Crohn’s Disease (CD) is one of two forms of IBD, a chronic illness affecting the gastrointestinal tract. While variants differ based on the primary location of inflammation (the colon, small intestine, rectum, etc.), numerous medical and complementary treatments can help reduce severity and manage symptoms.
Corticosteroids
Corticosteroids are a class of steroids secreted by the adrenal glands. They control multiple processes in the body, including inflammation. Increasing the concentration of corticosteroids in the body reduces inflammation in the gut. For Crohn’s patients, corticosteroids can be prescribed for up to several months at a time to control the inflammation and abdominal pain associated with the disease. However, corticosteroids cannot be used long-term, as high-dose and chronic use can result in severe side effects like muscular atrophy, metabolic issues, osteoporosis, cataracts, and issues with water and nutrient uptake.
This makes corticosteroids helpful for urgent, short-term treatment of a flare-up, or for modulating severe symptoms of Crohn’s Disease. However, their use is best restricted to a few weeks at a time, and it’s best to avoid repeated courses due to their potential for cumulative increased risk of side effects.
Immunomodulators & Small Molecules
Immunomodulators work as their name suggests; by suppressing the immune system so the body doesn’t attack healthy tissue. This helps reduce inflammation and associated pain.
Unlike corticosteroids, this is a larger class of medications that decrease the immune response over longer periods. Immunosuppressants are often taken with another type of medication (mostly biologics), working in tandem to induce a stronger reduction of inflammation.
Small molecules are newer immunomodulators that similarly work to reduce the overactive immune system in IBD patients. While these medications can be taken over a longer time than corticosteroids, they do suppress the entire immune system, leaving the patient more vulnerable to pathological infections and some types of cancer.
Biologics
Biologics are a newer class of immuno-modulating drugs that target specific proteins produced by the immune system. They are termed ‘biologics’ because they are engineered proteins, lab-created to suppress the immune system attacking the body, and may be used in combination therapy with other immunomodulators for maximum effect.
Biologics are used to induce and maintain remission but some may cause a host of side effects, including the risk of increased infections and rarely some types of cancer, which are associated with anti-TNF biologics, although less so with other newer biologics.
Resection Surgery
Many Crohn’s patients require surgery at least once throughout their lives. Resection surgery is an operation in which the inflamed part of the bowel is removed and the healthy bowel is stitched together. More often, the resected part may not be inflamed but rather narrowed due to stenosis (stricture) as a result of intestinal damage caused by prolonged disease. Surgery is used to remove the strictured part to prevent or treat the bowel obstruction it causes.
During surgery, an ileostomy may be performed to aid healing. This involves a part of the small intestine being attached to the skin to allow excretion (ostomy, or stoma). A bag to collect the intestinal excretion is placed over the skin, which needs to be changed several times throughout the day to evacuate the intestinal excretions.
An ostomy may be temporary (i.e. canceled and the intestine re-connected in a subsequent surgery) or permanent, depending on the severity of the situation.
Complementary & Alternative Treatments for Crohn’s Disease
IBD patients often integrate complementary and alternative treatments to reduce symptoms, extra-intestinal manifestations, and quality of life. These can include herbal remedies, acupuncture, and even lifestyle and diet changes.
Curcumin
Curcumin is an organic molecule derivative of turmeric root, used for thousands of years to treat gut inflammation in Chinese and Indian medicine. Modern medicine also recognizes it for its potent anti-inflammatory effects.
Curcumin has shown particular promise as an add-on therapy for reducing inflammation in IBD patients. As with any medication, dosage is highly individualized, and patients should consult a doctor or medical expert before and during the process of taking curcumin for Crohn’s disease.
Acupuncture
Acupuncture is an alternative medicinal practice that stimulates nerve activity through the insertion of a thick needle into acupoints, or strategic bundles of nerves throughout the body. It has been used traditionally for thousands of years, and has been found beneficial for IBD patients, with clinical studies backing these results. Studies cite the increased growth of anti-inflammatory gut bacteria, reduced inflammatory agents, and reduced IBD symptoms as positive effects of this treatment.
Diet & Exercise
With any gastrointestinal disease, it’s important to eat well while avoiding foods that may cause excess inflammation. Caffeine and alcohol are known inflammatory agents of the dietary tract, and doctors recommend limiting their consumption, if not avoiding them entirely.
There are also more personal trigger foods that can cause a flare-up of symptoms. Trigger foods should be tracked and patients should refrain from consuming them as much as possible.
It has been increasingly appreciated that industrial food additives and content may promote intestinal inflammation, which is why it is often advised to try to consume as little as possible of ultra-processed packaged food and fast food. It’s always best to eat home-cooked food following the Mediterranean diet, or other less processed types of dietary habits and regimes.
Likewise, it is also important to exercise regularly. Exercise is associated with the release of anti-inflammatory hormones throughout the body, which can help maintain remission and prevent more severe symptoms of IBD. Even a brisk walk for 15 minutes or a light jog is enough to make a considerable difference.
Stress Relief
Research suggests a strong brain-gut connection, showing correlations between chronic stress and higher levels of gut inflammation in IBD patients, which leads to increased inflammation and abdominal pain. Therefore, practicing stress relief methods is vital to retaining IBD remission. CBT (Cognitive Behavioral Therapy) is helpful in this regard, as it gives patients an outlet for their stress while helping them work through it.
Evinature’s Tips & Recommendations
While Crohn’s disease is a complex condition, a holistic approach using conventional medication and complementary treatments, as well as embracing healthy lifestyle changes, can help manage symptoms and improve quality of life.
Summer Pitocchelli-Schwartzman
