How to Treat Crohns Disease?

Things to note:

• Smoking cessation, as smoking is a strong predictor of relapse.
• Refer to dietician for dietary advice.

Medical Treatment:
Antidiarrhoeal medication should not be used in acute flares of inflammatory CD. Diarrhoea will subside with appropriate care.

• After terminal ileal resections, to reduce diarrhoea due to bile salt malabsorption:
• Cholestyramine, oral, 2-8 g daily.

Ileal disease
All patients:

• Vitamin B12, IM, 1 mg, 3 monthly.

Monitor for iron and folate deficiency.
Colonic disease

• Sulfasalazine, oral, 500 mg 12 hourly, up to 1.5 g 8 hourly.
• Acute attacks: 1-2 g, 4-6 hourly.
• Maximum dose: 3-4 g daily.

AND

• Prednisone, oral, 1.5 mg/kg daily. Taper dose to lowest possible maintenance dose over 3-4 weeks.

Severe disease
Maintenance of remission: Sulfasalazine may be useful for maintaining remission in patients with Crohns colitis but is of no real use in purely ileal CD.
For patients with recurrent attacks of CD or those with extensive disease, i.e. ileum and colon:

• Azathioprine, oral, 2 mg/kg daily. Specialist initiated.

OR

• Methotrexate, oral, 15-25 mg weekly. Specialist initiated.

PLUS

• Folic acid, oral, 5 mg weekly with methotrexate.

Emergency management at specialist facility will include:

• Resuscitation with parenteral fluids;
• Blood transfusions;
• Corticosteroids;
• Antibiotics; and
• Nasogastric suction as indicated.

Peri-anal disease
There is evidence of recurrence on withdrawal of therapy and prolonged treatment may be indicated.

• Metronidazole, oral, 400-800 mg 8 hourly.

OR

• Ciprofloxacin, oral, 500 mg 12 hourly.

When to refer

• For further therapy.
• Peri-anal abscesses/fistula if surgery is required after appropriate assessment.