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Crohns sykdom: Behandling

Sykdommen lar seg ikke kurere verken med medisiner eller kirurgi. Hensikten med behandlingen er å oppnå sykdomskontroll og vedlikeholde denne. Det er også viktig å motvirke komplikasjoner som arrdannelser med innsnevringer på tarmen.

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Generelt gjelder at det er viktig med næringsrik mat og tilstrekkelig kaloritilførsel. Betennelsen i tarmen fører til noe redusert opptak av næring, i tillegg til at selve betennelsesprosessen øker næringsbehovet. Dette må kompenseres ved økt tilførsel. Det kan dessuten bli nødvendig med langvarig tilskudd av folsyre, jern, vitamin B12, vitamin-A, vitamin-D, vitamin-K, kalium, kalsium og magnesium.

Medikamenter er viktige for å dempe betennelsen. Kortikosteroider, immundempende og biologiske medisiner er hjørnestenene i legemiddelbehandlingen.

  • Steroider benyttes som regel i starten av en sykdomsoppblussing og brukes i noen uker som betennelsesdemping for å få pasienten over i en bedre fase.
  • Immundempende medisiner har langsomt innsettende effekt, men de bidrar både til å få sykdommen til å falle til ro, og til å forebygge tilbakefall. 
  • Biologiske medisiner er en ny gruppe medisiner som ser ut til å bedre langtidsprognosen ved sykdommen. Disse medisinene brukes i økende grad og tidligere i sykdomsforløpet enn slik det var før. 

Biologiske medisiner som infliximab og adalimumab (TNF-alfa hemmere), samt vedolizumab og ustekinumab blir i økende grad anvendt hos pasienter som ikke reagerer på konvensjonelle medisiner, eller hvor man ikke klarer å redusere eller stanse bruken av kortikosteroider. Biologiske medisiner gir langt bedre effekt og mindre bivirkninger enn immundempende medisiner som azatioprin eller metotreksat, som brukes stadig mindre.

Hos barn har man sett god effekt av kurer med eksklusiv enteral ernæring (EEN) for å få sykdommen til å falle til ro. Denne behandlingen går ut på at man ikke spiser vanlig mat, men får dekket hele næringsbehovet gjennom flytende næringsløsninger (sondemat). Selv hos barn med relativt utbredt sykdom, har denne behandlingen vist effekt på linje med steroider. Hvorfor denne behandlingen fungerer, vet vi ikke.

Legene prøver fortrinnsvis å holde sykdommen i sjakk med medisiner, men de fleste pasienter med Crohns sykdom har frem til nå endt opp med å måtte opereres minst én gang. Dette gjelder først og fremst dersom det danner seg innsnevringer i tarmen som hindrer fri passasje av tarminnhold. Ved slike operasjoner fjerner man deler av tarmen, eller man behandler komplikasjoner som forsnevringer, fisteldannelse, abscess eller blødninger. Imidlertid kan det se ut til at introduksjonen av biologiske medisiner fører til at færre må opereres.

Røykestopp er viktig. Dersom du røyker, er risikoen for oppblussing av sykdommen klart høyere enn blant dem som ikke røyker.

Dette dokumentet er basert på det profesjonelle dokumentet Crohns sykdom . Referanselisten for dette dokumentet vises nedenfor

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