Crohn's disease treatments
As there is no cure for Crohn's disease, medical treatment aims to control your symptoms and bring on a remission of the disease. Ideally, medical treatment of Crohn's disease should prevent complications developing and prevent nutritional deficiencies developing due to nutrients not being absorbed properly from your food by your gut.
Treatment will depend on how severe your condition is, whether your disease is active at present and where in your bowel it’s located.
There are several different types of treatments, and some work better than others for different stages of the disease.
Corticosteroids can be given to treat active disease. They are not used for maintenance therapy, but can help induce remission.
Corticosteroid medicines for Crohn’s disease are usually taken by mouth. In severe exacerbations of Crohn's disease, steroids may be administered intravenously (through a drip into a vein) in hospital.
Steroids are very potent anti-inflammatory medicines and are effective in treating active Crohn's disease. However, a major problem with using them is that people taking high doses of steroids for a long time tend to develop side effects, such as:
- a round face;
- mood changes;
- wasting of the muscles;
- high blood pressure;
- thinning of the bones (osteoporosis);
- cataracts; and
These anti-inflammatory medicines are similar to aspirin and include:
- mesalazine (brand name Mesasal, Salofalk, Pentasa); and
- sulfasalazine (Salazopyrin, Pyralin).
These medicines are available as tablets or granules, some with a delayed-release coating. They can treat active inflammation in the colon (large intestine), but are not effective in treating Crohn’s that affects the small intestine.
Aminosalicylate medicines may be given during a flare-up or as maintenance treatment, but these medicines are more effective in the treatment of ulcerative colitis than Crohn’s disease.
Side effects include:
- diarrhoea; and
- abdominal pain.
Immunosuppressants or immune modifiers
These medicines suppress the activity of the body’s immune system and can be prescribed to help treat a disease flare-up and also as maintenance therapy for Crohn’s disease. These medicines may take several weeks or even a couple of months to work.
Immunosuppressant medicines include:
- azathioprine (for example, Imuran, Thioprine);
- mercaptopurine (Puri-Nethol); and
Infliximab (brand name Remicade), adalimumab (Humira) and vedolizumab (Entyvio) are medicines that may be used in people with moderate to severe Crohn’s disease, usually if other medicines are poorly tolerated or ineffective.
Side effects can include:
- liver problems;
- pancreatitis (inflammation of the pancreas);
- increased risk of developing certain cancers; and
- low white blood cell count.
When taking some of these medicines, frequent blood tests are needed to check on your blood cell counts and liver function.
Antibiotics may be used to control infection and reduce disease activity.
Medicines to control diarrhoea and pain are also often prescribed.
If your disease is severe, you may need to be admitted to hospital where you will be given medications intravenously.
In some circumstances, your doctor may recommend resting the bowel by not eating solid foods for a short period to help relieve the inflammation in the bowel. This treatment is for severe disease, and involves drinking only clear fluids, or sometimes having no oral intake. Fluids and nutrients are given via a feeding tube or via a drip into a vein during this time.
For people with severe disease that isn’t controlled by medicines, or if there is a bowel obstruction or other complication, surgery may be needed. Often this involves an operation to cut out the diseased section of bowel and join the 2 ends of unaffected bowel together (anastomosis). However, although this usually stops the symptoms, the disease often recurs and many people need a repeat operation.
Because Crohn's disease results in parts of the gastrointestinal tract being diseased and also results in diarrhoea and loss of appetite, people with the disease often do not have good absorption of nutrients, vitamins and minerals from the foods they eat. For this reason, people with Crohn's disease may have to take nutritional supplements and/or have vitamin injections.
Eating a healthy balanced diet is important, particularly as it’s important for a person with Crohn's disease to maintain a good weight. If you find that certain foods make your diarrhoea worse, it makes sense to avoid these.
Always discuss any supplements you are planning to take with your doctor.
Although Crohn's disease is a serious condition, many people who have it lead productive lives and feel well and free of symptoms in between flare-ups of the disease.
2.Crohnâ€™s disease (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Jul. http://online.tg.org.au/complete/ (accessed Oct 2015).
3. National Institute of Diabetes and Digestive and Kidney Diseases. Crohnâ€™s disease (updated 3 Sep 2014). http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/crohns-disease/Pages/facts.aspx (accessed Oct 2015).