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Crohn’s Disease

尝试一下，不是：浏览克罗恩治疗的技巧

From medication changes to lifestyle hacks, here are strategies to help you get the most out of your IBD treatment.

by拉拉·德桑托（Lara DeSanto） 卫生作家

December 14, 2022

Medical Reviewer

Mona Rezapour, M.D.

Getty Images/Courtney Hale

December 14, 2022

Medical Reviewer

Mona Rezapour, M.D.

While there’s no的解药Crohn’s disease这是一种炎症性肠病（IBD）的形式，有比以往任何时候都多的药物来帮助您管理症状并努力缓解。但是，通过许多策略进行筛选可能是压倒性的 - 克罗恩的治疗并不是一定程度的一切，并且与您的医疗保健团队合作，找到适合您的治疗计划，可以花一些时间。

The hopeful news? If one path to symptom relief isn’t cutting it, something else probably will. We spoke to Crohn’s experts to learn more about different approaches to consider when you feel your Crohn’s treatment isn’t working as it should.

尝试一下，然后用克罗恩的药物

“Ultimately, the goal of Crohn’s treatment is making someone feel better, making their symptoms go away, and really restoring quality of life to get someone back to what they love doing,” explains Brigid S. Boland, M.D., gastroenterologist at UC San Diego Health in San Diego, CA. To get there, your treatment will aim to heal existing ulcers and resolve inflammation in the GI tract to relieve symptoms like pain, diarrhea, and beyond, she says—and that’s where Crohn’s medications come in.

There are different classes of medications, according to theCrohn’s and Colitis Foundation of America(CCFA). If the first one on the list isn’t providing relief, your doctor will likely advance you to the next, and the next:

氨基白杨（5-ASA）。These drugs contain 5-aminosalicylic acid and aim to reduce inflammation in the GI tract. Typically, they are prescribed for mild-to-moderate Crohn’s cases. However, it's important to know that guidelines from theAmerican College of Gastroenterologyindicate that 5-ASAs show only a limited effect and aren't effective in maintaining long-term remission, so they're not recommended for long-term use.Over time, doctors have realized that the 5SA medications aren’t very effective, says Dr. Boland, so she doesn’t tend to use them in her own practice.也就是说，一些医生可能仍会开处方。

皮质类固醇。Steroids are often prescribed for Crohn’s as an acute treatment. They work by suppressing the immune system to reduce inflammation. Used long-term, they can have serious side effects, so they are usually limited to short-term use.

Immunomodulators.这种类型的药物还抑制了免疫系统以帮助减少炎症。通常，当上述两个选项不够有效时，它们会处方。

Biologics.Biologics是通过靶向体内某些引起炎症蛋白的实验室生长的抗体。由于其有效性，它们的流行程度越来越高，通常是针对克罗恩斯严重案件的规定。有几种不同的“生物制剂类别”以不同的方式起作用，包括抗肿瘤坏死因子（抗TNF），整联蛋白受体拮抗剂以及白介素12和-23拮抗剂。

Which medication your gastroenterologist prescribes depends on the specifics of your disease—for example, how severe it is, where inflammation is located in the GI tract, your symptoms, and more, explains Bing Zhang, M.D., a gastroenterologist specializing in IBD at Keck Medicine at the University of Southern California in Los Angeles, CA.

“If they are mild, we would treat them to make sure symptoms resolve, and they can choose to watch and wait,” Dr. Zhang says. “But if Crohn’s is moderate to severe, then we will put them on maybe a biologic, which is longer-lasting and can help prevent future flares.”

在您的治疗游戏计划中尝试一下（不是）

When you first start a new therapy for Crohn’s, you and your doctor should plan for how to monitor the treatment. “There should be a management strategy for how we are going to assess if it is working, setting up expectations about how long we think a therapy might take to work, what symptoms we are watching over time, and any other things we are watching like blood and stool tests as periodic markers of how things are going,” Dr. Boland says.

Once you and your doctor establish this plan, they will have clearer next steps for what to do if your therapy isn’t working. For example, your doctor may evaluate your disease activity through endoscopy, imaging, or bloodwork, according to theCCFA。

博兰德博士说，他们可能还可以检查以确保没有其他感染可能使情况复杂化。她说：“一个常见的是C. diff，它可能导致腹泻，看起来很像是活跃的克罗恩斯的。”

不该怎么办？不要等到症状达到无法忍受的点，然后再服用药物治疗。Research showsthat early treatment can make a major difference in slowing the progression of Crohn’s;other studiesindicate that staying consistent with your meds will help with symptom management. (As many as 45% of people with inflammatory bowel disease, like Crohn’s, struggle to stick with treatment, leading to worse outcomes.)

What Treatment to Try Next?

博兰德博士说，如果排除其他感染，您和您的医生决定您已经有足够的工作时间工作了，并且您仍有症状，那么该是时候提倡其他选择了。

例如，如果您的克罗恩（Crohn）开始温和，并且服用了5SA药物，那么类固醇可能是一个不错的短期选择。博兰德博士说：“如果[症状]更温和，我们将尝试类固醇，但是类固醇是短期治疗，而不是长期计划。”

Boland博士解释说，克罗恩治疗选择的更好方法可能更多地是关于预测疾病的未来。“如果某人处于中度至严重的类别，或者他们面临问题的高风险，那么我们现在确实转向了现在早些时候使用有效的治疗，意识到我们希望早些时候进行干预以防止损害在恶化之前造成更严重的损害，“ 她说。

博兰德博士说，市场上最有效的疗法是生物制剂。“最近，已经有了更早地使用它们的转变，而不是等待我们知道没有那么有效的药物。这种方法往往更早地有效，并且可以防止损坏，因为我们没有追逐尾巴，而是等待不良的事情发生。”

If a Biologic Isn’t Working, Try This

因此，假设您已经使用了生物学，但是这种生物学的运作不佳，或者根本没有。克罗恩（Crohn）的人是什么？

Boland博士说，解决方案可能与改变药物的剂量一样简单。仍然没有骰子？有很多不同的生物制剂可用，因此您很有可能可以尝试。

When on a biologic, your doctor will be monitoring for its effectiveness for you in a few ways. “For patients on anti-TNF therapies, for example, we monitor their levels and see whether they form antibodies to the anti-TNF,” explains Dr. Zhang. Forming antibodies to a medication can make it less effective. “If they have no antibody formation and good levels of the medication in their system, but they are still having symptoms, this makes them a ‘primary non-responder.’” That means your doctor may switch you to a biologic in another class that works differently—like an integrin receptor antagonist—that may be better for you, he says. “But if they develop antibodies to the medication, we could switch to another drug within the same class.”

There are also other factors doctors consider when trying to pick a biologic that may work best for you, Dr. Boland says. “For example, some people have a lot of non-GI symptoms like joint pain or other non-gut symptoms, so that might lead us to a different medication such as one that may target joints as well.” Anti-TNF agents may be more effective for those with more systemic, non-gut symptoms of Crohn’s, she says, while vedolizumab is more gut-specific, so may not be as helpful for non-GI symptoms. That said, vedolizumab may be a good option for people for whom anti-TNFs didn’t work: One large学习found that patients with moderate to severe Crohn’s who had failed at least one conventional therapy had higher rates of remission with vedolizumab compared with placebo.

Another biologic, an interleukin-12 and -23 antagonist called ustekinumab, is what Dr. Boland describes as “somewhere in between” when it comes to addressing gut and non-gut symptoms. A最近的研究发现这种药物对不反应抗TNF的人有效。

Unfortunately, insurance may impact which medications you try and when, thanks to something called “step therapy.” This is where insurance companies require you to try and fail on one or more medications before covering other (often more expensive) options, Dr. Boland says. This can be a major frustration for someone with a chronic illness like Crohn’s looking to treat their disease as effectively as possible for long-term health. Many individuals and groups, like theCCFA目前，正在倡导改革步骤疗法，以更好地在此过程中更好地对患者健康进行优先级分。如果您担心保险限制您的药物选择，请与您的医生交谈，他们可能会帮助您指导您。

尝试以下操作：组合治疗

如果一种药物无法充分起作用，那么您的医生可能会考虑在某些情况下以一种联合疗法的形式在第一种药物上添加药物。张博士解释说：“当一种行动机制有所帮助，但还不够，GI可能会尝试将两种不同类型的药物放在一起，以试图完全控制克罗恩的药物。”例如，您可能会在不同类别具有不同作用机理的不同类别中使用两种生物制剂。他说，但是随着药物的增加，可能会有增加副作用风险的权衡，例如感染风险增加。“我们想避免这种情况，但是有时候有必要控制他们的炎症，如果一个班级还不够。”

Another type of combination therapy your doctor may suggest is taking a biologic—typically an anti-TNF agent—alongside an immune modulator like methotrexate or azathioprine, says Dr. Boland. This can be more beneficial than using either on its own in some cases. For example, a large学习found that 56.8% of patients on a combination of infliximab and azathioprine reached clinical remission after 26 weeks compared with just 30% of those only taking azathioprine and 44.4% of those only taking infliximab.

她解释说：“对于高危患者，患有更深的溃疡的患者，这可能是一种更有效的方法。”她补充说，患有骨质疾病或瘘管也可能使您成为从联合疗法方法中受益的良好候选人。

通过生活方式改变什么（并跳过）什么

虽然医疗疗法是克罗恩管理层最重要的部分，但其他事情也可以提供帮助！健康的生活方式选择也很明智，可以增加克罗恩的管理程序，以最大程度地利用您的利益。

Lifestyle habits that may help your Crohn’s include:

跳过：吸烟

“Smoking worsens Crohn’s, so I recommend people to stop,” Dr. Zhang says. Need help quitting? Call theCenters for Disease Control and Prevention’s免费退出行，以提供1-800询问的支持。

Skip It: Nonsteroidal Anti-Inflammatory Drug (NSAID) Overload

Taking NSAIDs like ibuprofen or naproxen often has been shown to increase the risk of Crohn’s flares, Dr. Zhang says, so it’s best to limit their use. If you are experiencing Crohn’s-related pain, talk to your doctor about other pain relief medications that may be less harmful, says theCCFA。

尝试：健康饮食

It used to be thought that饮食didn’t really impact Crohn’s disease, but that may be changing: “We now realize that diet can be effective on its own, but more so alongside the medications,” Dr. Boland says. “What is sustainable and doable for adults that can be effective is theMediterranean diet。Get fats from things like olive oil, eat lean meats and fish, try to get varied fruits and vegetables, and that is shown to be effective in reducing Crohn’s-related symptoms and some reduction in inflammatory markers.”

Skip It: Stress

张博士说：“压力实际上会导致症状的增加，甚至可能增加爆发的潜力。”“焦虑和抑郁确实与IBD合并在一起，因此管理压力，这些条件也非常重要。”

尝试：保持活跃

“It’s really hard when you feel sick, but even little things where you are moving your body can help,” Dr. Boland says. Finding a low-impact activity you enjoy, whether that’s walking, yoga, or even gentle stretching, will help overall body health, says theCCFA。

The Bottom Line

It can be extremely disheartening to find that your latest Crohn’s medication is not working as it should. Thankfully, there is a range of medications available, and working closely with your doctor can help you be prepared for treatment changes and find alternatives that work better for your specific disease. “Patients should build a relationship and frequently interact with their GI when they have symptoms,” Dr. Zhang says.

虽然还不是现实，但也希望有更好的方法来选择克罗恩的有效药物。博兰德博士说：“我们希望有一天能进行血液或粪便测试，以告诉我们您最有可能反应哪种药物。”“其中一些药物有些细微差别，而给药非常个性化，而且不是一定程度的。”

So if your medication isn’t working as well as you’d hoped, reach out to your doctor ASAP—sometimes, the solution may be as simple as changing your biologic dose. In other cases, switching to another class of drugs or adding on medications may be the key.

认识我们的作家

拉拉·德桑托（Lara DeSanto）

劳拉（Lara）是一位卫生作家，创伤知情的艺术治疗师，并在洛杉矶执业的注册合伙人婚姻和家庭治疗师。她还是HealthCentral的前数字编辑，涵盖了性健康，消化更多的

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