Treatment of Crohn’s Disease

Overview

Dietetic treatment of Crohn’s disease has the objective to calm down the gut either by a polymeric or elementaldiet. In superacute conditions also total parenteral nutrition can be used. In the quiescent stage the patient must havean adequate energy intake and a low-residue (low-fibre) diet. As to medication, sulfasalazine which has someside-effects is abondoned and 5-ASA (5-aminosalicylic acid) preparations are used, either by the oral route or inenemas, while 4-ASA is little used in this country and is known as PAS. The administration of corticoids which alsohave side-effects will be abondoned in favour of so-called rapidly metabolized corticoids (Tixocortol pivalate,beclomethasone, budenoside and fluticasone) by the oral route and in enemas and foams. As antimicrobial treatmentciprofloxacine is used combined with metronidazole. As to immunosupressive drugs azathioprine, 6-mercaptopurine,cyclosporin A, cyclophosphamide and methotrexate are tested. A hope for the future is so-called biological treatment(anticytokines, monoclonal antibodies against cytokines, against CD4+ TNF, interleukines IL-10 and 11, immuno-globulin; plasmapheresis is also tested). Treatment must be individual and surgery as late as possible, only in caseof complications, and should be very sparing, stenoses should be treated by plastic operations of strictures.

Key words:
m. Crohn, sulfasalazine, corticoid, 6-mercaptopurine, cyclosporin A, cyclophosphamide, methotrexate