Crohn's Disease (cont.)

Dietary changes and supplementation that may help control Crohn's disease.

• 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 parenteral 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 antispasmotics also can help relieve symptoms of cramps and diarrhea.

Vaccination recommendations for individuals with Crohn's disease

It is recommended that adults with inflammatory bowel disease generally follow the same vaccination schedules as the general population.

They should receive a single dose of Tdap, then Td booster every 10 years.

Women between the ages of 9 and 26 should receive 3 doses of HPV vaccine (and consideration should be given to older patients who are HPV negative on Pap smear). Men in the same age range should also consider being vaccinated given the increased risk of HPV with immunosuppression.

The influenza (flu) vaccine should be given annually to all patients (though the live intranasal vaccine is contraindicated in patients on immunosuppressive therapy).

One dose of pneumococcal vaccine should be given between age 19-26 and then revaccination after 5 years.

If not previously vaccinated, all adults should receive 2 doses of hepatitis A vaccine and 3 doses of hepatitis B.

Meningococcal vaccine is only recommended for patients with anatomic or functional asplenia, terminal complement deficiencies, or others at higher risk (college students, military recruits, etc).

Mumps/measles/rubella, varicella, and zoster vaccines are contraindicated for patients on biologic therapy, as they are all live vaccines.¹¹

Other factors that may affect Crohn's disease

A recent study found that active smoking is a risk factor for Crohn's disease, and passive smoking can also contribute to a worse prognosis. Therefore, smoking cessation should be advised among patients with Crohn's disease.¹¹

Osteoporosis with markedly reduced bone mineral densities has also increasingly been recognized as a significant health problem in patients with inflammatory bowel disease. Screening with a bone density study is recommended in postmenopausal woman, men > age 50, patients with prolonged corticosteroid use (> 3 consecutive months or recurrent courses), patients with personal history of traumatic fractures with minimal trauma, and patients with hypogonadism¹¹. Most patients with inflammatory bowel disease should be taking calcium and vitamin D supplements.

Source: MedicineNet.com
http://www.medicinenet.com/crohns_disease/article.htm