Treatment for Crohn’s Disease
How do doctors treat Crohn’s disease?
Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.
No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.
Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.
Although no medicine cures Crohn’s disease, many can reduce symptoms.
Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include
Some of the common side effects of aminosalicylates include
Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include
Side effects of corticosteroids include
- bone mass loss
- high blood glucose
- high blood pressure
- a higher chance of developing infections
- mood swings
- weight gain
In most cases, doctors do not prescribe corticosteroids for long-term use.
Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include
Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:
- a low white blood cell count, which can lead to a higher chance of infection
- feeling tired
- nausea and vomiting
Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.
Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work quickly to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include
- adalimumab and adalimumab-atto
- infliximab and infliximab-dyyb
Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.
Other medicines. Other medicines doctors prescribe for symptoms or complications may include
- acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
- antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
- loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.
If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may
- ask you to drink a liquid that contains nutrients
- give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
- give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm
You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.
Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.8 Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat
- bleeding that is life threatening
- intestinal obstructions
- side effects from medicines when they threaten your health
- symptoms when medicines do not improve your condition
A surgeon can perform different types of operations to treat Crohn’s disease.
For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.
Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are
- laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
- open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.
Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by
- laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
- open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.
Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.
A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.
If you have this type of surgery, you will have the ileostomy for the rest of your life.
How do doctors treat the complications of Crohn’s disease?
Your doctor may recommend treatments for the following complications of Crohn’s disease:
- Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
- Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
- Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
- Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
- Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
- Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
- Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.
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