Omeprazole, sucralfate and H2 blockers can partially or completely eliminate the symptoms of Crohn’s disease. Mesalazine long-acting begins to be released in the proximal part of the small intestine, so it can be used for duodenal ulcers. However, the effectiveness of the drug is not confirmed by clinical trials.
If these drugs are not enough, prescribe prednisone. In the absence of the effect of therapy with glucocorticoids or with the development of steroid dependence, azathioprine or mercaptopurine is used.
With stricture of the duodenum, long-term results are obtained by balloon dilatation.
With asymptomatic flow or minimal manifestations of Crohn’s disease, treatment is started with 5-aminosalicylic acid derivatives. With ileitis, sulphasalazine is ineffective, perhaps because its bacteria require bacteria that live in the large intestine. With ileitis, mesalazine (4 g day inside) helps.
Treatment with derivatives of 5-aminosalicylic acid begins with a small dose, which with good tolerance is gradually increased.
In colitis and ileocolitis, sulfasalazine and mesalazine can help achieve remission; Improvement occurs after 2-4 weeks.
With ileitis, which is not amenable to treatment with derivatives of 5-aminosalicylic acid, it is possible to try to prescribe antimicrobial therapy.
With ileocolitis or colitis appoint metronidazole at an initial dose of 10 mg kg day inward, with good tolerability gradually increasing it to 20 mg kg day. The clinical effect develops after 3 to 4 weeks; Longer doses of metronidazole may cause neuropathy. Sometimes used ciprofloxacin and clarithromycin.
Glucocorticoids are prescribed for severe systemic manifestations and ineffectiveness of 5-aminosalicylic acid derivatives and antimicrobial agents. Prednisone is prescribed internally at an initial dose of 30-60 mg day, depending on the patient’s condition. It is best to begin treatment with 60 mg day for 10 days, and then gradually reduce the dose.
Justified the use of poorly absorbed glucocorticoids. In two controlled clinical trials, long-acting budesonide made it possible to achieve remission in 50% of patients. This drug is superior in strength to prednisone; Most budesonide is disintegrated on first passage through the liver, which reduces its concentration in the systemic circulation. In general, with Crohn’s disease budesonide is inferior in effectiveness to glucocorticoids for systemic use.
In severe course of ileolitis or colitis, emergency hospitalization for parenteral nutrition, infusion therapy, intravenous administration of glucocorticoids, and possibly antimicrobial therapy may be required. Such patients should beware of the development of anemia, severe intestinal bleeding and toxic megacolon.
For maintenance treatment, 5-aminosalicylic acid derivatives are used, although they are less effective than with ulcerative colitis. The use of glucocorticoids to maintain remission is not fully established, but the abundance of side effects severely limits their use. Azathioprine and mercaptopurine are also used for maintenance therapy, especially in patients who achieved remission on the background of their administration.