Treatment of Crohn's disease

It is generally recognized that the treatment of patients with Crohn's disease should always be the first conservative, although dietary restrictions and medications may not lead to recovery of patients. Even in case of the positive decision of a question on surgical intervention in the process of preoperative preparing usually should be the course of complex treatment, including sedatives, vitamins and other means.
Conservative treatment is applied in all cases the so-called acute ileitis, in patients without complications, with diffuse enolitech until you see signs of intestinal obstruction, abscesses or bleeding. In addition, the indications for such treatment are cases with symptoms of other organs and systems (arthralgia, anemia and other), as well as recurrent variations after the operation is proceeding without complications.
In the absence of the effect of the therapy, while increasing local changes in the intestine, a progressing emaciation, and the manifestation of complications it is necessary to resort to surgery. The latter is not possible with early manifestations of Crohn's disease. The destruction of large segments of the colon inevitably leads to serious violations of the absorption and assimilation of essential nutrients. In many cases, the combined purpose of diet and drugs allows for a long time not to resort to surgery.
In the period of exacerbation all patients expressed General intoxication and temperature rise should recommend bed rest. The improvement in physical activity of the patients may increase depending on the dynamics of body weight, blood counts, biochemical shifts. Usually patients are recommended daily rest during 1,5 - 2 hours.
Diet recommendations aim to reduce abdominal pain and eliminate diarrhea. This task is achieved by coarse, ill-treated foods, and products that excite peristaltic activity of the intestine: alcohol, coffee, cold drinks, very hot food. It should refrain from fresh fruit, Apple and plum juice with laxative properties. You must always be considered with the instructions of patients on food allergies. In connection with anorexia, impaired absorption and diarrhea patients, as a rule, lose weight, so one of the important principles of compiling diet is the inclusion of products, stimulating the appetite, rich in protein and enough calories. In the case with steatorrhea sharply limited fats. With intolerance to milk it is completely eliminated from the diet. Foods rich in fiber, you are limited to include in the diet of patients with Crohn's disease. During periods of exacerbation of food should be a fraction, but high in calories, which is achieved by adding the menu egg yolk, cheese, boiled meat, chicken and so on
In many cases with prolonged chronic course is depression, mental instability, which require the use of pharmacological agents - tranquilizers, sedatives on the background of systematic interviews doctor about the essence and the nature of the disease, which the patient suffers. The doctor should aggressively to fight the feeling of hopelessness disease.
Treatment for diarrhea are used antiholinergicakie substances (holinolitiki), who are appointed for 15-30 minutes before meals. When bowel obstruction they absolutely contraindicated. Sometimes taking codeine in a high enough dose (30-60 mg per reception) reduces diarrhea. When cramping abdominal pain, in addition to holinolitikov, undoubtedly, effective tincture belladonna, heat (warmer). Pain permanent usually caused by inflammation of the intestine wall and require active anti-inflammatory therapy.
Antibiotics should be prescribed to patients with fever, pregnancy, cracks, ulcers ulcers, suspected suppuration granulomas. Most researchers suggests to use the sulfonamides (best salazopyrin), as antibiotics (particularly tetracycline) broad-spectrum often lead to intestinal dysbacteriosis. Salazopyrin assigned courses several times a day to a total dose of 2-4, In patients with Crohn's disease, complicated iron deficiency anemia, shown iron products, better tolerated parenteral form - farbital, Emperon, ferum-Lek, or iron sulfate per os (ferrochel). In some cases, resort to blood transfusions. When hyperchromic macrocytic forms of anaemia associated with the defeat of the ileum, usually use vitamin B12 and folic acid in the standard dosage.
With a long, rich diarrhea often electrolyte disorders, most often in connection with the loss of potassium and calcium, which require medical correction.
In recent years, subjected to critical evaluation of the effectiveness of steroid therapy in Crohn's disease (Eisenstadt, 1965; Jones and Lennard-Jones, 1966; Fielding and Cooke, 1969). All the researchers note in the immediate result in the appointment of steroid hormones: improves health, decrease of abdominal pain and diarrhea. According to Fielding and Cooke (1969), among 124 patients receiving glucocorticoids and ACTH, 6 months after the start of treatment in 16% of symptoms were resolved, 60% had improved, and 24% effect was absent. However, remote observations testified that among patients treated steroid hormones, 2 times more often had to resort to surgery, and the mortality rate was 2 times higher than in the control group who did not receive these drugs. Jones and others (1966, 1968) believe that the appointment of steroid hormones are expedient only in the diffuse common lesions of the small intestine, and in cases of relapse after bowel resection.
Bockus (1964) shared the opinion of the Bargen, which was considered expedient to steroids in cases when Crohn's disease is accompanied by fever, pyoderma, uveitis and other extra-intestinal changes of organs and systems. Apparently, the only hormone therapy suppresses activity of the pathological process, but does not eliminate it completely.
When the lesions of large intestine (ileocolitis) effect of hormone therapy depends on the clinical manifestations caused by inflammation of the mucous her shell or intestinal obstruction and secondary infection. Hardly proceeding form easier to treat steroid hormones. Local application of the latest failure of the rectum and anus are particularly justified. In General, steroid hormones get restrained assessment as a means of therapy granulomatous colitis (Takunde and Patankar, 1969). In Crohn's disease steroid hormones are appointed smaller than in nonspecific ulcerative colitis, doses, usually 5-10-30 mg a day, the long-term, with a gradual reduction of dose and supportive therapy in the course of a year or more. Patients receiving long-term steroid hormones, and undergoing further surgery require the introduction of cortisol during the operation and in postoperative period.
Obviously, we should refrain from General-purpose hormonal therapy for all patients with Crohn's disease without special indications.
Some patients was successfully applied radiotherapy (Bargen, 1957). Bockus (1964) considers it to be shown in recurrent forms of the disease after bowel resection, if you cannot re-operations, with extremely common lesions of the small intestine, when the gastro-duodenal lesions requiring gastro-Anastasii, to inhibit the activity of obkladochnykh cells for prevention of peptic anastomosis, as well as the early, early Crohn disease. In 1/3 of cases, there is some improvement, confirmed by x-ray data. Radiotherapy should be repeated short courses, sectoral, usually in doses of 100-150 RUB for one session. This treatment is not recommended for long-existing, and far advanced forms of Crohn's disease, as well as young women.
Recently, Jones and others (1969) have traced back the dynamics of radiological symptoms influenced by the successful conservative therapy in patients with lesions of large intestine. However, in most cases, at certain stages of the disease development, particularly when complications, it is necessary to resort to surgery in a particular volume.