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 think about 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, their effectiveness against inflammatory bowel diseases like ulcerative colitis and Crohn's disease was discovered. Since then, they have become widely used as a standard foundational medication for ulcerative colitis and Crohn's disease.

It is not clearly understood how these drugs produce their effects on ulcerative colitis or Crohn's disease; they are currently used without a precise understanding of their mechanism of action. They are primarily used in mild, early-stage cases.

Limitations and Relapse

In cases of early-stage ulcerative colitis, for example, 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, even increasing the dosage often fails to re-induce remission.

Side Effects

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

Step 02

2. Steroids

They are powerful anti-inflammatory drugs, but long-term use is impossible due to severe side effects.

Commonly used drugs: Prednisolone, a powerful steroid, is frequently used. (Brand name: Solondo)
Steroids are powerful anti-inflammatory agents, so symptoms often improve after taking them because they strongly suppress inflammation. Treatment typically begins by taking 6–8 tablets of 5mg Solondo per day.

Tapering

However, since steroids are accompanied by serious side effects, they cannot be taken for a long time. Therefore, in general cases, the medication is gradually reduced by one tablet per week until it is discontinued; this process is called tapering. The international recommended duration for steroid use is 4 weeks. It is a method where you start with 6 or 8 tablets initially and gradually reduce by one tablet per week, stopping after 6 or 8 weeks.

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

Administration is never a cure

Steroid administration is never a cure; you should consider it merely as a way to put out an urgent fire.

Severe side effects from long-term, high-dose use
Cushing syndrome / Moon face
Cardiomegaly / Hypertension / Diabetes
Osteoporosis
Depression / Memory loss
Hair loss / Hypertrichosis
Skin striae / Thinning skin
Skin ulcers / Fragile vessels/bruising
Menstrual irregularities / Adrenal insufficiency
Medication Example Image
Step 03

3. Immunosuppressants

Product names: Imutera, Purinethol, Imuran, etc.

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

Rather than directly inhibiting inflammation, they suppress the immune system to reduce inflammation. However, in actual clinical practice, they are often not that effective. Long-term use of immunosuppressants causes problems where the immune system is weakened, making the patient vulnerable to even simple illnesses like the common cold.

Major side effects and risks
  • Mild side effects: Severe fatigue, loss of appetite, nausea, vomiting, hepatotoxicity, etc.
  • Severe side effects: Decrease in white blood cell count and platelets due to bone marrow suppression. This can lead to sepsis or bone marrow failure.
Management and Response: When using immunosuppressants, you must regularly undergo blood tests every 1–2 months to check white blood cell (WBC) counts. During the treatment of ulcerative colitis or Crohn's disease, the use of immunosuppressants can lead to a decrease in WBC counts. In such cases, while taking herbal medicine to improve symptoms, stopping the immunosuppressant allows the WBC count to return to normal.
Step 04

4. Biologics

Injectable agents used when oral medications are insufficient.
While mostly developed as injectables in the past, they are recently being developed and released in oral forms as well.

Because the effectiveness of existing biologics is insufficient, new biologics continue to be developed.

4.1 TNF-α Inhibitors

Anti-TNF agents

These agents inhibit TNF-α, an inflammatory cytokine active in our body. TNF stands for Tumor Necrosis Factor, so these can be seen as agents that inhibit the factor that causes tumor cells to necrose.

  • - Method: Effectiveness varies per individual; after the first dose, intervals are extended to 2, 4, and 8 weeks. Once stabilized, injections are administered at 8-week intervals. Due to the possibility of latent tuberculosis, a TB test is performed before injection. In addition to intravenous injections, there are subcutaneous self-injection methods.
  • - Limitations: The duration of effect ranges from as short as 3 months to as long as 5 years, and there is no case where the effect lasts more than 5 years due to the generation of autoantibodies.
  • - Side Effects: Viral infections, respiratory infections, indigestion, vomiting, nausea. Long-term use increases cancer incidence (especially lymphoma).

4.2 Interleukin Inhibitors

Anti-IL agents

Agents that inhibit IL-12 and IL-23, which induce immune inflammatory responses. They bind to the p40 subunit, blocking IL-12 and IL-23 cytokines from binding to receptors, thereby reducing Th1 and Th17 immune responses.

  • - Characteristics: Unlike TNF-α inhibitors, they feature more selective immune modulation, resulting in relatively less systemic immune suppression. Initially, intravenous injection is performed, followed by subcutaneous injection at 8 or 12-week intervals.
  • - Side Effects: Common side effects include upper respiratory infection, headache, injection site pain, and fatigue. Although rare, severe infections or increased cancer incidence, similar to TNF-α inhibitors, may occur.

4.3 Integrin Inhibitors

Anti-integrin agents

Monoclonal antibodies that target α4β7 integrin. By blocking the migration of immune cells to the gut mucosa to suppress inflammation, they can be considered gut-selective immunosuppressants.

  • - Characteristics: They bind to α4β7 integrin to selectively block lymphocyte migration to the gut mucosa. Since they only inhibit localized inflammation in the gut mucosa, the risk of infection and systemic side effects is relatively low. Only available via intravenous injection.
  • - Side Effects: Common side effects include headache, nausea, joint pain, fatigue, and upper respiratory infection.

4.4 JAK Inhibitors

Janus Kinase Inhibitors

Oral targeted immune modulators that directly inhibit the action of various inflammatory cytokines inside cells by blocking intracellular JAK signaling pathways. They block the activation of inflammatory cytokines from within the receptor.

  • - Action: The drug is absorbed systemically, inhibiting signal transduction not only in the gut but also in systemic immune cells. As an oral drug, it is easy to use and has the advantage of rapid onset of action.
  • - Side Effects: Common side effects include upper respiratory infection, headache, acne, and gastrointestinal symptoms. Serious side effects include increased risk of shingles, deep vein thrombosis, pulmonary embolism, cardiovascular risk, and cancer.
Last Resort

5. Bowel Resection Surgery

If symptoms remain uncontrolled and inflammation is too severe despite using 5-ASA agents, steroids, immunosuppressants, and biologics, bowel resection surgery is performed. In Crohn's disease, surgery is necessary when bowel stricture, perforation, or fistula occurs.

Stat 1
20~40%

Rate of first surgery within 3 years

Stat 2
80%

Rate of surgery within 20 years for Crohn's

Stat 3
28%

Re-surgery rate within 5 years for patients

Stat 4
68%

Additional surgery within 2 years for re-surgery patients

Consequences of repeated small bowel surgery

  • Resection Limit: Since the adult small intestine is about 6–7m in length, resecting 30–59cm does not cause major issues in daily life.
  • Short Bowel Syndrome: However, after the first surgery, inflammation frequently recurs in the surrounding areas, leading to 2nd and 3rd surgeries; if the small intestine becomes too short, significant impairment in nutrient absorption and digestion occurs.
  • Adhesions and Chronic Indigestion: In the case of open surgery, the mesentery at the surgical site is damaged, causing the bowel to adhere to the abdominal wall, which leads to chronic indigestion throughout life due to impaired bowel motility.

Quality of Life after Colon/Rectal Resection

  • Artificial Anus (Ostomy): If the entire colon is resected or the rectal area is removed, an artificial anus is brought out to the abdomen, and the patient lives with a stool bag for 2–3 years before undergoing surgery to reconnect it to the anus.
  • Chronic Diarrhea: If more than 2/3 of the colon or the entire colon is resected, the organ that creates stool is gone, resulting in lifelong diarrhea.
  • Frequent Bowel Movements: Food waste from the small intestine is discharged directly, so the patient must live with diarrhea at least 4–6 times a day, or even 15–20 times on many days.

"A removed bowel does not grow back."

If you are considering bowel resection surgery,
it is strongly recommended to consider Korean Medicine treatment as your final option.

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