Patients must seek help if they become extremely sick with fever, vomiting, dehydration, or severe debility. Severe attacks of Crohn's disease put patients at risk of losing too much blood, or more fluid and nutrients than they can make up through eating and drinking. Hospitalization may be required to stabilize the individual and help bring the disease under control.
Fever, pain, vomiting, and weakness can indicate an emergency situation such as an intestinal perforation, blockage, or severe infection. Such conditions must be treated at once, often with surgery.
Adequate rest and a healthy diet are essential during flare-ups. During attacks, patients are in danger of becoming malnourished and dehydrated due to excessive fluid and nutrient loss through diarrhea. People may feel nauseated, and may not wish to eat. Although it is sometimes hard to force oneself to consume enough food and fluids, it is essential in order to maintain overall health.
Frequent, small meals that are high in protein and calories and low in fat and fiber are recommended. No special diet has proven effective for either preventing or treating Crohn's disease. In general, during flare-ups and for those with symptoms of narrowed or partially obstructed intestines, doctors recommend eating frequent, small meals that are high in protein and calories and low in fiber. Bland, soft foods and bouillon may be tolerated best. Avoid caffeine, fruit juices, sweets, and alcohol. Some 35% of patients with Crohn's disease are lactose intolerant, and should avoid milk products, although dairy foods need not be restricted for everyone. Many people find they can easily tolerate fatty fish, such as salmon, sardines, herring, and mackerel.
A daily multivitamin with iron is recommended. Vitamin B-12 may need to be supplemented for those who have had their ileum removed, and patients taking sulfasalazine (Azulfidine) should take folate.
For people who are having trouble maintaining their weight, or for children with poor growth, high-calorie and high-nutrient milkshake-type drinks, which can be purchased at drug stores, are recommended. Those who have had most of their small intestine removed sometimes develop a state of chronic malnutrition known as “short-bowel syndrome.” In such cases, supplemental nutrition provided intravenously may be needed at home.
If you feel you need help coping emotionally, talk with your doctor. Individual counseling, a support group, or antidepressant medications may be helpful.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery is an important adjunct to treatment. It is used to correct complications of the inflammatory process of Crohn's disease, such as obstructions and fistulas. Surgery is sometimes needed to relieve obstruction, to repair a perforation, to treat an abscess, or to close a fistula. In emergency situations, the need to operate is usually obvious. Otherwise, using surgery as a treatment for Crohn's disease is a difficult decision requiring careful consultation with surgeons experienced with the disease. Most doctors and patients would prefer to treat it with medications if possible, but waiting too long to operate can allow life-threatening conditions to develop.
Most surgeons experienced with treating Crohn's disease feel that more conservative surgery is generally the best option. Most would prefer to repair damage as best they can without taking out a lot of the bowel. In some cases, however, the entire colon needs to be removed. Feces are then excreted into a disposable bag that the patient attaches on the outside of the body. Most colostomy systems are well designed these days, and should not smell bad or even be noticeable to others. Patients should be able to enjoy an active life that includes swimming and other sports as well as sexual relations. Special close-fitting bands that fit around a person's trunk are available for those who wish to hide a colostomy when not wearing a shirt.
Women with Crohn's disease may have children, but the pregnancy should be watched carefully. Women with Crohn's disease used to be advised not to have children, but now most can safely do so. If the disease is inactive, most women have no special problems during pregnancy. If active disease is present, women have higher rates of miscarriage, premature deliveries, and babies born below normal weight. However, with proper medical care, these problems can usually be handled with a successful outcome.
Treatment of pregnant women with active disease should be managed carefully with the help of a gastroenterologist. X-ray studies and colonoscopy should be avoided. Although the use of medications during pregnancy is always of concern, in most cases the risks from untreated, active Crohn's disease are greater than the risks of drug treatment. Corticosteroids and sulfasalazine (Azulfidine) have been safely used in pregnancy, but immunosuppressant drugs should not be used if possible.
The use of non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen to control joint symptoms may worsen other symptoms of Crohn's disease. Crohn's disease sometimes also causes inflammation in the joints. Doctors usually recommend non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin (Bayer), ibuprofen (Advil), and naproxen (Aleve), although unfortunately these drugs have a tendency to make inflammation worse within the intestines.
Crohn's disease is a serious, chronic, and recurring disease. Fortunately, with good medical care, most patients do well most of the time. Crohn's disease is serious, but is not considered to be a terminal illness. The rare deaths are associated with the risks of surgery. With proper use of medications and appropriately timed surgery, most people with Crohn's disease can keep the disease in check most of the time. It is important to have a doctor experienced with the disease in order to provide the most advanced treatments and recommend surgery when appropriate.
There is a controversial association between Crohn's disease and cancer. Ulcerative colitis is associated with an increased risk of colon cancer. Whether patients with Crohn's disease develop this cancer at a higher-than-average rate, however, is not well studied. To be safe, most doctors screen patients with longstanding Crohn's disease for colon cancer with periodic colonoscopy.
Crohn's patients are known to have an increased risk for cancer of the small intestine. Because this cancer is so rare, the risk is still very small. There are no practical screening methods for this type of cancer.
Patients need to keep in close contact with their gastroenterologist. Patients with Crohn's disease should see their gastroenterologist annually, even if they are well. Any change in symptoms or alterations in medications should at least be reported with a phone call.
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