Medical Edge Newspaper Column

Crohn's Treatment Plan Must Be Tailored To Individual

June 19, 2006
DEAR MAYO CLINIC:
A dear young friend of mine has been diagnosed with Crohn's disease. Is there a cure for it? I would hate to see her suffer with the disease for the rest of her life. -- Los Angeles

ANSWER:
There is no cure for Crohn's disease, which is a chronic inflammatory disorder of the intestinal tract. Common symptoms include diarrhea, abdominal pain, reduced appetite, fatigue and weight loss.

However, having the disease doesn't necessarily mean your friend will always feel ill. Like arthritis, another chronic inflammatory condition, symptoms of Crohn's disease can range from mild to severe and may come and go. Your friend could have long periods without signs of the disease or have frequent episodes of troublesome symptoms. No one can predict what course her disease will take.

For the best outcome, it's important that she works closely with her doctor, communicating when her treatment is effective and if she experiences any side effects from medications. Since treatments don't cure the disease, she shouldn't stop or skip doses of her medicines when she is feeling well.

Treatment: Many different medications are used to treat Crohn's disease. They include anti-inflammatory drugs, steroids, immune modulators, antibiotics and a newer class of drugs called biologics, which are antibodies to some of the proteins in the body that contribute to the inflammation process. Each medication has certain benefits and risks of side effects. The best medication and dose must be individualized for each patient.

Despite medical treatment, about 70 percent of patients with Crohn's disease eventually require surgery to remove the segment of the intestine that is causing symptoms. Even surgery isn't a cure. Some patients eventually need additional operations.

Causes: Doctors aren't sure what causes Crohn's disease. Although it makes sense that a disease of the intestinal tract would be affected by foods, there are no foods proven to make Crohn's disease worse. Also, there are no foods that heal Crohn's disease.

Stress can worsen the symptoms of Crohn's disease, but it doesn't appear to be the cause.

Genes appear to play a role. About 10 percent of patients with Crohn's disease have a brother, sister, parent or child with inflammatory bowel disease.

Fortunately, much research is under way to find the cause and cure for Crohn's disease. Promising areas of research include genetics, the role of bacteria and the immune response.

Here's one way you can help your friend. If she's a smoker, encourage her to stop. Smoking makes Crohn's disease worse. If she doesn't think she can stop on her own, she should ask her doctor about medicines and other measures to help her stop smoking.

I recommend that patients and their families learn as much as possible about the disease. On the Web, MayoClinic.com has accurate information. So does the Crohn's and Colitis Foundation of America or (800) 932-2423.

-- William Tremaine, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.