What is the treatment for Crohn disease?
At this time there is no cure for Crohn disease; however, several methods are helpful in controlling it. The usual goals of treatment are to:
- Correct nutritional deficiencies.
- Control inflammation.
- Relieve abdominal pain, diarrhea, and rectal bleeding.
Specific treatment will be determined by your child's physician based on the following:
- Your child's age, overall health, and medical historyThe extent of the disease
- Expectations for the course of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Your opinion or preference
Treatment may include:
- Drug therapy (anti-inflammatory medications, corticosteroids, immune system suppressors, biologic therapies, antibiotics, anti-diarrheal medications, and fluid replacements). Abdominal cramps and diarrhea may be helped by medications, which often lessen the inflammation in the colon. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system.
- Diet and vitamin supplements. No special diet has been proven effective for preventing or treating Crohn disease. Some symptoms are made worse by milk, alcohol, hot spices, or fiber, but this may not be true for everyone. Large doses of vitamins are ineffective and may even cause harmful side effects.
Children lose weight because of inadequate calorie intake, which can be due to several factors:
They may avoid eating to prevent pain associated with digestion.If favorite foods are eliminated from the diet, they may not feel enthusiastic about eating.
- They may absorb nutrients poorly through the inflamed digestive tract.
- They have greater nutritional needs than average because of their disease.
Nutritional supplements or special high-calorie liquid formulas may sometimes be suggested, especially for children with delayed growth.
- Feeding through a vein. A small number of patients, who temporarily need extra nutrition, may need periods of feeding by vein (intravenously).
- Surgery. Crohn disease may be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return to the areas of the intestine next to the area that has been removed. Surgery may help to either relieve chronic symptoms of active disease that does not respond to medical therapy or to correct complications, such as intestinal blockage, perforation, abscess, or bleeding.
Types of surgery include:
- Drainage of abscesses or removal of a section of bowel due to blockage.
- Ostomy. Some people must have part of their intestines removed, and a new method of removing the stool from the body is created. The surgery to create the new opening is called ostomy and the new opening is called a stoma.
Different types of ostomy are performed depending on how much and what part of the intestines are removed, and may include:
- Ileostomy. The colon and rectum are removed and the bottom part of the small intestine (ileum) is attached to the stoma.
- Colostomy. A surgically-created opening in the abdomen through which a small portion of the colon is brought up to the surface of the skin. Sometimes, a temporary colostomy may be performed when part of the colon has been removed and the rest of the colon needs to heal.
- Ileoanal reservoir surgery. An alternative to a permanent ileostomy, this procedure is completed in two surgeries. First, the colon and rectum are removed and a temporary ileostomy is performed. Second, the ileostomy is closed and part of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.
What is the long-term outlook for a child with Crohn's disease?
Crohn's disease is a chronic condition that may recur at various times over a lifetime. Children may experience physical, emotional, social, and family problems as a result of the disease, increasing the importance of proper management and treatment of the condition.
The following chart summarizes some of the problems children may face.
|Emotional Responses||Social Problems||Effects on the Family|
Mood swings due to illness and medications
Blaming self for disease
Frustration with physical problems
Feeling different from everyone else
Anger: "Why me?"
Worry about appearance, slow growth, weight loss
Feeling vulnerable; unable to rely on body to function normally like everyone elseFrustration at physical limitations, being unable to keep up with friends
Coping with being teased by classmates
Embarrassment over frequent bathroom use
Peer pressure regarding food choices
Handling other people's lack of knowledge about the disease
Change in physical staminaChanges in ability to concentrate on schoolwork
Understanding the needs of the child with Crohn's disease, as well as the rest of the family's needs
Need for mutual support of all family members
Need for all family members to learn about the disease and understand its effects on the childLearning to cope with unexpected changes in family routine
Trying to channel frustration when angry
Respect for privacyEncouraging independence of the child with Crohn's disease
The problems listed above can be very frustrating for the child with Crohn’s disease and his or her family. However, just as intestinal inflammation in Crohn’s disease can be managed with medical therapies, coping difficulties & psychological distress can be managed by a multidisciplinary approach to care. In addition to excellent medical care of the child with Crohn’s disease, we provide the following services to ensure a comprehensive approach:
- Formal education about Crohn’s disease, including disease process, medications & nutrition
- Nutritional support provided by a registered dietitian
- Social work support for community resources & assistance with insurance as needed
- Access to mental health services as needed
- Collaboration with your child’s school nurse to ensure continuity of care
If you have concerns about the way your child is coping with his or her diagnosis, please let us know – our goal is to meet the specific needs of each patient and family.