By Dr. Paul G. Donohue June 20, 2011 12:00 AM

Dear Mayo Clinic: My son was diagnosed with Crohn’s disease at age 13, and he’s now 19. He used to be active, but now he’s exhausted. He’s been on numerous medications, but nothing works for him. what can be done? He has been bleeding a lot, and has severe pain when going to the bathroom, up to eight times each day.

Reply: Crohn’s disease can indeed be a very distressing and frustrating illness, but a determined approach to treatment can often result in symptom relief.

A chronic condition, Crohn’s disease causes inflammation of the digestive tract. While inflammation can occur anywhere from one’s mouth to the anus, it has a special predilection for affecting the small intestine. the cause is unknown. Symptoms can be mild or severe enough to disrupt everyday activities.

Crohn’s disease can occur in patients of all ages, but peak incidence is between ages 15 and 30 years. Symptoms can be nonspecific, but often include diarrhea, abdominal pain, reduced appetite and weight loss. Crohn’s disease can’t be cured but it may go into remission for long periods of time, particularly with medical treatment.

For patients like your son, who continue to have problematic symptoms despite aggressive treatment, I would recommend a thorough reassessment by a physician who specializes in this area of medicine. Seek out a board-certified gastroenterologist with expertise in treating Crohn’s disease.

The doctor will also need to consider other conditions that could be driving the symptoms. one example could be an undiagnosed infection. Aggressive treatment of any coexisting conditions could help relieve your son’s symptoms.

There’s a long list of medication options to manage Crohn’s disease. Even if you’ve tried several, there may be other choices and combinations to consider. your son might also think about participating in a clinical trial to evaluate new ways to treat the disease.

Stress can have an adverse affect on various diseases, and stress reduction may play a role in managing symptoms of Crohn’s disease.

I wish there were an easy formula to improve your son’s health. but the treatment of Crohn’s disease can be complicated, and your son will need to work closely with his medical team.

Even when it seems like you’ve tried everything, there are likely to be more options to consider. Continue to seek effective treatment as well as support for yourself and your son. the Crohn’s and Colitis Foundation (ccfa.org) is a great resource. — David Bruining, M.D., Gastroenterology, Mayo Clinic

Send questions to medicaledge@mayo.edu or to Medical Edge From Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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