Crohn's disease - Kids & Teens
Treatment plan for Crohn’s disease
In addition to
liquid diets, there are also medicines that may help. Here is a
general list of currently available treatments for Crohn’s disease
in children, including how they work and when they might be used.
5-ASAs (5-aminosalicylic acid)
may be used to help reduce inflammation. It is usually used for mild
to moderate symptoms. It is useful to help lessen symptoms and
restore health (induction of remission), but is not useful for
keeping your symptoms from returning (maintaining remission). It may
take 4–8 weeks before you start to feel better.
usually taken daily, either orally or rectally (as an enema or
suppository). They are considered a safe treatment option when used
5-ASAs include: mesalamine, balsalazide, olsalazine and
Corticosteroids are also used to help reduce inflammation. They help
lessen symptoms and restore health (induction of remission) in
moderate and severe Crohn’s disease. They are not, however, meant to
be used long-term due to side effects.
may start relieving symptoms within 1–3 weeks. Remission (having no
symptoms) may be reached within 6–8 weeks.
doctor will want to see you again in 2–3 weeks after you have
started taking corticosteroids, to see how you are doing and whether
you are getting good results from the medicine or if you are still
having any problems.
are taken by an intravenous tube, orally or rectally (eg, an enema).
The most commonly reported side effect is infection. Other related
problems include bone mineral loss (which may be treated with
supplements of calcium and vitamin D), slowing of growth in
children, increased appetite, weight gain, disturbed sleep pattern,
a so-called ‘moon-shaped face’ due to fluid retention in the skin
(called Cushing’s syndrome), or acne.
corticosteroids include: prednisone, methyl prednisolone and
at the end of the small intestine, or right side of the colon,
budesonide (a glucocorticosteroid drug) may be used and is
considered to have fewer safety concerns.
Two-thirds of people with IBD (Crohn’s disease and ulcerative
colitis) will take an immunosuppressant at some point. These
medicines help keep down inflammation by lowering the activity of
the immune system. Immunosuppressants are most helpful for keeping
symptoms from returning (maintenance of remission) and are
‘steroid-sparing’, meaning they can help reduce the dose of
corticosteroids needed. They are often used to treat moderate to
severe Crohn’s disease.
Immunosuppressants take a while to start working (approximately 2–4
months), so they are often taken along with corticosteroids. They
are either taken by mouth, or orally (thiopurines such as
azathioprine or 6-mercaptopurine, also known as 6-MP) or as
It is important
to keep taking your medication, as there are good benefits. However,
some people may have to stop because of side effects. It is
important to discuss this with your doctor first. Side effects may
include: nausea, myelosuppression (lowering the bone marrow’s
ability to make blood cells, which can require frequent blood tests)
or risk of infection such as viral herpes (eg, cold sores).
Thiopurines also have a risk of pancreatitis (inflammation of the
pancreas). Treatment with azathioprine or 6-mercaptopurine may also
bring about a slight increased risk of lymphoma (cancer of the
lymphatic system). Regular monitoring, therefore, is important.
If you have any
of these problems, or any other symptoms while taking this medicine,
contact your doctor right away. Your doctor will also probably want
to monitor you regularly while you are taking this medicine.
immunosuppresants include: azathioprine, 6-mercaptopurine (6-MP) and
Current anti-TNF drugs are used for moderate to severe Crohn’s
disease. They work quickly (generally within 2–4 weeks) and can be
helpful in people with inflammation limited to the gut wall and also
if you have a fistula. They may also be used in people in whom other
treatments haven’t worked well.
Anti-TNFs can be
taken as either subcutaneous injections (given at home) or through a
drip (given in the hospital).
this medicine, your doctor will ask to screen you for tuberculosis
with a chest X-ray and/or a skin test. There is a risk of infection,
although it is lower than that associated with steroid use. There
may also be an allergic reaction causing joint pain, rash, or a
short-term (transient) reaction or fever. Other possible problems
include heart failure in the elderly (watch for swollen ankles or
shortness of breath) or skin problems.
If you are
taking anti-TNF medicine and experience any symptoms such as night
sweats, cough or shortness of breath, contact your doctor.
There have been
rare reports of cancers associated with biological therapy, but it
is not yet known whether these were due to these medicines or to
other medicine given at the same time. Research is ongoing to look
at both possibilities.
anti-TNFs (in Europe) include: infliximab and adalimumab.
Cells of the
immune system called white blood cells (or leukocytes) defend the
body against infections. In people with active IBD types of
leukocytes called granulocytes and monocytes are often increased or
over active. Large numbers of these cells enter the wall of the
intestines and can release substances that cause bowel injury and
stimulate inflammation. It is believed that the watery diarrhoea
seen in severe IBD is a result of injury to the absorptive
epithelium which makes it unable to absorb water.
Apheresis, or leukocytapheresis, is performed with a medical device
that selectively binds excess or activated granulocytes and
monocytes from the blood. Blood is pumped from a vein in one arm
(via a simple venopuncture) through a column containing cellulose
acetate beads or a filter. This binds granulocytes and monocytes
while the rest of the blood passes right through and is infused back
into the body through the other arm. The outcome is a reduction in
the number of inflammatory cells that can move from the blood into
the intestinal wall. As a result, the symptoms of IBD are relieved,
and the bowel gets a chance to heal.
The treatment lasts for 1 hour and is usually given once a week for
5 weeks. It can be performed in hospital or in an outpatient
Leukocytapheresis involves mainly adults with IBD – there is some
debate as to whether it is suitable for children. It can be used to
reduce symptoms during a severe flare up, or in moderate to severe
active IBD in which satisfactory effects have not been achieved with
corticosteroids or other immunosuppressive therapy.
Some temporary side effects can occur, such as low blood pressure,
palpitations, and hot flushes; however, little is known about the
long-term side effects of apheresis.
biological processes through which leukocytapheresis affects the
course of disease remain largely unknown, and it is difficult to
draw conclusions from the existing clinical trial data on how
effective the treatment really is.