Crohn's Disease Treatments London

Treatment of Crohn's Disease and Ulcerative Colitis in London

At present, the cause of these Crohn's Disease and Ulcerative Colitis is not known. However, as one of the main features is an over-reactive immune system in the intestine, most successful treatments are aimed at damping this down. In UC, but also in CD, this can often involve simple medicines, e.g. Mesalazine, which reduce inflammation within the gut wall and are only minimally absorbed into the body. These can be given as oral medicine or, when the inflammation is in the rectum or last part of the colon, suppositories or enemas can deliver the medicine more effectively.

There is increasing interest in targeting the bacterial flora in the intestine. Antibiotics can certainly be effective in a flare-up of CD, or where there is a definite infection. Probiotics (Bifidobacteria, lactobacilli etc) may be of benefit, especially in UC.

When the symptoms and inflammation in the gut is more severe, stronger medicines are needed. These include steroids which are the usual first choice medicine for reducing severe symptoms and inflammation quickly. Steroids have significant side effects particularly if used long term and are therefore only used as short courses. In UC, this is usually enough to return the condition to a level where mesalazine will help keep the condition in remission. In CD, however, stronger treatment is needed more often. This takes the form of immunosuppressive drugs such as azathioprine, 6-mercaptopurine and methotrexate.

Immunosuppressive drug treatment

To many patients, the thought of suppressing the immune system does not sound very good when first mentioned as a treatment option. However, CD and UC, as above, are conditions in which the immune system in the gut is over-active, and suppressing this makes perfect sense as a logical treatment approach. Also, the level of immunosuppression induced by drugs (azathioprine, 6-mercaptopurine, methotrexate and others) is not actually that significant. The risk of getting infections, for example, is only increased a little. The drugs do need to be monitored to make sure the immune system is not over suppressed and therefore regular blood tests are needed. Blood tests before starting can also identify certain people who should only have reduced doses of azathioprine (TPMT testing). A lot more is now known about how to tailor the dose of these drugs to individuals (one of Dr. Sanderson’s particular areas of expertise).

Importantly, immunosuppressive drugs are effective in inducing and maintaining remission and helping to come off or avoid steroids. Used properly, they are an essential part of the successful treatment of CD and UC (especially CD).

Anti-TNF agents and biologic agents

These have been available for many years now and form an important part of the management of more severe CD and to some extent UC. The treatments involve infusions or injections of antibodies which target TNF, one of the main mediators of the inflammation in CD and UC. These treatments can be very effective but can also cause side effects such as infection or allergic reactions. They are reserved for more severe cases where the balance of risk versus benefit falls strongly in favour of benefit. There is a move towards earlier use which is more controversial but may be important to avoid complications or operations.

Surgery

Operations (surgery) is a vital part of successful treatment of CD and UC. Up to half of people with CD will need an operation at some stage because of the tendency of segments of the intestine affected by the condition to become narrowed by scar tissue. This causes a blockage in the intestine for which surgery is usually the only effective treatment. In UC, surgery is needed less often but in some cases, the inflammation is so severe, and life threatening, that the colon has to be removed. This can also happen when UC does not respond well to medicines over many years and a patient’s quality of life would be hugely improved by removing the colon (which is effectively a cure for UC as it only affects the colon).

Many people worry about surgery meaning they will have a stoma bag. This is, in fact, rare nowadays. Many people need a stoma bag temporarily (for several months for example) in the recovery phase from delicate surgery but permanent stoma bags are fortunately now needed very rarely.

It is important to view surgery in its proper place – it is not a last ditch option – rather it is an important part of the treatment of CD and UC along with other treatments. Done at the right time, it can be one of the best means of getting a patient’s life back on track.

The overall outlook in Crohn's Disease and Ulcerative Colitis

Overall, the prognosis in Crohn's Disease and Ulcerative Colitis is very good. Whilst the condition is causing problems, work or school is obviously affected and a normal life is difficult. However, most of the time people are well and it is said the average is to have a flare up every 2 years or so. Life expectancy is close to normal.

Crohns Disease Patient support

The National Association for Colitis and Crohn’s offer an excellent support service and can be contacted on www.nacc.org.uk

Dr Jeremy Sanderson has a specific interest and expertise in the management of CD and UC and receives many referrals for opinions on patients. His approach has always been to consider any option and to try and get every patients life back on track in the way they would have liked. Many people have misconceptions about the disease and its treatment and it is often by resolving these that

How do I get treatment?

To get further information or treatment, please contact one of our consultants at The London Bridge Digestion centre, on:

tel: +44 (0) 20 7403 3814
email:
admin@londondigestion.co.uk