Information on Crohn's Disease Symptoms, Causes, Diagnosis, and Treatment by MedicineNet.com

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Crohn's Disease

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Methotrexate (Rheumatrex, Trexall)

Methotrexate (Rheumatrex, Trexall) is both an immuno-modulator and antiinflammatory medication. Methotrexate has been used for many years in the treatment of severe rheumatoid arthritis and psoriasis. It has been helpful in treating patients with moderate to severe Crohn's disease who are either not responding to azathioprine and 6- MP or are intolerant of them. Methotrexate also may be effective in patients with moderate to severe ulcerative colitis who are not responding to corticosteroids, azathioprine, or 6-MP. It can be given orally or by weekly injections under the skin or into the muscles, but it is more reliably absorbed with the injections.

One major complication of methotrexate is the development of liver cirrhosis when the medication is given over a prolonged period of time (years). The risk of liver damage is higher in patients who also abuse alcohol or are severely obese. Although it has been recommended that a liver biopsy should be obtained in patients who have received a cumulative (total) methotrexate dose of 1.5 grams or higher, the need for such biopsies is controversial.

Other side effects of methotrexate include low white blood cell counts and inflammation of the lungs.

Methotrexate should not be used in pregnant women because of toxic effects on the fetus.

Surgery in Crohn's disease

There is no surgical cure for Crohn's disease. Even when all of the diseased parts of the intestines are removed, inflammation frequently recurs in previously healthy intestines months to years after the surgery. Therefore, surgery in Crohn's disease is used primarily for:

Removal of a diseased segment of the small intestine that is causing obstruction.

Drainage of pus from abdominal and peri-rectal abscesses.

Treatment of severe anal fistulae that do not respond to drugs.

Resection of internal fistulae (such as a fistula between the colon and bladder) that are causing infections.

Usually, after the diseased portions of the intestines are removed surgically, patients can be free of disease and symptoms for some time, often years. Surgery, when successfully performed, can lead to a marked improvement in a patient's quality of life. In many patients, however, Crohn's disease eventually returns, affecting previously healthy intestines. The recurrent disease usually is located at or near the previous site of surgery. In fact, 50% of patients can expect to have a recurrence of symptoms within four years of surgery. Drugs such as Pentasa or 6-MP have been useful in some patients to reduce the chances of relapse of Crohn's disease after surgery.

General measures

General measures which may help control Crohn's disease include dietary changes and supplementation. Since fiber is poorly digestible, it can worsen the symptoms of intestinal obstruction. Hence, a low fiber diet may be recommended, especially in those patients with small intestinal disease. A liquid diet may be of benefit when symptoms are more severe. Intravenous nutrition or TPN (total peripheral nutrition) may be utilized when it is felt that the intestine needs to "rest." Supplementation of calcium, folate and vitamin B12 is helpful when malabsorption of these nutrients is apparent. The use of anti-diarrheal agents [diphenoxylate and atropine (Lomotil), loperamide (Imodium)] and anti-spasmotics also can help relieve symptoms of cramps and diarrhea.