The latest and greatest Crohn’s Disease treatments have significant risk from some of the drugs. Often older treatment are discarded and forgotten because the new treatments are alleged “to be better”. In some cases this means more in remission but with more harm being done by adverse reactions – whether this is “better” is debatable.

The purpose of this page is to survey historic treatments and their success rate.

“The disease decreases quality of life and leads to complications including stenoses, abscesses, and fistulae necessitating repeated surgeries and bowel resections. Until the late 1990s, standard therapies included mainly

  • glucocorticosteroids,
  • 5-aminosalicylic acid (5-ASA),
  • antibiotics, and to a lesser extent,
  • immunosuppression with
    • azathioprine (AZA)/6-mercaptopurine (6-MP) or
    • methotrexate.

These therapies, especially glucocorticosteroids, mainly controlled symptoms without modifying the long-term disease course.” [2004]

With both old and new treatments, we must heed these words “Unfortunately, these agents have yet to have an established optimal benefit due to variations in genetically determined metabolism.”  [2004] IMHO, variations in inherited and acquired microbiome are a significant part of this.

A 1964 Lecture makes some crisp observations:

“The aetiology of Crohn’s disease remains obscure despite the fact that similar lesions can be produced in the experimental animal by obstruction of the lymphatics (Reichert and Mathes, 1936) or by an immune reaction (Slaney, 1962). In man the multiplicity of suggested causes, which range from auto-immune disease to the ingestion of toothpaste (Edwards, 1958), shows how far we are from the solution.”

“The treatment of Crohn’s disease may be conservative or operative. Since the aetiology is unknown, medical treatment tends to be empirical, consisting of rest, a diet of high nutrition with vitamin supplements, the correction of anaemia and occasionally antibiotics and steroids.”

“Malabsorption may produce various deficiency states…. I shall concentrate my remarks on one aspect of this problem, namely the malabsorption of vitamin B12 which I have specially studied.” – Note that B12 deficiency is also common with CFS and may be associated with a loss/decrease of L.Reuteri in the gut.

“The best treatment is minimal excision or bypass to overcome any obstruction, leaving active disease still present, for massive excision leads to gross malnutrition and there is evidence that the disease may burn itself out producing multiple fibrous strictures which are much more amenable to surgery.”

A 1968 Paper includes the following comments

“improve with rest. The effectiveness of a prolonged sanatorium regime has never been formally assessed in such patients. One instance of spontaneous improvement in the disease has already been commented upon, and the possibility of such improvement must always be considered when assessing any form of treatment…. The emphasis as regards diet should be on nutritious meals, rich in protein. ”

“Our knowledge of the mode of development of Crohn’s disease and of factors which influence its course is very limited.”

Alternative Medicine (and not so alternative)

  • “Our results indicate that the new coated fish-oil preparation is an effective, well-tolerated treatment that prevents clinical relapses in patients with Crohn’s disease in remission. Its efficacy in relation to that of mesalamine, currently the standard treatment for the maintenance of remission in patients with Crohn’s disease, remains to be determined.” [NEJM 1996]