Confirmation of Diagnosis
Diagnosis of Crohn’s disease is based on several factors including a thorough medical history, clinical manifestations, physical exam and lab values. Diagnosis is also confirmed through diagnostic endoscopic and imaging studies of the bowel. These include colonoscopy, barium studies, wireless capsule endoscopy, computed tomography (CT), and magnetic resonance (MR) enterography. The CT scan can be helpful with the initial diagnosis of the disease, to determine the extent and location of the disease and to rule out abscess or perforation. MR enterography is used to help determine the location of the diseased bowel. (Smith & Harris, 2014)
Figure 9. Key Lab Finding in Patients with Crohn Disease (Smith & Harris, 2014)
Evidence-Based Management
While there is no definitive cure for Crohn’s disease, the focus is on treating the symptoms associated with this disease by using several different medications. There are four major classes of drugs that are normally used to treat Crohn’s disease. These include aminosalicylates, corticosteroids, immunomodulators and biologic therapies. All of these medications are designed to suppress the inflammatory response while decreasing flare up symptoms and maintaining remission.
Aminosalicylates contain 5-aminosalicyclic acid and specifically help control inflammation. Some examples of aminosalicylates include balsalazide, mesalamine, olsalazine and sulfasalazine. Corticosteroids aid in the suppression of the immune system and decrease inflammation. These drugs include budesonide, hydrocortisone, methylprednisolone and prednisone. Immunomodulators lessen activity of the immune system causing a decrease in inflammation of the GI tract. Examples of immunomodulators include 6-mercaptopurine, azathioprine, cyclosporine and methotrexate. Lastly, biologic therapies target a specific protein made by the immune system that will decrease inflammation particularly in the intestine. These include adalimumab, certolizumab, infliximab, natalizumab and vedolizumab.
Dietary modifications are also an important way to control signs and symptoms of the disease. Some foods have been shown to exacerbate symptoms of Crohn’s disease. Limiting the amount of dairy and high fat foods in the diet as well as staying hydrated can help with the exacerbation of symptoms.
Smoking cessation should also be encouraged for patients who smoke. Smoking has been shown to worsen the progression of the disease, encourage fistula formation and inhibit the outcome of medical therapies.
Surgery is commonly performed to manage the complications that arise from Crohn’s disease. Most patients will require at least one (if not multiple) surgeries at some point in their life. Anal fissures, perianal abscesses and fistulas, which can occur in up to 30% of Crohn’s patients, are complications that can require surgery. Surgery can also be indicated for removing diseased bowel and forming colostomies. (McCance & Huether, 2014; Smith & Harris, 2014)
Figure 10. Drugs Commonly Prescribed for Crohn Disease ( Smith & Harris, 2014)