Crohn’s Disease Treatment Options For Health Professionals
You’ll hear more emphasis on how to treat Crohn’s disease in kids…due to a growing incidence and new guidelines.
Uncontrolled Crohn’s disease in kids combined with low food intake can impair growth…and impact psychological well-being.
The goal of therapy is to promote intestinal healing through induction and maintenance treatments.
For induction, it’s reasonable for kids to start with exclusive enteral nutrition…a liquid, formula-based diet with no solid foods.
If meds are needed, consider aminosalicylates (5-ASA, etc) only for very mild colonic disease.
Otherwise, recommend Entocort® (budesonide) for mild to moderate disease in the ileum or right colon. It has fewer side effects compared to prednisone…since very little active drug is absorbed into the blood.
But for more diffuse Crohn’s Disease , recommend prednisone instead.
For maintenance, point to oral thiopurines (6-mercaptopurine, azathioprine) or weekly subcutaneous methotrexate.
Recommend ways to manage side effects. For example, suggest folic acid supplementation with methotrexate to limit mouth sores, etc…and pre-dosing with ondansetron if needed for nausea or vomiting.
Expect biologics (Remicade, Humira, Stelara) to be saved for induction or maintenance in kids with severe disabling disease…or who fail other options. This is different than the “top-down” approach we’re seeing in adults…until biologics are studied more in kids.
Reserve antibiotics (metronidazole, etc) for complex cases of Crohn’s Disease …such as kids with anal fistulizing disease…due to concerns of adverse effects and developing antibiotic resistance.
Discourage alternative health products, such as cannabis or probiotics…since there’s no good evidence of benefit and they could potentially delay using more effective therapies.