FREQUENTLY ASKED QUESTIONS
So far my Crohn's disease has required for me to undergo one or more surgical resections. Is there another way to prevent recurrence?
There have been many studies about this subject. Medications like sulfasalazine and steroids have been tried with no real benefits. Azathioprine seems to give a modest benefit but only in patients operated on several times. Finally, antibiotics such as metronidazole seem to prevent recurrence in the short-term but are poorly tolerated in the long term, given their side effects (abdominal pain, metallic taste, malaise). Studies first conducted by specialists now associated with Carilion Clinic have shown that biologics such as Remicade and Humira might be the best option to prevent a relapse after surgery, especially in patients at high risk.
I have good control of bowel function but I have fistulas, which do not seem to respond to my current medical therapy. What should I do?
The treatment of fistulas, especially perianal, can be very difficult. Immuno-suppressants, such as azathioprine and 6-mercaptopurine, may help. You can also try antibiotics, such as metronidazole or tinidazole. However, biologic agents such infliximab are far more effective.The treatment of perianal disease should always involve the surgeon as well as the gastroenterologist - since the combined therapy seems the most effective.
After years of having diarrhea I have noticed the frequency of discharge has decreased and sometimes I have alternating constipation and diarrhea. I have also noticed an increase in abdominal pain. What is going on?
In these situations it is recommended to start a liquid diet immediately and consult the specialist as soon as possible for further evaluation, as this may be a complication or worsening of the disease over time. Strictures (narrowing) of the intestinal lumen may cause pain or even constipation and in some cases there is a risk for total obstruction.
I have stenosis of the last loop of the small intestine. Could this be managed by medical therapy or should I have surgery?
Strictures related to Crohn's disease may be of three types:
- Type A. Related to the current inflammatory disease (the lumen is narrowed because the intestinal wall is thickened by edema (swelling due to water retention);
- Type B. Related to past inflammatory disease which has developed scar tissue (the lumen is narrowed because the inflammatory process has led to scarring resulting in a stricture); Often, the picture is intermediate between A and B.
- Type C. Related to a surgical resection and intestinal-type scar (as in the type B, but generally very short and essentially a consequence of surgery).
It is not always easy to make a precise diagnosis of the type of stricture. Certain radiologic exams, such as MR enterography, may help.
Theoretically, type A stenoses may be managed with medical therapy, but strictures of type B almost always require surgery. In contrast, type C strictures (being generally short) may potentially respond to dilation with an endoscopic balloon.
I have been offered alternative medical therapies. Do they work?
It depends on which alternative therapies:
For example, for dietary measures such as essential fatty acids, amino acids, and manipulation of the bacterial flora with enzymes, probiotics, etc., there are some encouraging data in the literature, but only for specific forms of disease and in any case with a limited benefit.
As in all other fields of medicine, alternative therapies such as herbs, remedies, etc. not only are generally ineffective, but can seriously harm the patient. Unfortunately, even though there might not be any scientific evidence that they are effective, many of these are available on the market and can be taken without any precaution.