Crohns Disease

Crohn’s Disease
Inflammation of gastro-intestinal tract from mouth to anus

Symptoms 
  • Abdominal pain
  • Diarrhoea
  • Rectal bleeding
  • Weightless
  • Fatigue

Colestyramine is licensed for the relief of diarrhoea associated with Crohn’s disease.

Diarrhoea: Loperamide hydrochloride or codeine phosphate can be used to manage diarrhoea associated with Crohn’s disease in those who do not have colitis.

Longterm Problems
  • Abscess (in the wall of the intestine)
  • Anaemia
  • Malnutrition
  • Growth failure/ delayed puberty
  • Secondary osteoporosis
  • Fistulae (complication that involves the formation of a fistula between the intestine and adjacent structures, such as perianal skin, bladder, and vagina)
  • Extra-intestinal manifestation: the most common are arthritis and abnormalities of the joints, eyes, liver and skin.

Treatments

One flare up in 12 months/ first presentation
Corticosteroids: 

Prednisolone
Methylprednisolone
IV Hydrocortisone

Alternative for ileocaecal, right sided colonic disease or if corticosteroid 
contraindicated:  

Budesonide or
Aminosalicilate (less effective than budesonide or aminosalicylate)

Two or more flare ups in 12 months

Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide

Alternative: Methotrexate (In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient)

Monocloncal antibiodies (under specialist supervision)

Remission:
Azathioprine or mercaptopurine [unlicensed indications] as monotherapy can be used to maintain remission when previously used with a corticosteroid to induce remission

Alternative
Methotrexate 

Corticosteroids or budesonide should not be used.

Maintenance of remission after surgery 

Ileocolonic Crohn’s disease: Azathioprine [in combination with up to 3 months’ postoperative metronidazole [unlicensed indication]

Aminosalicylates are no longer recommended due to the lack of clinical efficacy