What to Expect From Your Crohn’s Disease Treatment
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Knowing what to expect from your Crohn’s disease treatment plan can help you physically and emotionally when you’re battling the disease. Because it's a chronic condition, Crohn's disease requires ongoing treatment to control symptoms and provide relief, but with the right approach, that relief can lead to remission.
The Goals of Treatment
The first goal of Crohn’s disease treatment is to clear common symptoms, such as abdominal pain and diarrhea, so that you can stay healthy and lead a normal life, says Ramanujan Samavedy, MD, a gastroenterologist and a clinical assistant professor in the department of medicine at the University of Tennessee Medical Center in Knoxville. Relieving these symptoms also lessens the risk for complications, such as intestinal blockages and ulcers and the inability to absorb nutrients properly. Treatment may include medications, nutritional supplements, and surgery.
The overall goal of Crohn’s disease treatment is to achieve and maintain remission. “The average amount of time it takes a person with a Crohn's disease flare to achieve remission depends on the severity of the disease and the choice of medicine used to treat the illness,” says Patrick A. Hyatt, MD, a gastroenterologist with the Institute for Digestive Health and Liver Disease at Mercy Medical Center in Baltimore.
If Crohn's disease is mild, remission can be achieved fairly quickly, within a matter of weeks, with the use of topical mesalamine drugs, Dr. Hyatt says. Corticosteroid drugs may be used to induce remission more rapidly, but because of increased risk for side effects, they're typically reserved for treatment of more severe cases of Crohn’s disease, he says.
With moderate Crohn’s disease symptoms, it may take a little longer to reach remission, possibly one to two months. Your doctor may consider a variety of approaches, such as a combination of corticosteroids and higher doses of mesalamine drugs than prescribed for milder cases of Crohn’s disease, Hyatt says. A dose of a biologic medication may be used to achieve remission quickly, with additional doses given at set intervals to maintain remission. Immunomodulator drugs are another option. These drugs help reduce inflammation by influencing or “modulating” the way your immune system works. Immunomodulators can take up to 12 weeks to achieve their maximum therapeutic effect, so they're often used in combination with topical medications, biologic therapy, or short-term courses of corticosteroids, Hyatt says.
When Crohn’s disease has progressed to a severe stage, the goal is to prevent the need for surgery, Hyatt says. You might be prescribed a regimen of corticosteroid drugs and biologic medications right away because topical agents are generally ineffective at this point and immunomodulator drugs can take too long to kick in, he says. Remission of Crohn’s disease at this stage can still be achieved in about eight weeks.
Types of Crohn’s Disease Remission
It’s important to note that just because you’re feeling well doesn’t mean your Crohn’s disease is in remission. “It’s not uncommon to feel normal and still have ongoing inflammation in the lining of the bowel," Dr. Samavedy says. This may be detected during a follow-up endoscopy, colonoscopy, or blood test.
Various methods are used to determine and measure Crohn’s disease remission. “Endoscopic remission refers to normalization of the lining of bowel as seen during an endoscopy,” Samavedy says. But even as this healing occurs and symptoms lessen, there may still be ongoing inflammation that can only be detected with a biopsy, he says.
A histological remission is when a biopsy after treatment shows that inflammation, abscesses, and damage to the lining of the bowel have healed, Hyatt says.
Once you’ve achieved remission of Crohn’s disease, you need to continue taking your medication as prescribed. Remission isn’t a cure — there's still the likelihood of an occasional Crohn’s disease flare.
“The most common reason for a Crohn’s disease flare is because people stop taking their medication because they feel better," Hyatt says. "This will often result in a recurrent flare that’s sometimes worse and more difficult to control than the initial one."
No Crohn’s Disease Remission: What’s Next?
It can take several attempts to find the best Crohn’s disease treatment combination to achieve remission, and that may mean changing medications or considering surgery. Discuss all of your symptoms and lifestyle habits with your doctor as openly and honestly as possible. Having a clear picture of your individual Crohn’s disease experience will help guide your doctor in prescribing the treatment regimen that will be most effective at achieving and maintaining remission for you.
Video: What is Crohn's Disease?
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