Internal Medicine

Is Crohn's disease curable?

Where is the therapy today?

Crohn's disease is a chronic inflammatory disease affecting the entire gastrointestinal tract. Even today, the disease is considered incurable, although it can usually be controlled well with modern drugs. Where only a few decades ago patients could only be treated with cortisone, today we are able to dampen the inflammatory reactions of the body with immune modulators such as ciclospoprin A or tacrolimus or with state-of-the-art antibodies such as adalimumab or trastuzumab.

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In this way it is possible for most patients to achieve an almost normal quality of life and an undiminished life expectancy. In addition, the drugs used today for treatment, if used correctly, have significantly fewer side effects than the lifelong cortisone therapy that was common in the past. However, it is still not possible to cure the disease - just control its symptoms.

What can the therapy achieve?

Four out of five patients are able to lead a largely normal life with specialist treatment. The typical symptoms like diarrhea or stomach pain can usually be treated well, so that there is no impairment of the quality of life during the relapse-free period. The occurrence of new relapses can also be prevented relatively well in many patients.

Nevertheless, the current drugs only weaken the inflammation in the gastrointestinal tract and thus the resulting symptoms. The actual cause of the inflammation, however, has not yet been clarified. Therefore, a causal therapy of the disease and thus its cure is currently not possible even with the most modern drugs.

Will Crohn's Disease Ever Be Curable?

In order to have a chance of curing a disease, its causal cause must first be clarified. However, this has not yet been found despite intensive research efforts by many universities around the world. What is certain is that Crohn's disease is not a hereditary disease. Nevertheless, the genes play a major role, the inherited proportion (so-called "concordance rate") of the disease could be set at 60 - 70% in twin studies. But this also means that about 30 - 40% of the development of the disease can be traced back to external influences.

What is certain is that the development of Crohn's disease is an extremely complex process that will take many decades to be explored. That there will ever be a drug that cures the disease forever is possible, but unlikely. Diseases such as Crohn's disease, which arise from the interaction of genes and the environment (so-called “multifactorial diseases”), cannot be treated causally with the current state of medicine.

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Which treatment approaches are promising from today's perspective?

In recent years there has been an intensive search for new therapeutic options for Crohn's disease. The main focus here was the development of new so-called Biologicals in the foreground. These are drugs that are produced by other organisms (mostly bacteria). Most recently, the integrin antibody vedolizumab received approval, which has a different mechanism of action than all other antibodies previously approved for chronic inflammatory bowel disease. In the future, we can expect new drugs from this group of active ingredients.

Active ingredients such as ustekinumab or etrolizumab are currently still being tested, and in some countries they are already being used for treatment.
However, only symptomatic treatment of the disease can be expected from these new active ingredients.

The so-called "Stool transplant". Here, cleaned stool from a healthy donor is introduced into the patient's intestine (by capsule or probe). The hypothesis behind this is that the damaged intestinal flora of the IBD sufferer is brought back into balance. In rare cases, a cure for the disease would theoretically be conceivable. However, the process is still in its infancy and extensive tests are still pending.

What is the current life expectancy with Crohn's disease?

In general, inflammatory bowel diseases such as Crohn's disease and ulcerative colitis have only a very small or no negative impact on life expectancy. That means that those affected usually live as long as healthy people. This applies as long as the disease is treated by a specialist. It is therefore important for those affected to take their own treatment seriously, seek medical treatment and take the prescribed medication as directed by the doctor.

On the one hand, the probability of the occurrence of typical long-term effects such as Bottlenecks in the intestine or Fistulas which are not life-threatening, but severely limit the quality of life. On the other hand, good treatment also reduces the likelihood of rare complications that can be acutely life-threatening. These include, for example, the so-called toxic megacolon or an intestinal perforation.

What influence do antibiotics have on healing a relapse?

Antibiotics are not part of the standard therapy for an acute flare-up in Crohn's disease, as it has not yet been proven that they increase the likelihood of remission (improvement in symptoms). Nevertheless, many affected people are treated with antibiotics in the episode, especially metronidazole and ciprofloxacin have become established. This is because it has been proven that these two active ingredients can reduce disease activity in the episode by almost 30% (placebo only by around 1%).

They seem to be as effective as the tried and tested active ingredient 5-ASA (mesalazine, sulfasalazine). Another indication for antibiotics in flare-up is bacterial inflammation of Abscesses or Fistulas in the Anal area. These can be effectively treated with the two active ingredients already mentioned.

On the other hand, antibiotics are not suitable for maintaining remission in long-term therapy.Metronidazole can, for example, cause nerve damage to the extremities after prolonged use, while ciprofloxacin can damage the tendons, among other things. The role of antibiotics in the treatment of Crohn's disease could increase even further in the future, as some researchers attribute a role in the development of the disease to the bacterium “Mycobacterium avium sebspecies paratuberculosis”. Studies on the effectiveness of specific antibiotic therapies against this pathogen are still ongoing.