugs used depend on the severity of the condition:

• Mild-to-moderate Crohn's disease is generally treated with antibiotics and an oral mesalamine or sulfasalazine. (Some researchers suggest, however, that corticosteroids are more effective than these drugs in patients with disease in the small intestine and ascending colon. Furthermore, new forms of oral corticosteroids, such as budesonide capsules, pose a lower risk for adverse effects.)
• Moderate to severe Crohn's disease is treated with corticosteroids, infliximab, and drugs that modify or suppress the immune system. Such drugs may be used alone or in combinations. Some patients with severe Crohn's may be candidates for surgery.

Determining Success. The success of therapy is determined by its ability to induce and maintain remissions without incurring significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms, such as diarrhea, abdominal cramps, and tenesmus (painful defecation), are normal or close to normal. It is more difficult to define remission in Crohn's disease because diagnostic test results do not always correlate with a patient's symptoms or complications outside the intestine.

Corticosteroids

General Guidelines. Corticosteroids (commonly called steroids) are powerful anti-inflammatory drugs that are the drugs most often used for Crohn's disease in adults. Because of their adverse effects, in treating children, steroids should be reserved for those with severe disease or who relapse after other therapies. Steroids appear to be safe for pregnant women and can be used if necessary during pregnancy.

Steroids are frequently combined with other drugs to produce more rapid symptom relief and to allow quicker withdrawal, although such combinations do not improve remission time.

In general, they are recommended only for active Crohn's, because long-term treatments cause significant side effects and alternative drugs exist. Unfortunately, most doctors also use them for maintenance treatment, in spite of the fact that two major analyses of oral steroids reported no reduction in relapse rates with their use.

Patients who are malnourished are less likely to respond to steroids, and those who had an initial inadequate response to steroids are also less likely to do well with repeat therapy. Some patients who have had Crohn's disease for a long time may have partial or complete resistance to corticosteroids.

Corticosteroid Types. Prednisone, prednisolone, hydrocortisone, and methylprednisolone are the most common corticosteroids. Newer steroids, such as budesonide, fluticasone, beclomethasone, dipropionate, prednisolone-21-methasulphobenzoate, and tixocortol, affect only local areas in the intestine and do not circulate throughout the body. Such drugs may avoid the widespread side effects that are a serious problem with long-term treatment using the older conventional steroids. Recent studies suggest that budesonide can help prolong and maintain remission periods in patients with Crohn’s disease.