Hospital therapy. Treatment of Crohn's disease (most important)

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Hospital therapy. Treatment of Crohn's disease (most important)

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49. Treatment of Crohn's disease

Treatment. A mechanically and chemically sparing diet is prescribed with a high content of proteins, vitamins, microelements, with the exception of milk in case of its intolerance, and the restriction of coarse plant fiber. The use of liquid enteral hydrolysates is shown.

Salazopreparations and corticosteroids form the basis of pathogenetic drug therapy. The daily dose of drugs is 3-6 g. With the localization of the pathological process in the large intestine, the activity of sulfasalazine exceeds the activity of prednisolone.

In the absence of the effect of the use of sulfasalazine, with lesions predominantly of the small intestine and pronounced signs of immune inflammation, as well as in the presence of systemic manifestations of the disease, the use of corticosteroids is indicated. The effect of their use is noted in the first 8 weeks from the start of treatment. Prednisolone is prescribed according to the following scheme: at the height of an exacerbation, 60 mg per day, then the dose is gradually reduced and by the 6-10th week is adjusted to a maintenance dose of 5-10 mg per day. Upon reaching clinical remission, the drug is gradually canceled. If remission is not achieved, treatment with prednisolone is continued on an outpatient basis until 52 weeks. In severe course of the disease, in case of complications in the form of torpid current rectovaginal, skin-enteral, entero-enteral fistulas, the appointment of 6-mercaptopurine orally at 0,05 g 2-3 times a day is indicated for 10-day courses with an interval of 3 days until reaching clinical remission. Subsequently, they switch to taking maintenance doses of the drug during the year. The dose of 6-mercaptopurine in this case is 75 mg per day. The effect of treatment with immunosuppressants can be determined no earlier than after 3-4 months.

Metronidazole has found widespread use in the treatment of Crohn's disease, the main indications for which are perianal fistulas and fissures, lack of effect from salazal drugs and glucocorticoids, as well as relapses of the disease after proctectomy. The drug is prescribed at a dose of 500-1000 mg per day. The duration of the continuous course should not exceed 4 weeks.

Symptomatic therapy for Crohn's disease is reduced to the prescription of short courses (2-3 days) of antidiarrheal drugs (imodium, loperamide). Doses are selected individually according to the clinical effect. Antidiarrheal drugs should not be prescribed for a long time (more than 5 days). Due to the presence of malabsorption syndrome in Crohn's disease, enzyme preparations that do not contain bile acids (pancreatin, mezim-forte, solisim, somilase) are used in a dose of 2 to 6 tablets with each meal. According to indications, anemia and hypoalbuminemia are corrected by prescribing iron supplements (parenterally) and administering alvesin, protein hydrolysers, aminopeptide, aminokrovin. Multivitamins are prescribed in pills and essentials in capsules. Treatment of dysbiosis is carried out according to general rules.

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