How do steroids help manage Crohn’s disease symptoms. What are the main types of steroids used for Crohn’s. What potential side effects should patients be aware of when taking steroids for Crohn’s. How do steroids compare to other treatment options for Crohn’s disease.

Understanding Steroids as a Treatment for Crohn’s Disease

Steroids, also known as corticosteroids, are a crucial component in the treatment arsenal for Crohn’s disease. These powerful anti-inflammatory medications have been utilized since the 1950s to manage the symptoms of Crohn’s and other inflammatory bowel diseases (IBD). Their primary function is to reduce inflammation in the digestive tract, providing relief from the irritation and swelling that characterize Crohn’s disease.

While steroids can effectively alleviate symptoms in the short term, it’s important to note that they do not prevent recurrence of Crohn’s flare-ups. Additionally, long-term use of steroids can lead to significant side effects, making them a treatment option that requires careful consideration and monitoring.

How do steroids work in managing Crohn’s disease?

Steroids work by suppressing the immune system’s inflammatory response. In Crohn’s disease, the immune system mistakenly attacks the digestive tract, causing inflammation. Steroids interfere with this process, reducing inflammation and allowing the affected tissues to heal. This can lead to a rapid improvement in symptoms such as abdominal pain, diarrhea, and rectal bleeding.

Types of Steroids Used in Crohn’s Disease Treatment

Several types of steroids are commonly prescribed for Crohn’s disease. The choice of steroid depends on the severity of symptoms, the location of inflammation, and the individual patient’s response to treatment.

• Prednisolone: This is one of the most frequently prescribed steroids for Crohn’s disease. It’s typically taken orally as tablets once a day.
• Budesonide: This steroid is designed to act primarily in the intestines, potentially reducing systemic side effects.
• Hydrocortisone: In severe cases, this steroid may be administered intravenously in a hospital setting.
• Methylprednisolone: Another option for severe flare-ups, often given intravenously.

The duration of steroid treatment can vary, but it typically ranges from a few weeks to a couple of months. It’s crucial for patients not to stop taking steroids abruptly without medical advice, as this can lead to withdrawal symptoms.

Benefits and Risks of Steroid Use in Crohn’s Disease

While steroids can provide significant relief from Crohn’s symptoms, their use comes with both benefits and risks that patients and healthcare providers must carefully weigh.

What are the primary benefits of using steroids for Crohn’s disease?

• Rapid symptom relief: Steroids can start to work within a few days to weeks, providing quick relief from acute symptoms.
• Reduction in inflammation: They effectively reduce inflammation in the digestive system, allowing damaged tissues to heal.
• Improved quality of life: By alleviating symptoms, steroids can significantly improve a patient’s day-to-day functioning and overall quality of life during flare-ups.

What potential risks and side effects are associated with steroid use?

Despite their benefits, steroids can cause a range of side effects, especially with long-term use. These may include:

• Weight gain and increased appetite
• Mood swings and irritability
• Insomnia or sleep disturbances
• Increased risk of infections
• Osteoporosis (weakening of bones)
• High blood pressure
• Diabetes or worsening of existing diabetes
• Cataracts or glaucoma
• Slower growth in children

It’s important for patients to discuss these potential side effects with their healthcare provider and report any unusual symptoms during treatment.

Steroid Administration and Dosage in Crohn’s Disease

The administration of steroids for Crohn’s disease can vary depending on the severity of symptoms and the specific medication prescribed.

How are steroids typically administered for Crohn’s disease?

• Oral tablets: Most commonly, steroids are taken as tablets once daily.
• Intravenous injections: In severe cases or during hospital stays, steroids may be given through an IV.
• Topical applications: For inflammation limited to the rectum or lower colon, steroids may be administered as suppositories or enemas.

Dosage is typically highest at the start of treatment to quickly bring inflammation under control. The dose is then gradually reduced over time, a process known as tapering. This approach helps minimize side effects and allows the body to adjust to decreasing steroid levels.

Why is it important not to stop steroid treatment abruptly?

Abruptly stopping steroid treatment can lead to withdrawal symptoms and potentially trigger a Crohn’s flare-up. The body’s natural production of steroids may be suppressed during treatment, and sudden discontinuation doesn’t allow time for this function to recover. Always follow your healthcare provider’s instructions for tapering off steroids.

Comparing Steroids to Other Crohn’s Disease Treatments

While steroids are a valuable tool in managing Crohn’s disease, they are not the only treatment option available. Understanding how steroids compare to other treatments can help patients and healthcare providers make informed decisions about disease management.

How do steroids compare to immunosuppressants in treating Crohn’s disease?

Immunosuppressants, such as azathioprine, mercaptopurine, and methotrexate, work by reducing the overall activity of the immune system. Unlike steroids, which provide rapid symptom relief, immunosuppressants are typically used for long-term management to prevent flare-ups. They may be prescribed alongside steroids initially, with the goal of maintaining remission after the steroid course is complete.

Advantages of immunosuppressants include:

• Fewer side effects compared to long-term steroid use
• Potential for long-term disease control
• Ability to reduce or eliminate the need for repeated steroid courses

However, immunosuppressants also carry risks, including an increased susceptibility to infections and potential liver problems. They may take several months to become fully effective.

What role do biological medicines play in Crohn’s disease treatment?

Biological medicines, such as adalimumab, infliximab, vedolizumab, and ustekinumab, are newer treatment options for Crohn’s disease. These medications target specific components of the immune system involved in causing inflammation.

Biological medicines may be considered when other treatments, including steroids and immunosuppressants, have not been effective. They are administered by injection or intravenous infusion every few weeks.

Advantages of biological medicines include:

• Potential for long-term disease control
• Targeted action, potentially reducing side effects compared to systemic treatments
• Ability to induce and maintain remission in some patients who haven’t responded to other therapies

However, biological medicines can be expensive and may increase the risk of certain infections. They require careful monitoring and are not suitable for all patients.

Lifestyle and Dietary Considerations for Crohn’s Patients Using Steroids

When using steroids to manage Crohn’s disease, certain lifestyle and dietary adjustments can help maximize treatment effectiveness and minimize side effects.

How can diet impact steroid treatment for Crohn’s disease?

While there’s no one-size-fits-all diet for Crohn’s disease, certain dietary considerations can be helpful when taking steroids:

• Calcium and Vitamin D: Steroids can increase the risk of osteoporosis. Ensuring adequate intake of calcium and vitamin D can help protect bone health.
• Low-sodium diet: Steroids can cause fluid retention and increase blood pressure. Limiting salt intake may help mitigate these effects.
• Balanced nutrition: Steroids can increase appetite and lead to weight gain. Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to maintain a healthy weight.
• Avoid trigger foods: Keep a food diary to identify and avoid foods that exacerbate your Crohn’s symptoms.

What lifestyle modifications can help manage steroid side effects?

Adopting certain lifestyle habits can help minimize the impact of steroid side effects:

• Regular exercise: Physical activity can help maintain bone density, manage weight, and improve mood.
• Sleep hygiene: Establish a consistent sleep schedule to combat steroid-induced insomnia.
• Stress management: Techniques like meditation or yoga can help manage mood swings and reduce stress.
• Regular check-ups: Keep up with scheduled medical appointments to monitor for potential side effects and adjust treatment as needed.

It’s important to discuss any lifestyle or dietary changes with your healthcare provider to ensure they’re appropriate for your individual situation.

Long-Term Outlook and Alternatives to Steroid Treatment

While steroids can be highly effective in managing acute flare-ups of Crohn’s disease, they are generally not recommended for long-term use due to the risk of side effects. Understanding the long-term outlook and exploring alternatives to steroid treatment is crucial for comprehensive disease management.

What is the long-term prognosis for Crohn’s patients who use steroids?

The long-term outlook for Crohn’s patients who use steroids can vary significantly depending on individual factors such as disease severity, response to treatment, and overall health. While steroids can effectively manage acute symptoms, they do not alter the underlying disease course or prevent future flare-ups.

Repeated or prolonged use of steroids can lead to cumulative side effects and complications. Therefore, the goal of treatment is often to use steroids sparingly to control acute flares while relying on other medications for long-term disease management.

What alternatives to steroids are available for long-term Crohn’s management?

Several alternatives to steroids are available for long-term Crohn’s disease management:

1. Immunomodulators: Medications like azathioprine, 6-mercaptopurine, and methotrexate can help maintain remission and reduce the need for steroids.
2. Biologics: These targeted therapies, such as anti-TNF drugs (infliximab, adalimumab) and anti-integrin drugs (vedolizumab), can be effective in maintaining remission and healing the intestinal lining.
3. Aminosalicylates: These anti-inflammatory drugs can be useful in maintaining remission, particularly in mild to moderate cases.
4. Enteral nutrition: Especially beneficial for children, this liquid diet can induce remission without the side effects associated with steroids.
5. Surgery: In some cases, surgical removal of severely affected portions of the digestive tract may be necessary.

The choice of treatment depends on various factors, including disease severity, location of inflammation, previous response to treatments, and individual patient characteristics. A comprehensive treatment plan often involves a combination of these approaches, tailored to the individual patient’s needs.

How can patients work with their healthcare providers to minimize steroid use?

Minimizing steroid use while effectively managing Crohn’s disease requires a collaborative approach between patients and healthcare providers:

• Regular follow-ups: Maintain regular check-ins with your gastroenterologist to monitor disease activity and adjust treatment as needed.
• Adherence to maintenance therapy: Consistently taking prescribed maintenance medications can help prevent flares and reduce the need for steroid courses.
• Early reporting of symptoms: Promptly communicating any changes in symptoms can allow for early intervention, potentially avoiding the need for steroids.
• Lifestyle management: Adopting a healthy lifestyle, including proper nutrition, stress management, and regular exercise, can contribute to overall disease control.
• Exploring new treatments: Stay informed about emerging therapies and discuss with your healthcare provider whether newer treatment options might be suitable for your situation.

By working closely with healthcare providers and taking an active role in disease management, many Crohn’s patients can effectively control their symptoms while minimizing reliance on steroids.

Crohn’s disease – Treatment – NHS

There’s currently no cure for Crohn’s disease, but treatment can control or reduce the symptoms and help stop them coming back.

Medicines are the main treatments, but sometimes surgery may be needed.

Steroids

Most people with Crohn’s disease need to take steroids (such as prednisolone) from time to time.

Steroid medicines:

• can relieve symptoms by reducing inflammation in your digestive system – they usually start to work in a few days or weeks
• are usually taken as tablets once a day – sometimes they’re given as injections
• may be needed for a couple of months – do not stop taking them without getting medical advice
• can cause side effects like weight gain, indigestion, problems sleeping, an increased risk of infections and slower growth in children

The charity Crohn’s & Colitis UK has more information about steroids

Liquid diet

For children and young adults, a liquid diet (enteral nutrition) can also help reduce symptoms.

This involves having special drinks that contain all the nutrients you need, instead of your usual diet, for a few weeks.

It avoids the risk of slower growth that can happen with steroids.

Enteral nutrition has few side effects, but some people may feel sick or have diarrhoea or constipation while on the diet.

Crohn’s & Colitis UK has information about food and Crohn’s disease

Immunosuppressants

Sometimes you might also need to take medicines called immunosuppressants to reduce the activity of your immune system.

Common types include azathioprine, mercaptopurine and methotrexate.

Immunosuppressants:

• can relieve symptoms if steroids on their own are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are usually taken as a tablet once a day, but sometimes they’re given as injections
• may be needed for several months or years
• can cause side effects like feeling and being sick, increased risk of infections and liver problems

Crohn’s & Colitis UK has more about azathioprine and mercaptopurine

Biological medicines

If other medicines are not helping, stronger medicines called biological medicines may be needed.

The biological medicines for Crohn’s disease are adalimumab, infliximab, vedolizumab and ustekinumab.

Biological medicines:

• can relieve symptoms if other medicines are not working
• can be used as a long-term treatment to help stop symptoms coming back
• are given by injection or a drip into a vein every 2 to 8 weeks
• may be needed for several months or years
• can cause side effects like increased risk of infections and a reaction to the medicine leading to itching, joint pain and a high temperature

Crohn’s & Colitis UK: adalimumab and Crohn’s & Colitis UK: infliximab

Surgery

Your care team may recommend surgery if they think the benefits outweigh the risks or that medicines are unlikely to work.

Surgery can relieve your symptoms and help stop them coming back for a while, although they’ll usually return eventually.

The main operation used is called a resection. This involves:

1. Making small cuts in your tummy (keyhole surgery).
2. Removing a small inflamed section of bowel.
3. Stitching the healthy parts of bowel together.

It’s usually done under general anaesthetic (while you’re asleep).

You may be in hospital for about a week and it might take a few months to fully recover.

Sometimes you may need an ileostomy (where poo comes out into a bag attached to your tummy) for a few months to let your bowel recover before it’s stitched back together.

You may need to take medicine after surgery to help prevent symptoms returning.

Crohn’s & Colitis UK has more information about surgery for Crohn’s disease

Page last reviewed: 22 April 2021
Next review due: 22 April 2024

Tips for People Using Steroids in Crohn’s Disease

Written by Shishira Sreenivas

• How Can Steroids Help Crohn’s Disease?
• What Are Some Types of Steroids?
• Drug and Food Interactions to Watch Out For
• What Are the Side Effects of Steroids?
• Things You Should Know Before Taking Steroids for Cohn’s Disease
• What If You Miss a Dose?
• More

When you have Crohn’s disease, it can make your digestive tract irritated, swollen, and inflamed. Steroids, also called corticosteroids, are powerful anti-inflammatory drugs often used for a short time to help.

But they don’t stop your Crohn’s problems from coming back. And over time, steroids can have serious side effects.

They’ve been used to treat Crohn’s and other forms of inflammatory bowel disease (IBD) since the 1950s. They’re helpful during flare-ups, but they’re not a good choice long-term. Side effects include getting infections and causing your bones to thin.

Steroids can help reduce inflammation in your gut fast, especially during a flare-up. They can also reduces inflammation in other parts of your body, like your joints, eyes, and skin. Doctors usually recommend them if you don’t get good results with other treatments. If you’re like most people, you’ll notice improvement within a few days, but steroids don’t work at all for 20% to 30% of people with Crohn’s.

They’re meant to be used for a short time, only 3-4 months at most. There are different types of steroids, and the exact length of your treatment will depend on the one you take. The goals of steroid therapy are to ease symptoms causing your pain and push your condition into remission. Remission means you have no signs of Crohn’s disease.

Depending on the type of steroid you use, it can be taken by mouth as pills or liquids, rectally as a suppository that you insert into your bottom, or as an injection.

Some types include:

Oral steroids

• Prednisone (Deltasone). This is commonly used to bring about remission. It can have many side effects, ranging from minor and severe.
• Budesonide (Entocort EC). This is designed to be absorbed in the small intestine and colon. Unlike prednisone, budesonide is quickly broken down by the liver. This lowers the odds of side effects.
• Budesonide-MMX (Uceris). It’s identical to budesonide, but it has a special coating that protects it until it reaches your gut. Because it’s designed to release specifically in the colon, your doctor may recommend it if your inflammation is mostly in your colon.

Rectal steroids

Rectal steroids, which you put into your bottom, are used to treat inflammation that’s just in your anus, rectum, or sigmoid colon (the part of the large intestine closest to your rectum). This way your whole body isn’t exposed to the steroid and you’ll have fewer side effects. Rectal steroids include:

Suppositories (hydrocortisone). These lower inflammation in your anus and rectum when you have Crohn’s. This can help reduce the frequent and urgent need to poop. But long-term use can weaken the muscles in your anus and rectum and cause a condition called steroid myopathy.

Steroid enemas. These are available as hydrocortisone and methylprednisolone (Cortenema). They’re helpful for inflammation higher up in your gut that can’t be reached by suppositories. Like suppositories, steroid enemas can reduce inflammation in your gut without exposing other parts of your body. That reduces the odds of side effects and risks compared to oral steroids like prednisone.

Rectal foams(hydrocortisone acetate, Proctofoam-HC, Uceris). These drugs improve and limit their absorption in your rectum and the colon.

Oral steroids can interact with other medications, making them either more effective or less effective:

• Amphotericin B
• Aspirin
• Barbiturates (Phenobarbital, Donnatal)
• Birth control pills
• Carbamazepine (Tegretol)
• Coumadin
• Cyclosporine
• Estrogen
• Ketoconazole
• Phenytoin (Dilantin)
• Rifampin

You should avoid foods high in salt, as prednisone and other oral steroids can make your body retain water and cause bloating.

If you’re taking budesonide, avoid drugs like:

• Erythromycin
• Ketoconazole
• Itraconazole
• HIV treatment medications

Also, avoid grapefruit and grapefruit juice because they can make steroids less effective.

Before you take steroids, let your doctor know your medication history and provide them with a list of all the medications you’re taking. This includes prescription and over-the-counter medicine.

They can cause a range of health problems, from minor to severe. It’s important to work with your doctor to monitor your dosage and length of use. Side effects vary depending on which one you’re taking. Because they suppress your body’s immune system, they make you more likely to get infections such as yeast infections (thrush) or urinary tract infections.

Minor side effects include:

• Acne
• Weight gain
• Facial roundness (moon face)
• Rash
• Nervousness
• Mood swings

More serious side effects include:

• Abdominal pain
• Blurred vision
• Bloody or black stools
• Painful joints
• Osteoporosis (weakening of bones)
• Depression
• Infections
• Severe fatigue
• Stretch marks
• Headaches
• High blood pressure
• Growth problems in children
• Unwanted facial hair
• Insomnia
• Cataracts
• High blood sugar levels

If you notice any side effects, let your doctor know. They may switch you to another steroid or adjust your dosage. If you have an allergic reaction, tell your doctor immediately. If it’s an emergency, call 911 or head to your nearest hospital.

If you take oral steroids like prednisone, you can:

• Take them with or without food.
• Crush the pills if it’s easier to take them. Steroids are also available as liquids if you need that.
• Take them along with calcium and vitamin D supplements, as steroids can hurt your bone health.

If you’re taking budesonide, you should:

• Swallow the whole pill. Don’t crush it.
• Take it in the morning.
• Tell your doctor if you’ve been around someone who has chickenpox or measles.

Oral steroids are similar to cortisol, a hormone your body makes. If you take oral steroids for more than a few weeks, it can cause your body to stop making cortisol or make less of it.

Because of this, it’s important you don’t stop taking steroids suddenly. You should slowly reduce the amount you take. As you do, your body will begin to make normal amounts of cortisol again. If you’re planning to stop taking steroids, check with your doctor.

If you’re only taking an oral steroid like prednisone once a day, take it as soon as you remember. If you miss a day, take one dose the next day. Don’t double up on your dose. Let your doctor know.

If you’re taking prednisone twice a day, take the missed dose as soon as you remember and get back to taking it on your regular schedule.

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Treatment of Crohn’s disease in Israel

Crohn’s disease is an inflammatory bowel disease that involves various areas throughout the gastrointestinal tract from mouth to rectum. Treatment of Crohn’s disease in Israel, at the Medical Center. Rabin is aimed primarily at achieving a stable long-term remission, which allows to relieve symptoms and provide the patient with a high quality of life.

One of the most respected experts in the treatment of Crohn’s disease is Prof. Iris Dotan.

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Specialist gastroenterologist for the treatment of Crohn’s disease

• Professor Iris Dotan

  Gastroenterology

  Gastroenterologist of the highest category,
  Department of Gastroenterology, MC named after Rabina

Symptoms of Crohn’s disease

The clinical picture of Crohn’s disease can vary greatly from patient to patient and depends on the location of inflammation, the duration of the disease and many other factors. In some cases, inflammation occurs only in the lower part of the small intestine (ileum – ileum), in others – in the lower part of the large intestine. However, inflammation is most common in both of the above segments of the intestine.

Inflammation penetrates deep into the intestines and can cause pain, chronic diarrhea, weight loss and malnutrition. The disease can be complicated by anemia, the formation of ulcers, scars and fistulas, the occurrence of an intra-abdominal abscess. Having Crohn’s disease increases the risk of bowel cancer.

The symptoms of Crohn’s disease usually appear gradually, although they can sometimes appear unexpectedly. There may also be periods without showing any symptoms.

When the disease is active, the following complaints and symptoms may appear:

• Diarrhea,
• Heat,
• Fatigue,
• Abdominal pain and cramps,
• Blood in stool,
• Mouth ulcers,
• Decreased appetite and weight loss,
• Pain and dryness around the anus due to inflammation and fistula.

Extraintestinal manifestations may also occur in Crohn’s disease:

• Inflammation of the skin, eyes and joints,
• Inflammation of the liver and bile ducts,
• Stunted growth or sexual development in children
• Anemia.

Diagnosis of Crohn’s disease

Diagnosis of Crohn’s disease in Israel, carried out to determine the foci of the disease and its severity, consists of the following:

• Colonoscopy to visually examine the intestinal mucosa and take a biopsy of suspicious areas.
• Histological examination of the tissue of the affected areas.
• Computed tomography to evaluate tissues inside and outside the intestine. CT enterography helps to better see the small intestine.
• Magnetic resonance imaging is needed to evaluate fistulas (fistulas) around the anus, as well as to visualize the small intestine (MR enterography).
• Capsule endoscopy or virtual colonoscopy is a test in which the patient swallows a capsule with an integrated camera that takes pictures of the small intestine and transmits the image to a recorder worn on a belt. The files are then downloaded to a computer and analyzed for signs of Crohn’s disease by a doctor. The capsule comes out painlessly with a stool.
• Balloon-assisted enteroscopy. This method allows you to look into the small intestine, which is not available with other methods. This test is performed if the virtual colonoscopy shows abnormalities.

Blood tests:

• Tests for infections and anemia.
• Tests for specific markers and antibodies.
• Stool test for occult blood.

Treatment of Crohn’s disease in Israel

Treatment of Crohn’s disease in Israel, at the Medical Center. Rabin, involves the use of various modern methods, including: drugs that have proven their effectiveness in clinical trials conducted in the world’s leading medical centers; surgical treatment, in complicated cases. When determining the strategy for the treatment of Crohn’s disease and choosing one or another drug or their combination and methods, the experience and narrow specialization of the treating specialist is extremely important.

In MC im. Rabin has a specialized unit that specializes specifically in inflammatory bowel diseases, headed by Israel’s leading specialist in this field, Professor Iris Dotan.

Anti-inflammatory drugs

• Corticosteroids can reduce inflammation, but this method is not suitable for all patients. Generally, corticosteroids are used if the disease does not respond to other methods. These drugs can be used short-term (up to three to four months) and can be combined with immunosuppressants.
• Oral amino salicylates (5-ASA or 5-ASA) have been widely used in the past, but their effectiveness is currently considered limited.

Immunosuppressants

These drugs also reduce inflammation, but they reduce the function of the immune system as a whole, increasing the overall risk of infection. For some patients, a combination of these drugs is more effective than one of them.

Antibiotics

May reduce dehydration and sometimes heal fistulas and abscesses in people with Crohn’s disease. Some researchers believe that antibiotics help reduce levels of pathogenic gut bacteria that can cause inflammation in the gut.

Other drugs

In addition to controlling inflammation, some drugs may reduce symptoms. Depending on the severity of Crohn’s disease in a particular patient, the doctor may prescribe the following drugs:

• Antidiarrheals
• Painkillers
• Iron preparations
• Vitamin B12. Crohn’s disease leads to a deficiency of vitamin B12, which prevents the development of anemia, ensures normal growth and development of the body, and also contributes to the normal functioning of the nervous system.
• Calcium and vitamin D containing preparations. Crohn’s disease and the steroids used to treat it can lead to osteoporosis, so it’s important to take calcium and vitamin D for absorption.

Nutritional Therapy

Your doctor may recommend special feedings given by tube (enteral nutrition) or intravenous (parenteral) nutrition through a drip to provide essential nutrients to treat Crohn’s disease. In Israel, this method is practiced because in this way the body receives the necessary nutrients while the intestines rest and heal in a short time.

This therapy can be combined with other drugs such as immunosuppressants.

Medical nutrition is usually used before surgery or when other treatments fail.

Your doctor may also recommend a diet low in fiber to reduce the risk of bowel obstruction if you have a stricture (narrowing) of the bowel.

Treatment of Crohn’s disease in Israel: surgical method

Surgeons

• Prof. Nir Wasserberg

  General and oncological surgery

  Surgeon of the highest category.
  Head of the Department of Surgery at the Beilinson Hospital of the Medical Center. Rabin.

• Dr. Ian White

  General and oncological surgery

  Surgeon of the highest category,
  Director of the Surgical Service for Inflammatory Bowel Diseases.
  Director of Colorectal Surgery.

If all of the above treatments for Crohn’s disease fail, your doctor may recommend surgery. Nearly half of patients with Crohn’s disease require at least one operation. However, surgery still does not cure this disease.

During the operation, the surgeon removes the damaged part of the gastrointestinal tract and connects its healthy parts. Surgery is also used to treat fistulas and abscesses.

To prolong the effect that accompanies the surgical treatment of Crohn’s disease in Israel, drug therapy is prescribed after surgery to reduce the risk of recurrence of the disease.

Risk factors for Crohn’s disease

• Age. Crohn’s disease can appear at any age, however, it most often appears in young people, around the age of 30 years.
• Nationality. Crohn’s disease can occur in people of any nationality, however, Caucasians are at the highest risk. However, the incidence of the disease is increasing among black people living in North America and England.
• Family history. Having a first-degree relative with Crohn’s disease increases the risk of developing the disease. One in five people with Crohn’s disease has a relative with the problem.
• Smoking. It is the most controlled risk factor for developing Crohn’s disease. Smoking also leads to a more severe course of the disease and the risk of surgery. If you smoke, it is very important to stop.
• Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen sodium, diclofenac sodium and others. These drugs cannot cause Crohn’s disease, but they can lead to intestinal inflammation and make Crohn’s disease more severe.
• Place of residence. If you live in a city or industrial area, your risk of getting Crohn’s disease is higher. Factors such as the environment, including a diet high in saturated fat and processed foods, may play a role in the development of Crohn’s disease.

Causes of Crohn’s disease

The exact causes of Crohn’s disease remain unknown. Previously it was believed that nutrition and stress were responsible for the onset of the disease. However, today it is clear that these factors can exacerbate the disease, but not the main cause. However, some factors, such as heredity and malfunctions in the immune system, can influence the development of Crohn’s disease.

• Immune system. There is a possibility that a virus or bacteria can trigger the development of Crohn’s disease. When the immune system fights foreign microorganisms, a malfunction in its response can cause immune system cells to attack its own digestive tract.
• Heredity. Crohn’s disease most often occurs in those with a family history of the disease, so genes may play a role in susceptibility to the disease. However, most people with Crohn’s disease do not have a family history of the disease.

Crohn’s disease: symptoms, causes, treatment, diet.

Crohn’s disease affects the digestive tract, causes unpleasant symptoms and reduces quality of life.

In this material, we will talk about the causes of the development of the disease and methods of treatment.

Contents

• What is Crohn’s disease?
• Why does it occur?
• How is she treated?
• Will diet help in treatment and prevention?

What is Crohn’s disease?

Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract that can affect any part of the gastrointestinal tract, from the mouth to the rectum. The disease belongs to a type of inflammatory bowel disease.

Crohn’s disease can be very debilitating and significantly reduce the quality of life, and sometimes even lead to dangerous complications.

Symptoms

The disease is typical for patients of all ages. Symptoms usually begin to appear in childhood or late adolescence. The symptoms of Crohn’s disease can vary in severity. They usually develop gradually, but sometimes they can appear suddenly.

Among the main symptoms:

• diarrhea,
• abdominal pain or cramps,
• blood in the stool,
• extreme fatigue,

9000 5 decreased appetite and weight loss,

• high fever,
• ulcers during mouth,
• pain in the anus.

Symptoms may be constant or come and go every few weeks or months.

People with severe Crohn’s disease may also develop:

• inflammation of the skin, mucous membranes of the eyes and joints,
• inflammation of the liver or bile ducts,
• kidney stones,
• iron deficiency anemia,
• growth retardation or sexual development (in children).

Why is Crohn’s disease dangerous?

Unfortunately, Crohn’s disease can lead to a number of serious complications:

• Bowel obstruction. Crohn’s disease can affect the entire thickness of the intestinal wall. Over time, scars can form and certain sections of the intestine can narrow, which significantly disrupts the functioning of the organ. As a result, surgery may be required to remove the affected area of ​​the intestine.
• Ulcers . Chronic inflammation can lead to open sores anywhere in the digestive tract, including the mouth and anus, as well as the genital area.
• Fistulas . Sometimes ulcers can lead to the formation of fistulas, abnormal connections between various organs. Fistulas can develop between the intestines and the skin, or between the intestines and other organs. Fistulas near or around the anal area are the most common. When fistulas form in the abdomen, there are problems with absorption. Fistulas can also occur between bowel loops, in the bladder, vagina, or through the skin. In some cases, fistulas can become infected and form abscesses that are life-threatening if left untreated.
• Anal fissure. This is a small tear in the tissue lining the anus or in the skin around it. When fissures occur, the risk of infections increases significantly, and this condition is often associated with painful bowel movements and can lead to a perianal fistula.
• Malnutrition . Diarrhea, pain, and cramps can make it difficult to eat normally or interfere with the absorption of nutrients in the intestines. In addition, iron deficiency or B12 deficiency anemia often develops against the background of the disease.
• Colon cancer. Crohn’s disease, which affects the colon, increases the risk of colon cancer. General recommendations for colon cancer screening for people without Crohn’s disease call for a colonoscopy every 10 years, starting at age 50. However, screening may be required more frequently in Crohn’s disease.
• Other health problems. Crohn’s disease can cause or worsen anemia, skin disorders, osteoporosis, arthritis, gallbladder and liver disease.
• Drug risks. Some drugs for Crohn’s disease that work by blocking immune system functions are associated with a small risk of developing lymphoma and skin cancer. They also increase the risk of infectious diseases.
• Blood clots . Crohn’s disease increases the risk of thrombosis.

Why does Crohn’s disease occur?

The exact cause of Crohn’s disease is unknown. It used to be thought that a certain diet and high levels of stress were the causes of the development of the disease. But it is now known that these factors can exacerbate, but not cause, the disease. Smoking, other diseases of the gastrointestinal tract, and imbalances in the gut microbiota can also exacerbate the course of the disease.

Doctors identify two main risk factors for developing Crohn’s disease – hereditary predisposition and malfunction of the immune system.

• Immune system. Sometimes, when the immune system fights foreign microorganisms, an abnormal immune response can occur. In this case, the immune system can attack, including the cells of the gastrointestinal tract.
• Hereditary predisposition . Crohn’s disease is more common in people whose family members also have the disease. However, most people with Crohn’s disease do not have a family history of it.

In addition, risk factors include a lack of dietary fiber in the diet, taking oral contraceptives and antibiotics, and living in the city.

Scientists also speculate that Crohn’s disease may be caused by a virus or bacterium, but there is no evidence for this theory yet.

Who is at risk?

• Young people. Although Crohn’s disease can begin at any age, most patients are diagnosed before the age of 30.
• People of Eastern European (Ashkenazi) Jewish origin. There is also an increasing incidence among black people living in North America and the UK. It is important to bear in mind that Crohn’s disease can affect any ethnic group.
• People with a family history of Crohn’s disease. If your parents, siblings (first-degree relatives) have the condition, your risk is increased. One in five people with Crohn’s disease has a family member with the disease.
• People who smoke. Cigarette smoking leads to a more severe course of the disease and a greater risk of surgery.
• People taking non-steroidal anti-inflammatory drugs. Although the drugs themselves do not cause Crohn’s disease, they can lead to inflammation in the intestines, which can make the disease worse.

How to assess risks

Genes that regulate various processes in the intestine are involved in the development of the disease. They are involved in inflammatory responses and in autophagy, the process of cell self-destruction. Associated genes also influence the interaction between the host and gut bacteria. You can find out if you have these genes with a genetic test.

To date, scientists have also been able to describe the microbiota profile seen in Crohn’s disease. The less your microbiota profile is similar to your disease profile, the lower the risks. The indicator is rated on a scale of 1 to 10. To find out how far your microbiota is from the profile for Crohn’s disease and whether you need to adjust your diet to avoid it, a microbiota test will help.

Crohn’s disease changes the ratio of opportunistic bacteria that trigger inflammation processes and beneficial bacteria. Also, the representation of beneficial bacteria, the producers of butyric acid, which protects the intestines from inflammation, often sharply decreases.

How is Crohn’s disease treated?

To date, Crohn’s disease cannot be completely cured, but there are a number of drugs and measures that indirectly alleviate the course of the disease. The most common treatment for Crohn’s disease is medication, but sometimes surgery may be required.

These techniques can significantly reduce the symptoms of the disease and even lead to long-term remission. With treatment, many people with Crohn’s disease can live a normal life with minimal restrictions.

Steroid medications

Most people with Crohn’s disease need occasional steroids, such as prednisolone.

These drugs can relieve symptoms by reducing inflammation. They are usually given as tablets once a day, but are sometimes given as injections. The course of treatment is usually several months. Drugs can cause side effects such as weight gain, indigestion, trouble sleeping, increased risk of infections, and slower growth in children.

Liquid diet

A liquid diet (enteral nutrition) may be suitable for children and adolescents. The diet involves replacing the usual way of eating with special drinks that contain all the necessary nutrients. Usually the diet is prescribed for several weeks.

This option avoids the risk of growth retardation in children, which can occur with steroids. Enteral nutrition has few side effects on average, but some patients may experience diarrhea or constipation.

Immunosuppressants

These drugs are prescribed to reduce the activity of the immune system, and usually when the steroids themselves do not work. Drugs are prescribed for long courses for several months or even years. Side effects include malaise, increased risk of infections, and liver problems.

Biosimilars

If other drugs fail, stronger drugs, biosimilars, may be needed. Drugs are prescribed in long courses for several months or years to prevent recurrence of the disease.

Biosimilar drugs are given by injection or drip every 2-8 weeks. Side effects include an increased risk of infections, itching, joint pain, and high fever.

Surgery

A doctor may recommend surgery if the benefits outweigh the risks, or if medications don’t work. Surgery can relieve your symptoms and prolong remission, but it doesn’t completely cure Crohn’s disease either.

The main type of surgery for Crohn’s disease is resection, the removal of a small portion of the bowel. Sometimes an additional ileostomy may be required for several months to allow the bowel to recover.

Can diet help treat and prevent Crohn’s disease?

There is no evidence that any particular type of diet causes Crohn’s disease. In this case, the attending physician may advise you to follow a certain diet if the disease has been diagnosed. This may help relieve symptoms or reduce their intensity. However, no diet, unfortunately, can save the patient from Crohn’s disease.

Some tips to follow:

• Eat small meals 4-6 times a day.
• Don’t forget water. It is better to drink water slowly and not through a straw to avoid swallowing air and gas formation.
• Prepare meals in advance and have on hand those foods that you tolerate well.
• Introduce new foods carefully, one at a time, in small portions.
• Avoid high fiber foods, raw fruits and vegetables, and caffeinated drinks.
• Use simple cooking methods such as boiling, steaming, grilling.
• Keep a food diary to help you keep track of which foods you tolerate well or poorly.

How to eat during an exacerbation?

Unfortunately, there is no universal list of recommended or prohibited foods for Crohn’s disease. For each patient, it will be different, the attending physician will help you choose it. You can also focus on personal observations – note what suits your body and what does not.

What to avoid?

• High-fiber foods that are difficult to digest: fruits with skins and seeds, raw green vegetables (especially cruciferous vegetables – broccoli, cauliflower), whole nuts and whole grains.
• Products containing lactose: milk, cheeses and other dairy products.
• Non-absorbable sugars: sorbitol, mannitol and other sugar alcohols. They are found in sugar-free gum, candy, ice cream, some fruits and juices.
• Sweets: pastries, sweets, juices.
• High-fat foods: fatty and fried foods, butter, margarine, coconuts.
• Alcohol and caffeinated drinks.
• Spicy food.

What is there?

• Low fiber fruits: bananas, melons, boiled fruits.
• Lean protein: fish, lean pork, white poultry, soy, eggs, and hard tofu.
• Refined grains: potato or gluten-free bread, white pasta, white rice and oatmeal.
• Non-cruciferous, seedless and skinless vegetables, fully cooked, eg cucumbers, potatoes, courgettes.

How to eat during remission?

Since patients with Crohn’s disease eat far from all foods, they may be deficient in certain macro- or micronutrients. During remission, you should pay attention to these foods:

• Foods rich in fiber: oat bran, beans, barley, nuts and whole grains (provided that you do not have special contraindications for this from your doctor).
• Protein: lean meat, fish, eggs, nuts and tofu.
• Fruits and vegetables: try to remove the skin and seeds from them.
• Calcium-rich foods: kale, kefir, milk (if you are lactose intolerant, choose lactose-free dairy products or use lactase enzyme).
• Foods with probiotics: yogurt, kimchi, miso, sauerkraut and tempeh.

Screening for Crohn’s disease

Crohn’s disease can sometimes be difficult to diagnose due to non-specific symptoms. Colonoscopy with biopsy, as well as computed tomography or magnetic resonance imaging, are usually performed to confirm the diagnosis.

In order not to confuse Crohn’s disease with similar ulcerative colitis, methods based on the detection of antibodies and biomarkers in the blood can be used.