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CROHNS DISEASE 2
Crohns Disease: Evidence-Based Treatment The American College of Gastroenterology guidelines define mild to moderate Crohns disease as ambulatory patients who can tolerate oral intake without evidence of dehydration, toxic features (fevers, rigors or prostration), abdominal tenderness, painful mass, obstruction or >10% weight loss (Wong & Bressler, 2008, p. 2420). The article presents treatment options for patients in the mild to moderate stage of luminal Crohns disease. The perspective is that many patients have yet to reach the moderate to severe stage where conventional methods of corticosteroids, immunosuppressant therapy or biological therapy are utilized. The overall goal of the article is to present an algorithm to treat patients in the mild to moderate stage of Crohns disease that involve both induction and maintenance strategies (Wong & Bressler, 2008, p. 2419). The clinical trials performed viewed several medications consisting of Budesonide, Sulfasalazine, Mesalazine, Antibacterials, Probiotics and Prebiotics. Clinical trials and studied showed that Budesonide, a corticosteroid, at 9mg/day provided good results as an induction agent for active terminal ileal or right colonic disease. A maintenance dose of 6mg/day was shown to be effective for three to six months, but its long term use could not be determined. Sulfasalazine, an antirheumatics and gastrointestinal anti-inflammatory agent, at 36g/day demonstrated to be an effective induction agent for active colonic Crohns disease. Studies illustrated that its maintenance capabilities are uncertain. Mesalazine was not a suggested
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treatment for mild to moderate Crohns disease. On the basis of the evidence to date addressing the benefits and risks of Mesalazine for treating Crohns disease, the use of this class of agents for treating Crohns disease should not be supported (Wong & Bressler, 2008, p. 2422). Also, there was not enough information to gain a full understanding of the effects of Antibacterials, Probiotics and Prebiotics on mild to moderate Crohns disease. Bressler and Wongs 2008 article explained the following: From an evidence-based perspective, certain medications such as Budesonide and Sulfasalazine have been shown to be effective to induce remission. What is a large deficiency in the field of Crohns disease treatment is an effective and safe drug for maintenance of remission in patients with mild to moderate disease. (p. 2424). My patient had a severe case of Crohns disease. He presented with a small bowel obstruction, three ileo fistulas and an ileo-colonic fistula. He had an exploratory laparotomy on 3/15/2011, which turned into an appendectomy, right colectomy, LOA, and small bowel resection. Crohns disease is a chronic and life altering disease dealing with remissions and exacerbations. It is important to provide emotional support, especially to a 23 year old male, along with treating the underlying signs and symptoms when developing nursing interventions for patients with Crohns disease. The care provided to my patient was concurrent with the appropriate nursing interventions necessary to advance his emotional and physical well-being. In conclusion, the information in this article allowed me to gain a better understanding of the importance of bringing on a remission in patients with
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Crohns disease. Trying to maintain a state of remission is the overall goal of treating patients. Although there are medications to induce remission, it does not appear there is a medication to maintain a remission in patients that have mild to moderate Crohns disease. My previous understanding of the disease was further confirmed after reading this article, as well as provides insight into the medical treatment of patients in various stages of the disease.
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References Wong, K., & Bressler, B. (2008). Mild to Moderate Crohn's Disease: an Evidence-Based Treatment Algorithm. Drugs, 68(17), 2419-2425.