Treatment of Crohn's disease
Western Medicine

Crohn's Disease
Western Medical Treatment

From medication to surgery, we examine the current status and limitations.

"Beyond symptom relief,
it is time to consider fundamental gut health."

Step 01

1. 5-ASA
(5-aminosalicylic acid)

Brand Names: Pentasa, Asacol, Mezavant, Salofalk, etc.
These are drugs in the sulfasalazine, mesalazine, and mesalamine classes. They are available in oral, suppository, and enema forms.

Initially developed as a treatment for arthritis, its efficacy for inflammatory bowel diseases such as ulcerative colitis and Crohn's disease was discovered. Since then, it has become a widely used foundational drug for ulcerative colitis and Crohn's disease.

It is not clearly understood how this medication produces effects on ulcerative colitis or Crohn's disease, and it is a drug used without an exact knowledge of its mechanism of action. It is mainly used in the mild initial stages.

Limitations and Relapse

In cases of initial ulcerative colitis, remission may be induced for about 1–2 years when first taken, but relapse generally occurs after 1–2 years even with continued use. After a relapse, there are many cases where remission is not induced again even if the dosage is increased.

Side Effects

Side effects include headache, dizziness, abdominal pain, fever, dermatitis, hair loss, hepatotoxicity, nephrotoxicity, and darkening of urine, most of which are relatively mild.

Step 02

2. Steroids

Although they are powerful anti-inflammatory agents, long-term use is impossible due to serious side effects.

Commonly Used Medication: Prednisolone, a potent steroid, is frequently used. (Brand name: Solondo)
Steroids are potent anti-inflammatory agents, so symptoms often improve after taking them because they strongly suppress inflammation. Generally, treatment starts with taking 6–8 tablets of 5mg Solondo daily.

Tapering

However, because steroids are accompanied by serious side effects, they cannot be taken for a long time. Therefore, in general cases, the dosage is reduced by 1 tablet per week until they are discontinued, a process called tapering. The internationally recommended duration for steroid use is 4 weeks. It is a method of starting with 6 or 8 tablets and reducing by 1 tablet per week to discontinue them after 6 or 8 weeks.

* Even if inflammation is suppressed using steroids, generally, when the dosage is reduced to about 1–2 tablets, symptoms often worsen again, or in long-term cases, symptoms recur about 1–2 months after stopping the steroids.

Administration is never a cure

Steroid administration is never a cure; it should be thought of as merely extinguishing an urgent fire.

Serious Side Effects from Long-term/High-dose Use
Cushing's Syndrome / Moon Face
Cardiomegaly / Hypertension / Diabetes
Osteoporosis
Depression / Memory Loss
Hair Loss / Hirsutism
Skin Striae / Skin Thinning
Skin Ulcers / Vascular Weakness Bruising
Menstrual Irregularity / Adrenal Insufficiency
Example image of medication
Step 03

3. Immunosuppressants

Brand names: Azaprine, Immutera, Purinethol, Imuran, etc.

Due to the serious side effects of steroids, they cannot be used for long-term treatment; these are agents used with the goal of 'maintaining remission without steroids.'

Rather than directly suppressing inflammation, they work by suppressing immunity to reduce inflammation. However, in actual clinical practice, they are often not that effective. If immunosuppressants are used long-term, problems arise where immunity drops, making the patient vulnerable to simple illnesses like the common cold.

Major Side Effects and Risks
  • Mild Side Effects: There are side effects such as severe fatigue, loss of appetite, nausea, vomiting, and hepatotoxicity.
  • Serious Side Effects: Reduction in white blood cell and platelet counts due to bone marrow suppression. Side effects such as sepsis or myelodysplasia may occur.
Management and Coping: When using immunosuppressants, regular blood tests should be conducted every 1–2 months to check white blood cell (WBC) levels. During the treatment of ulcerative colitis or Crohn's disease, a situation where WBC counts decrease due to the use of immunosuppressants can occur. In this case, by taking herbal medicine to improve symptoms and stopping the intake of the immunosuppressant, the WBC count will return to normal.
Step 04

Biologic (Injectable) Agents and Targeted Oral Therapies

These are agents used when oral medication is not sufficiently effective. While many were initially developed in injectable form, they have recently been developed in oral form as well. Because the effects of existing biologics are not sufficient, new drugs are constantly being developed.

Anti-TNF agents

4.1 TNF-α InhibitorsRemicade, Remsima, Humira, Simponi

Action: Blocks the factor that kills cancer cells by inhibiting TNF-α (tumor necrosis factor), an inflammatory cytokine active in our body.

Administration & Maintenance: Administered after the 1st dose at 2-week, 4-week, and 8-week intervals. The duration of effect is from 3 months to 5 years at most, and if antibodies to the drug are generated, effectiveness is lost.

Features: Latent tuberculosis testing is mandatory, and there are subcutaneous self-injection methods in addition to intravenous injections.

Side Effects: Viral and respiratory infections, indigestion, vomiting, nausea. Increased cancer incidence with long-term use (especially lymphoma).

Anti-IL agents

4.2 Interleukin InhibitorsStelara

Action: Inhibits IL-12 and IL-23, which induce immune inflammatory responses. It binds to the p40 subunit to reduce Th1 and Th17 immune responses.

Features: Unlike TNF-α inhibitors, it performs selective immune modulation, resulting in relatively less systemic immune suppression.

Administration: Subcutaneous injection is performed at 8-week or 12-week intervals after the initial intravenous injection.

Side Effects: Upper respiratory infections, headache, injection site pain, and fatigue are common; there is a risk of severe infection or increased cancer incidence.

Gut-selective

4.3 Integrin InhibitorsEntyvio

Action: A monoclonal antibody targeting α4β7 integrin, selectively blocking lymphocyte migration to the gut mucosa.

Features: A gut-selective immunosuppressant that suppresses only local inflammation of the gut mucosa, resulting in a relatively lower risk of infection and systemic side effects.

Administration: Available only by intravenous injection.

Side Effects: Headache, nausea, arthralgia, fatigue, and upper respiratory infections are common side effects.

Oral / Janus Kinase Inhibitors

4.4 JAK Inhibitors (Oral)Xeljanz, Rinvoq

Action: Blocks the intracellular JAK signaling pathway to directly inhibit the action of various inflammatory cytokines inside cells.

Features: Convenient to use as an oral medication and effective quickly, but it is absorbed systemically and suppresses signaling not only in the gut but also in systemic immune cells.

Side Effects: Upper respiratory infection, headache, acne, gastrointestinal symptoms. Serious side effects include shingles, thrombosis, pulmonary embolism, cardiovascular disease, and cancer risk.

Last Resort

5. Bowel Resection Surgery

If symptoms do not improve and inflammation is too severe even after using all 5-ASA agents, steroids, immunosuppressants, and biologics, bowel resection surgery is performed. In the case of Crohn's disease, surgery is required when intestinal stricture, perforation, or fistula occurs.

Stat 1
20~40%

First surgery within 3 years

Stat 2
80%

Surgery rate within 20 years of Crohn's

Stat 3
28%

Reoperation rate within 5 years

Stat 4
68%

Additional surgery within 2 years for reoperated patients

Results of Repeated Small Bowel Surgeries

  • Resection Limits: Since the entire small intestine of an adult is about 6–7m, no major problems in daily life occur if about 30–59cm of the small intestine is resected.
  • Short Bowel Syndrome: However, there are frequent cases where a 2nd or 3rd surgery is performed because inflammation recurs in the surrounding area after the first surgery; if the small intestine becomes too short, major disabilities in nutrient absorption and digestion occur.
  • Adhesions and Chronic Indigestion: When open surgery is performed, the mesentery at the surgical site is damaged, causing the bowel to adhere to the abdominal wall; this leads to problems in intestinal motility, resulting in chronic indigestion for the rest of one's life.

Quality of Life after Colon/Rectal Resection

  • Artificial Anus (Stoma): In cases where the entire colon or the rectal area is removed, an artificial anus is brought out to the abdomen, and the patient lives with a stool bag for about 2–3 years before undergoing surgery to reconnect it to the anus.
  • Chronic Diarrhea: If more than 2/3 of the colon is resected or the entire colon is resected, the organ that creates stool is gone, so the patient will have diarrhea for life.
  • Frequent Bowel Movements: Since food residue from the small intestine is excreted directly, the patient must live with diarrhea every day, ranging from 4–6 times, or up to 15–20 times at most.

"A removed bowel does not grow back."

If you have been considering bowel resection surgery,
it is strongly recommended that you consider Korean medicine treatment as your last resort.

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