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How Is Crohn's Disease Treated?
Crohn's disease is a type of chronic inflammatory bowel disease (IBD) that causes inflammation in your gastrointestinal (GI) tract—which is the passageway that runs from your mouth to your anus. This inflammation can cause uncomfortable symptoms including abdominal pain, diarrhea, and unintentional weight loss. Among many others.
While there is no cure for Crohn's disease, a variety of medications, surgeries, and other procedures can help you manage your symptoms and reduce the frequency of flares—or periods of active or worsening symptoms. The goal of treatment is to limit inflammation and improve your overall quality of life.
If you receive a diagnosis of Crohn's disease, it's a good idea to keep in touch and establish regular care with your provider so they can monitor how treatment is working for you and make any changes to your treatment plan if necessary.
Healthcare providers use a variety of medications to treat and manage Crohn's disease symptoms. Most of these medications are focused on minimizing inflammation, reducing symptoms, and improving overall gut health—which is sometimes also called mucosal healing. There are several types of medications that can reduce symptoms. Which medication your healthcare provider recommends will depend on your symptoms, the severity of your condition, and your overall health. Corticosteroids Corticosteroids are the first line of treatment for mild to moderate cases of Crohn's disease. Budesonide and prednisone are generally the most common types of corticosteroids that your healthcare provider may prescribe you. A typical prescription includes taking a corticosteroid tablet by mouth daily for approximately eight weeks or until symptoms go away. Your exact dosage will depend on how severe your symptoms are and what's best for your overall health. Potential side effects of corticosteroids include: Corticosteroids are considered "induction therapy" which means that they help reduce symptoms and lower the frequency of flares. But, once you achieve remission (or, a period where symptoms go away), you may need additional medication to keep your symptoms in check as corticosteroids do not help maintain symptom remission. Immunomodulators Immunomodulators are a type of medication that many people with moderate or severe Crohn's disease use to lower their symptoms. This medication reduces inflammation by decreasing your immune system activity. Generally, your provider may prescribe you this medication if your body hasn't reached or stayed in remission after a course of corticosteroids or other treatments. Immunomodulator drugs not only help you reduce symptoms, but can also keep your symptoms at bay during periods of remission. This is known as "maintenance therapy." But, it's important to note that immunomodulators can often take up to three months to be effective before you notice substantial changes to your symptoms. Imuran (azathioprine) and Purinethol (6-mercaptopurine) are the most common types of oral immunomodulators that people with Crohn's disease use. However, other immunomodulators such as Otrexup (methotrexate) are injections that your provider can also use if you prefer to not take an oral pill. Side effects of these medications may include: Feeling tired or fatigued Nausea and vomiting Low white blood cell count which can increase your chance of developing other infections Biologics Like immunomodulators, biologics drugs directly target your immune system to reduce inflammation. The difference between biologics and immunomodulators is how they regulate the immune system. Immunomodulators affect the immune system across your whole body, while biologics target specific immune system proteins that cause inflammation. Typically, biologics are not the first medication option for people with Crohn's disease. If your provider recommends this medication, it may be because you have a severe case of Crohn's disease or your body has not responded well to corticosteroids or immunomodulators. Your provider may recommend one of the following biologics, which come in a variety of injectable forms: Remicade (infliximab) Humira (infliximab) Cimzia (certolizumab) Stelara (ustekinumab) Entyvio (vedolizumab) Your dose and how often you need an injection will depend on your condition and the severity of your symptoms. Generally, your provider may schedule you for an injection once every two to four weeks during the first few injections and once every four to eight weeks for maintenance therapy. Taking biologics isn't risk-free, however. Because the medication directly targets your immune system, you may be at an increased risk of developing other infections. Surgery can often help treat Crohn's disease complications like ulcers, perforations (holes) in your intestines, intestinal blockages, and life-threatening intestinal bleeding. According to the American Academy of Family Physicians, more than 50% of people with Crohn's disease may require at least one surgery during their lifetime while they live with a severe case of the condition. If you require surgery, the type of surgery you might need will depend on what part of your GI tract is most affected. Surgeries can take anywhere from four to eight weeks on average to heal. Common surgeries include: Small bowel resection: Removal of a part of the small intestine. Large bowel resection: Also known as a subtotal colectomy, this surgery is the removal of a part of the large intestine. Proctocolectomy: A major surgery that involves the removal of the entire colon and rectum. People who receive this surgery will also have to get an ileostomy procedure which attaches a removable pouch to your anus in order to collect stool and other waste. Recently, fecal transplantation has become an emerging area of research and a proposed treatment for inflammatory bowel diseases, such as Crohn's disease. A fecal transplantation procedure involves collecting a stool sample from a donor without an inflammatory bowel disease and introducing that stool to someone living with Crohn's disease. The purpose of this procedure is to restore healthy bacteria in your gut and reduce inflammatory symptoms caused by Crohn's disease. Keep in mind: research on this transplantation method is in the early stages. So far, clinical trials have shown promising results in people with ulcerative colitis—a related inflammatory bowel disease that shares some symptoms with Crohn's disease. According to a 2021 review published in the Journal of Gastroenterology and Hepatology, researchers found that fecal transplantation in people with ulcerative colitis have helped reduce symptoms in a safe and effective way. However, more research is needed to understand the effectiveness of this procedure in people with Crohn's disease. While this treatment is not widely available for most people, it's good to know the possibility of future treatments, should you need them down the line. Another major part of Crohn's disease treatment includes taking medicines to manage complications that you might experience due to Crohn's disease symptoms or the side effects of any medications you are taking. That said, your provider may prescribe one or more of the following medications to address these complications: Tylenol (acetaminophen): Helps reduce stomach pain Antibiotics: Treats potential infections and ulcers Imodium A-D (loperamide): Reduces diarrhea symptoms Because Crohn's disease is a life-long condition even under the best treatment conditions, its symptoms can significantly affect your quality of life. As a result, it's important to work with your healthcare provider to develop a treatment plan that is right for you. Along with medications, surgeries, and other procedures, your provider will likely also recommend making dietary changes that can reduce symptoms and improve your gut health. These changes may include: Incorporating an anti-inflammatory diet that includes meals such as leafy green vegetables, nuts, fruits, and fatty fish Avoiding carbonated drinks and alcoholic beverages Eating small portions Keeping a list of foods that trigger symptoms and removing them from your diet It's worth noting that you shouldn't drastically change your diet or try a liquid diet without the approval and recommendation from your provider. In some cases, if your symptoms are severe your provider may recommend you rest your bowels by eating very few meals or participating in a liquid diet. During this time, you may receive nutrients via a feeding tube or intravenously through an IV. Crohn's disease is a life-long chronic condition that requires very specific symptom treatment and management. Doctors use a number of medications to help reduce intestinal inflammation, cause symptom remission, and keep symptoms from coming back again. In some severe cases, surgery might be required to deal with disease complications like intestinal blockage and bleeding. Luckily, emerging therapies like fecal transplantation have shown promising results, providing a positive outlook for the future of Crohn's disease therapy. With the help of your doctor, medications and dietary adjustments can help you learn to manage your symptoms and improve your quality of life while living with Cronh's disease.How To Nourish Yourself If A Crohn's Diagnosis Has You Freaked Out About Food
While fiber can sometimes exacerbate symptoms, this isn't true for everyone with Crohn's—research suggests that, in some cases, eating fiber can help you feel better.1 The key to making those foods gut-friendly, says Ashley Hurst, RD, LD, owner of The Crohn's & Colitis Dietitians, is to "modify the texture," or make a fibrous food less bulky and therefore easier to move through the GI tract. This might look like blending spinach into a smoothie as opposed to eating it raw in a salad, or snacking on almond butter instead of raw nuts. "Sometimes taking the skins off things—to reduce the amount of fiber a little bit—can be helpful too," Dr. Feagins says.
If you have Crohn's, any big change to what you're eating should always happen under the supervision of a care team—so ask a GI doc or an IBD-focused registered dietitian about any type of elimination diet for Crohn's before starting one up.
Be aware of nutrient deficiencies.Between food restrictions and the possibility of frequent diarrhea, a lot of people with Crohn's are at risk of nutritional deficiencies,2 with vitamin D,3 A, and K4 deficiencies being the most common, Dr. Feagins says. However, if your terminal ileum (the narrowest part of the gut) is the most impacted part of your GI tract (which is common with Crohn's5), you might be more likely to have a B12 deficiency, Dr. Feagins explains.
You might show signs of a nutrient deficiency, or you might not—it's not easy to tell on your own! That's why you should always check with a doctor before taking any over-the-counter supplements. They can screen you for deficiencies—often through a blood test—to determine if you're low in essential nutrients. If you try to modify your vitamin or mineral levels on your own, you might overdo it, which could lead to even more health complications beyond Crohn's. But if your doctor decides that certain supplements are needed for your health, taking them in pill form is typically the most approachable option, especially for vitamins D, A, and K.
B12 is a big exception because the deficiency is caused by the small bowel's inability to absorb the vitamin, so oral supplements often don't work. Typically, a GI doc will administer B12 vitamins via an intramuscular injection, Dr. Feagins explains. Oral iron supplements can also cause constipation,6 so people can opt for an IV version instead.
The bottom line: If you're worried about a nutrient deficiency after your diagnosis, check in with your doctor to get your levels tested. If you need more of a particular vitamin or mineral, they (along with a dietitian) can guide you on the next steps to take; perhaps recommending reputable supplement brands to try (since the Food and Drug Administration does not regulate them), helping to determine the best dosage for you, and advising on diet changes that can up your intake.
You might feel weird about food at first, but it probably won't stay that way forever.Following a Crohn's diagnosis, you might feel wary about eating—and that can lead to issues of its own. Without the guidance of a GI doc and IBD-focused dietitian, things can get overwhelming—or even dangerous—fairly quickly. "Disordered eating in someone with a GI disorder looks very different [than in someone without it]," says Hurst, who has IBD herself. "People are dealing with a lot of physical pain, which is what's driving the restriction."
Crohn's Disease Medications And Treatments
Crohn's disease medications can help to suppress your immune system and reduce inflammation. Changes to your diet and other lifestyle factors can also help. In some cases, a doctor may recommend surgery.
Crohn's disease is a health condition that affects the gastrointestinal (GI) tract.
According to the Crohn's and Colitis Foundation, it's one of the conditions that make up inflammatory bowel diseases (IBDs), which affect as many as 3 million Americans.
Doctors still aren't completely sure what causes Crohn's, but it's thought to be an overreaction of the immune system in the GI tract.
Crohn's disease can affect any part of your GI tract, but it most often affects the small bowel and the beginning of the colon.
There are different classifications of Crohn's, based on where in the GI tract the condition affects you.
Because there are different types of Crohn's, the symptoms will also vary. They may include:
While there's no cure for Crohn's disease, medications and other treatment options — including diet and lifestyle changes — can help manage symptoms.
Crohn's disease often happens in cycles of remission and flare-ups, so treatment plans will require reevaluation and monitoring. Treatment for Crohn's is very personalized, so what works for someone else may not work for you and vice versa.
Work with your doctor to come up with a treatment plan to manage your specific Crohn's symptoms.
One of the primary ways you can manage Crohn's disease is through medications that suppress your immune system and reduce the inflammation in your GI tract.
The goal of taking medication to lower your immune response is to help ease your symptoms and give your GI tract a chance to rest and heal.
The following are medications that may be prescribed alone or in combination to help manage your Crohn's disease:
CorticosteroidsAccording to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK), corticosteroids are steroids that help reduce both inflammation and your immune response. They're often used as short-term treatment.
Common corticosteroids used to manage Crohn's include:
The side effects of corticosteroids can include:
Serious side effects, such as loss of bone density (osteoporosis) or liver issues, can occur if you take corticosteroids for more than 3 months.
Because of this, your doctor may have you take corticosteroids for only a certain period of time. Don't stop taking steroids without talking with your doctor first because this can lead to additional health concerns.
Aminosalicylates (anti-inflammatory drugs)Aminosalicylates are often used to treat another IBD called ulcerative colitis, but they may be prescribed for Crohn's as well. These drugs are thought to reduce inflammation in the intestine lining to ease symptoms.
They're commonly used in treating mild to moderate episodes of Crohn's.
These medications can be taken as a suppository, by mouth, or as a combination of both. How you take the medication depends on where Crohn's affects your body.
Common aminosalicylates used to manage Crohn's are:
The possible side effects of aminosalicylates include:
While taking this medication, your doctor may monitor your kidney function. They may also order blood tests to make sure your white blood cell level isn't too low.
Let your doctor know if you're allergic to sulfa drugs before taking any aminosalicylate drug.
Immunomodulator medications (immunosuppressants)Researchers believe Crohn's disease is caused by a problem with the immune system. Cells that usually protect your body instead attack the GI tract.
Because of this, medications that suppress or regulate your immune system can help treat Crohn's.
However, these drugs can take up to 3 months to start working, so you'll need to wait some time before you can know whether they'll help you.
Doctors may prescribe these types of medications if aminosalicylates and corticosteroids don't work for you or if you develop fistulas (abnormal openings that form in the bowels).
These medications can help you stay in remission. They may also heal fistulas.
Some common immunosuppressive medications include:
The side effects of these medications can include:
Some rare side effects are pancreatitis (inflammation of the pancreas), liver problems, and myelosuppression. Myelosuppression is a decrease in the amount of bone marrow your body makes.
Antibacterial medicationsAntibiotics can treat many infections, such as bacterial infections caused by Crohn's. This could include fistulas and abscesses.
Common antibiotics for Crohn's:
Side effects of antibiotics can include:
Biologics are a type of drug used for people with moderate to severe Crohn's or active Crohn's.
They work to reduce inflammation in specific areas, such as the lining of your intestines. They don't suppress your whole immune system.
Your doctor may prescribe biologics if you have moderate or severe symptoms or if your other drugs aren't working. They may also prescribe them if you have fistulas in your GI tract.
Biologics can also help taper (gradually decrease) use of steroid medications.
These medications are most often given by injection at a hospital or an outpatient center every 6 to 8 weeks.
The most common biologic drugs include:
You may have redness, swelling, or irritation where you receive the injection. You may also experience:
In rare cases, some people have had a toxic reaction to the medication, liver problems, or a higher risk of an infection, especially tuberculosis.
Other medicationsDoctors may prescribe additional medications to help with other symptoms of Crohn's — for example, an antidiarrheal drug called loperamide that may be taken short term if you have severe diarrhea.
Some people with Crohn's are also at risk of developing blood clots. Depending on your risk, your doctor may also prescribe a blood thinner to decrease your chance of complications from a blood clot.
Your doctor may recommend prescription-strength acetaminophen (Tylenol) for relieving pain. Avoid using ibuprofen (Advil), naproxen (Aleve), and aspirin for pain relief, since these can worsen symptoms.
During severe flare-ups, you may need to rest your bowels to enable healing. This may include either a full or partial liquid diet managed by your doctor.
Bowel rest treatment may include:
Liquid nutrition may be done at home or in a hospital, depending on the circumstances and your doctor's recommendations.
Doctors will first try to manage Crohn's disease with medication. But because it's a lifelong disorder, many people with Crohn's will eventually need surgery.
There are different types of surgeries for people who have Crohn's disease. The exact type of surgery will depend on:
Surgeries for Crohn's include:
Along with a medication regimen and surgery, there are also some complementary natural remedies you can discuss with your doctor.
These include:
You can make important lifestyle changes to help manage your symptoms, some of which are listed here:
Manage your stressManaging stress is an important part of any healthy lifestyle, but stress management is especially important with a chronic inflammatory condition.
This is because stress can make inflammation worse, according to a 2017 review — which, in turn, makes your symptoms worse.
You can try stress management techniques on your own, such as:
It's also a good idea to speak with a mental health professional to gain some new stress managements tools and strategies, especially if you have high levels of stress.
Take acetaminophen for painFor mild discomfort and pain (such as when you have a headache or a sore muscle), it's recommended that you take acetaminophen (Tylenol).
Avoid ibuprofen (Advil), naproxen (Aleve), and aspirin because these can cause a flare-up.
Stop smokingIf you smoke, it can:
Quitting smoking — no matter how long a person has been smoking and has had Crohn's — has been found to help manage symptoms, according to a 2013 study.
Keep a food journalStudies have not found that one specific diet or food helps Crohn's. Because it's such an individual condition, certain foods may trigger symptoms for you but not for someone else and vice versa.
Keeping a food journal and eating a nutrient-dense and balanced diet can help you get the nutrients you need and identify any foods that might make your symptoms worse.
Limit caffeine and alcoholExcess caffeine and alcohol may make symptoms worse, especially during a flare.
Crohn's disease is a type of IBD that affects everyone differently.
There are different types of Crohn's that may affect different parts of the GI system. Symptoms will vary depending on which part of the GI tract it affects and how severe it is.
Because Crohn's is a lifelong disorder that doesn't affect everyone the same way, you'll want to work with your doctor to develop an individual treatment plan that might include medication, lifestyle changes, or surgery.
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