Is a diseases arising from an unknown cause that result to chronic inflammation of the intestinal organs. This is a transmural (anatomy passing through the wall of an organ or any other). The inflammatory condition affecting mainly the distal ileum or colon, but in some other case may affect the entire gastro-intestinal tract. Common symptom are intestinal obstruction and abscess (formation of pus surrounded by inflamed tissue).
GENERAL CAUSE OF CROHN’S DISEASE (CD)
Smoking cessation, as smoking is a strong predictor of deteriorate in health. Such patient should be refer to dietician for dietary advice.
MEDICINE TREATMENT
Antidiarrhoeal medication should not be apply in an acute flares (sudden recurrence or worsening of symptoms) of inflammatory CD. The diarrhoea will subside when appropriate care is given to the patient. After surgical removal of part of a terminal ileal, to reduce diarrhoea due to bile salt malabsorption, the following medication should be given:
Cholestyramine, oral, 2–8 g daily.
Ileal disease
All patients should be given
Vitamin B12, IM, 1 mg, 3 monthly.
Monitor for iron and folate deficiency.
For Colonic disease, the patient should given
Sulfasalazine, oral, 500 mg 12 hourly, up to 1.5 g 8 hourly.
Acute attacks: 1–2 g, 4–6 hourly.
Maximum dose: 3–4 g daily.
AND
Prednisone, oral, 1.5 mg/kg daily. Taper dose to lowest possible maintenance dose over 3–4 weeks.
For Severe case of disease
For maintenance of degree of the manifestations of the disease.
Sulfasalazine may be useful for maintaining degree of manifestations of the disease in patients with a crohn’s colitis but is of no real use in purely ileal CD. For patients with recurrent attacks of CD or those with extensive disease, i.e.
For Ileum and colon the following medication should be given under supervision by a specialist
Azathioprine, oral, 2 mg/kg daily.
OR
Methotrexate, oral, 15–25 mg weekly. Under specialist supervision
ALIMENTARY TRACT
PLUS
Folic acid, oral, 5 mg weekly with methotrexate.
Emergency management at specialist facility will include:
Resuscitation with parenteral fluids;
Blood transfusions;
Corticosteroids;
Antibiotics; and nasogastric suction as indicated.
Peri-anal disease
There is evidence of recurrence on withdrawal of therapy and prolonged treatment may be indicated.
Metronidazole, oral, 400–800 mg 8 hourly.
OR
Ciprofloxacin, oral, 500 mg 12 hourly.
REFERRAL
For further therapy.
Peri-anal abscesses/fistula if surgery is required after appropriate assessment.
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