What are the treatment options for stomach pain in Crohn's disease?

From the Guidelines

Treatment for stomach pain in Crohn's disease should prioritize a Mediterranean diet rich in fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins, as recommended by the most recent guidelines 1. This approach is based on the latest evidence from 2024, which suggests that dietary modifications can play a crucial role in managing symptoms and achieving remission in Crohn's disease. Some key points to consider in the treatment of stomach pain in Crohn's disease include:

• Exclusive enteral nutrition (EEN) may be considered as a steroid-sparing bridge therapy for patients with Crohn’s disease, especially in children 1.
• A Crohn’s disease exclusion diet, a type of partial enteral nutrition therapy, may be an effective therapy for induction of clinical remission and endoscopic response in mild to moderate Crohn’s disease of relatively short duration 1.
• Medications such as aminosalicylates, corticosteroids, immunomodulators, and biologic agents may be necessary for moderate to severe cases, but should be used under the guidance of a healthcare provider 1.
• Pain management can include acetaminophen, and antispasmodics like dicyclomine can help with cramping.
• It is essential to identify and avoid trigger foods, eat smaller frequent meals, stay hydrated, and consider a low-residue diet during flares.
• Regular screening for malnutrition is crucial, and patients with IBD warrant regular assessment of signs and symptoms, including unintended weight loss, edema, and fluid retention, and fat and muscle mass loss 1.

From the FDA Drug Label

RENFLEXIS is a tumor necrosis factor (TNF) blocker indicated for: Crohn's Disease: • reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy. • reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in adult patients with fistulizing disease.

The treatment option for stomach pain in Crohn's disease is Infliximab (IV), which is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in adult patients with moderately to severely active Crohn's disease who have had an inadequate response to conventional therapy 2.

• The recommended dosage for Crohn's disease is 5 mg/kg at 0,2 and 6 weeks, then every 8 weeks.
• Some adult patients who initially respond to treatment may benefit from increasing the dose to 10 mg/kg if they later lose their response.

From the Research

Treatment Options for Stomach Pain in Crohn's Disease

• The treatment of stomach pain in Crohn's disease often involves the use of aminosalicylates, such as mesalamine, which have been shown to be effective in inducing remission in mildly to moderately active Crohn's disease 3.
• Mesalamine can be administered orally or topically, and its effectiveness may depend on the location and severity of the disease 4.
• In some cases, corticosteroids, such as budesonide, may be used to treat stomach pain in Crohn's disease, particularly in patients with more severe symptoms 3.
• Biological therapies, such as infliximab, may also be used to treat Crohn's disease, particularly in patients with moderate to severe symptoms who have not responded to other treatments 5.
• The choice of treatment will depend on the individual patient's symptoms, disease severity, and medical history, and may involve a combination of medications and lifestyle changes.

Medication Options

• Mesalamine: effective in inducing remission in mildly to moderately active Crohn's disease, particularly in patients with Crohn's colitis 3.
• Sulfasalazine: may be effective in inducing remission in mildly to moderately active Crohn's disease, but its use is limited by its side effects and inferiority to corticosteroids 3.
• Corticosteroids: effective in inducing remission in mildly to moderately active Crohn's disease, but their use is limited by their side effects and the risk of dependence 3.
• Infliximab: effective in inducing and maintaining remission in moderately severe and/or fistulising Crohn's disease, but its use is limited by its high cost and potential side effects 5.

Lifestyle Changes

• Dietary changes: avoiding trigger foods, eating a balanced diet, and staying hydrated may help manage stomach pain in Crohn's disease.
• Stress management: stress can exacerbate symptoms of Crohn's disease, and stress management techniques such as meditation and yoga may be helpful.
• Regular exercise: regular exercise may help improve overall health and reduce symptoms of Crohn's disease.