What are the goals in treating Crohn's disease?
The main goals in treating Crohn's disease are to:
- Induce remission
- Maintain remission
- Improve the patient's quality of life
- Minimize toxicity
There is no cure for Crohn's disease; it is a chronic illness that patients will be dealing with throughout their life. The goals of therapy are to control the inflammation and symptoms; get the patient feeling back to normal (induce remission), keep the patient feeling normal, and reduce the number of recurrent flares (maintain remission), with the least toxic medications (fewest side effects). By accomplishing this, the patient's quality of life is enhanced. The hope is that patients are able to live normal lives without any limitations related to their disease.
With the discovery of new, more powerful medications, the goals of treating Crohn's disease have evolved and expanded to include:
- Healing the intestinal mucosa
- Preventing the complications of Crohn's disease (fistulae, abscesses, cancer)
- Preventing hospitalization
- Preventing surgery
Recent data suggests that the immunomodulators and newer biologic therapies can heal the mucosa successfully in a significant number of patients. At least in the short term, the biologics have been associated with fewer hospitalizations and surgeries. However, these more powerful medications are also associated with potentially more significant toxicity. Balancing the risks and benefits of the medications becomes an extremely important issue for patients and physicians dealing with the treatment of Crohn's disease.
Since Crohn's disease tends to relapse, most patients will require long-term medication to sustain remission. The treatment of Crohn's disease requires a team of healthcare professionals including the primary care physician, gastroenterologist, and often a surgeon. A nutritionist, social worker, or psychologist may also be a part of the healthcare team if the situation dictates. The patients need to take an active role in their treatment. They should understand what their options are, how the medications work, what the side effects and toxicities of the medications are, and what the surgical options are. Most importantly, they should not be afraid to ask questions.