Crohn's Disease Treatment
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.

Originally developed as an arthritis treatment, its efficacy for inflammatory bowel diseases like ulcerative colitis and Crohn's disease was discovered. Since then, it has become a widely used primary medication for these conditions.

The exact mechanism by which this drug works for ulcerative colitis or Crohn's disease is not clearly understood, and it is used without a precise knowledge of its action mechanism. It is mainly used in the mild initial stages.

Limitations and Recurrence

In cases of initial ulcerative colitis, remission may be induced for 1–2 years upon first use, but recurrence generally occurs after 1–2 years even with continued use. Often, even if the dosage is increased after recurrence, remission is not easily re-induced.

Side Effects

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

Step 02

2. Steroids

Although powerful anti-inflammatories, their severe side effects make long-term use impossible.

Main Medication Used: Powerful steroids like Prednisolone are frequently used. (Brand name: Solondo)
Steroids are potent anti-inflammatory agents; because they strongly suppress inflammation, symptoms often improve upon taking them. Treatment generally starts with 6–8 tablets (5mg each) of Solondo per day.

Tapering

However, because steroids come with severe side effects, they cannot be taken for long periods. Therefore, usually, the medication is gradually reduced by one tablet per week until it is discontinued—a process called tapering. The internationally recommended duration for steroid use is 4 weeks. In a typical regimen, one starts with 6 or 8 tablets and tapers off over 6 to 8 weeks.

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

Administration is by no means a cure

Steroid administration is never a cure; it should be viewed only as a way to temporarily extinguish an urgent fire.

Severe Side Effects with Long-term/Overdose Use
Cushing's Syndrome / Moon Face
Cardiomegaly / Hypertension / Diabetes
Osteoporosis
Depression / Memory Loss
Hair Loss / Hirsutism
Stretch Marks / Thinning Skin
Skin Ulcers / Bruising
Menstrual Irregularity / Adrenal Insufficiency
Medication example image
Step 03

3. Immunosuppressants

Product Names: Azathioprine, Imuter, Purinethol, Imuran, etc.

Due to the severe side effects of steroids, which prevent long-term use, these agents are used with the goal of 'maintaining remission without steroids.'

Rather than directly suppressing inflammation, they suppress immunity to reduce inflammation. However, they are often not very effective in actual clinical practice. Long-term use of immunosuppressants can lead to compromised immunity, making the body susceptible to simple illnesses like the common cold.

Major Side Effects and Risks
  • Mild Side Effects: Severe fatigue, loss of appetite, nausea, vomiting, and hepatotoxicity.
  • Severe Side Effects: Suppression of bone marrow leading to a decrease in white blood cell and platelet counts. This may cause life-threatening issues such as sepsis or myelodysplasia.
Management and Response: When using immunosuppressants, regular blood tests are required every 1–2 months to monitor white blood cell (WBC) counts. During the treatment of ulcerative colitis or Crohn's disease, white blood cell counts may drop due to the use of immunosuppressants. In such cases, taking Korean herbal medicine can improve symptoms, and discontinuing the immunosuppressant will allow the white blood cell count to return to normal.
Step 04

Biologic (Injectable) Agents and Targeted Oral Therapies

These are used when oral medication is not sufficiently effective. Traditionally, they were developed as injectable forms, but recently, oral forms have also been developed. As existing biologics are not always effective, new drugs are continuously being developed.

Anti-TNF agents

4.1 TNF-α InhibitorsRemicade, Remsima, Humira, Simponi

Action: Inhibits TNF-α (tumor necrosis factor), an inflammatory cytokine active in our body, thereby blocking factors that cause tumor cell necrosis.

Administration and Maintenance: Administered after the 1st dose at 2, 4, and 8-week intervals. Efficacy lasts from 3 months to a maximum of 5 years; if antibodies against the drug are generated, efficacy is lost.

Features: Latent tuberculosis screening is mandatory. Available as intravenous or subcutaneous self-injection.

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

Anti-IL agents

4.2 Interleukin InhibitorsStelara

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

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

Administration: Subcutaneous injection administered at 8 or 12-week intervals following an initial intravenous dose.

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

Gut-selective

4.3 Integrin InhibitorsKinteles (Entivio)

Action: A monoclonal antibody targeting α4β7 integrin, selectively blocking the migration of lymphocytes to the intestinal mucosa.

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

Administration: Administered by intravenous injection only.

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, directly inhibiting the action of various inflammatory cytokines inside cells.

Features: Convenient to use as an oral drug and provides rapid results, but is absorbed systemically, suppressing signaling in immune cells not only in the gut but throughout the entire body.

Side Effects: Upper respiratory infections, headache, acne, gastrointestinal symptoms. Serious side effects include shingles, thrombosis, pulmonary embolism, cardiovascular risks, and cancer incidence.

Last Resort

5. Bowel Resection Surgery

If all treatments including 5-ASA, steroids, immunosuppressants, and biologics are unsuccessful and inflammation remains severe, bowel resection surgery is performed. In the case of Crohn's disease, surgery is necessary when complications like bowel stricture, perforation, or fistula occur.

Stat 1
20~40%

Rate of first surgery within 3 years

Stat 2
80%

Surgery rate for Crohn's disease within 20 years

Stat 3
28%

5-year re-operation rate for surgical patients

Stat 4
68%

Additional surgery within 2 years for re-operated patients

Consequences of Repeated Small Bowel Surgery

  • Resection Limits: Since an adult's small intestine is about 6–7m in length, resecting 30–59cm does not typically cause major problems for daily life.
  • Short Bowel Syndrome: However, after one surgery, recurring inflammation often leads to 2nd or 3rd surgeries. If the small intestine becomes too short, severe impairment in nutrient absorption and digestion occurs.
  • Adhesions and Chronic Indigestion: In open surgery, damage to the mesentery can cause the bowel to adhere to the abdominal wall, leading to bowel motility problems and lifelong chronic indigestion.

Quality of Life After Colon/Rectal Resection

  • Ostomy (Stoma): In cases of total colectomy or rectal removal, an artificial anus (stoma) is created in the abdomen. Patients wear a colostomy bag for 2–3 years, after which a reversal surgery is performed to reconnect the bowel to the anus.
  • Chronic Diarrhea: If more than 2/3 of the colon or the entire colon is removed, the organ responsible for forming solid stool is lost, resulting in lifelong diarrhea.
  • Frequent Bowel Movements: Since digestive waste from the small intestine is expelled immediately, patients suffer from diarrhea 4–6 times a day at best, and up to 15–20 times a day at worst.

"The bowel you cut away will not grow back."

If you are considering bowel resection surgery,
it is highly recommended to consider Korean Medicine as a final alternative.

Inquiry

F.A.Q

Frequently Asked Questions

Loading FAQ data...
Inquiry AI