Digestive Basics - Crohn's Disease

Part 3 - Surgery and current research on more effective drug treatments.

Surgery to remove part of the intestine can help CD but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Many CD 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 intestine.

Some people who have CD 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.

Sometimes only the diseased section of intestine is removed and no stoma is needed. In this operation, the intestine is cut above and below the diseased area and reconnected.

Because CD often recurs after surgery, people considering it should carefully weigh its benefits and risks compared with other treatments. Surgery may not be appropriate for everyone. People faced with this decision should get as much information as possible from doctors, nurses who work with colon surgery patients (enterostomal therapists), and other patients. Patient advocacy organizations can suggest support groups and other information resources. (See For More Information for the names of such organizations.)

People with CD may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with CD are able to hold jobs, raise families, and function successfully at home and in society.

No special diet has been proven effective for preventing or treating this disease. Some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. People are encouraged to follow a nutritious diet and avoid any foods that seem to worsen symptoms. But there are no consistent rules.

People should take vitamin supplements only on their doctor's advice.

Research has shown that the course of pregnancy and delivery is usually not impaired in women with CD. Even so, women with CD should discuss the matter with their doctors before pregnancy. Most children born to women with CD are unaffected. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases.

Researchers continue to look for more effective treatments. Examples of investigational treatments include

• Anti-TNF. Research has shown that cells affected by CD contain a cytokine, a protein produced by the immune system, called tumor necrosis factor (TNF). TNF may be responsible for the inflammation of CD. Anti-TNF is a substance that finds TNF in the bloodstream, binds to it, and removes it before it can reach the intestines and cause inflammation. In studies, anti-TNF seems particularly helpful in closing fistulas.
• Interleukin 10. Interleukin 10 (IL-10) is a cytokine that suppresses inflammation. Researchers are now studying the effectiveness of synthetic IL-10 in treating CD.
• Antibiotics. Antibiotics are now used to treat the bacterial infections that often accompany CD, but some research suggests that they might also be useful as a primary treatment for active CD.
• Budesonide. Researchers recently identified a new corticosteroid called budesonide that appears to be as effective as other corticosteroids but causes fewer side effects.
• Methotrexate and cyclosporine. These are immunosuppressive drugs that may be useful in treating CD. One potential benefit of methotrexate and cyclosporine is that they appear to work faster than traditional immunosuppressive drugs.
• Natalizumab. Natalizumab is an experimental drug that reduces symptoms and improves the quality of life when tested in people with CD. The drug decreases inflammation by binding to immune cells and preventing them from leaving the bloodstream and reaching the areas of inflammation.
• Zinc. Free radicals--molecules produced during fat metabolism, stress, and infection, among other things--may contribute to inflammation in CD. Free radicals sometimes cause cell damage when they interact with other molecules in the body. The mineral zinc removes free radicals from the bloodstream. Studies are under way to determine whether zinc supplementation might reduce inflammation.

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