Treatment may include medications, surgery, nutrition supplementation, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms such as abdominal pain, diarrhea, and rectal bleeding. Treatment for Crohn’s disease depends on its location, severity, and complications.
Treatment can help control Crohn’s disease and make recurrences less frequent, but no cure exists. Someone with Crohn’s disease may need long-lasting medical care and regular doctor visits to monitor the condition. Some people have long periods—sometimes years—of remission when they are free of symptoms, and predicting when a remission may occur or when symptoms will return is not possible. This changing pattern of the disease makes it difficult to be certain a treatment has helped.
Despite possible hospitalizations and the need to take medication for long periods of time, most people with Crohn’s disease have full lives—balancing families, careers, and activities.
Medications
Anti-inflammation medications. Most people are first treated with medications containing 5-aminosalicylic acid (5-ASA) agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of include nausea, vomiting, heartburn, diarrhea, and headache.
Cortisone or steroids. These medications, also called corticosteroids, are effective at reducing inflammation. Prednisone and budesonide are generic names of two corticosteroids. During the earliest stages of Crohn’s disease, when symptoms are at their worst, corticosteroids are usually prescribed in a large dose. The dosage is then gradually lowered once symptoms are controlled. Corticosteroids can cause serious side effects, including greater susceptibility to infection and osteoporosis, or weakening of the bones. See the “Nutrition Supplementation” section for more information about preventing and treating osteoporosis.
Immune system suppressors. Medications that suppress the immune system—called immunosuppressive medications—are also used to treat Crohn’s disease. The most commonly prescribed medications are 6-mercaptopurine and azathioprine. Immunosuppressive medications work by blocking the immune reaction that contributes to inflammation. These medications may cause side effects such as nausea, vomiting, and diarrhea and may lower a person’s resistance to infection. Some people are treated with a combination of corticosteroids and immunosuppressive medications. Some studies suggest that immunosuppressive medications may enhance the effectiveness of corticosteroids.
Biological therapies. Biological therapies are medications given by an injection in the vein, infliximab, or an injection in the skin, adalimumab. Biological therapies bind to TNF substances to block the body’s inflammation response. The U.S. Food and Drug Administration approved these medications for the treatment of moderate to severe Crohn’s disease that does not respond to standard therapies—mesalamine substances, corticosteroids, immunosuppressive medications—and for the treatment of open, draining fistulas. Some studies suggest that biological therapies may enhance the effectiveness of immunosuppressive medications.
Antibiotics. Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
Anti-diarrheal medications and fluid replacements. Diarrhea and abdominal cramps are often relieved when the inflammation subsides, but additional medication may be needed. Anti-diarrheal medications include diphenoxylate, loperamide, and codeine. People with diarrhea should drink plenty of fluids to prevent dehydration. If diarrhea does not improve, the person should see the doctor promptly for possible treatment with intravenous fluids.
Surgery
About two-thirds of people with Crohn’s disease will require surgery at some point in their lives.3 Surgery becomes necessary to relieve symptoms that do not respond to medical therapy or to correct complications such as intestinal blockage, perforation, bleeding, or abscess—a painful, swollen, pus-filled area caused by infection. Surgery to remove part of the intestine can help people with Crohn’s disease, but it does not eliminate the disease. People with Crohn’s disease commonly need more than one operation because inflammation tends to return to the area next to where the diseased intestine was removed.
- Proctocolectomy. Some people who have Crohn’s disease must have a proctocolectomy, a procedure that is performed by a specialized surgeon. Proctocolectomy is surgery to remove the rectum and part of the colon or the entire colon. People will receive sedation and general anesthesia during surgery. Most people need to remain in the hospital for 1 to 2 weeks, and full recovery can take 4 to 6 weeks.
- Ileostomy. During proctocolectomy, the surgeon also performs an ileostomy—an operation that attaches the ileum to an opening made in the abdomen called a stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. An ostomy pouch is then attached to the stoma and worn outside the body to collect stool. The pouch needs to be emptied several times a day. A specially trained nurse will teach the person how to clean, care for, and change the ostomy pouch and how to protect the skin around the stoma. The majority of people with an ostomy pouch are able to live normal, active lives.
- Intestinal resection surgery. Sometimes only the diseased section of intestine is removed and an ileostomy is not needed. Instead, the intestine is cut above and below the diseased area and the ends of the healthy sections are connected in an operation called an intestinal resection. People will receive sedation and general anesthesia during surgery. Most people need to remain in the hospital for several days, and full recovery can take 3 to 4 weeks.
Because Crohn’s disease often recurs after surgery, people considering surgery should carefully weigh its benefits and risks compared with other treatments. People faced with this decision should get information from health care providers who routinely work with GI patients, including those who have had intestinal surgery. Patient advocacy organizations can suggest support groups and other information resources.
Nutrition Supplementation
The health care provider may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used. A small number of people may receive nutrition intravenously for a brief time through a small tube inserted into an arm vein. This procedure can help people who need extra nutrition temporarily, such as those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.
The doctor may prescribe calcium, vitamin D, and other medications to prevent or treat osteoporosis for patients taking corticosteroids. People should take vitamin supplements only after talking with their doctor.
Eating, Diet, and Nutrition
No special diet has been proven effective for preventing or treating Crohn’s disease, but it is important that people who have Crohn’s disease follow a nutritious diet and avoid any foods that seem to worsen symptoms. People with Crohn’s disease often experience a decrease in appetite, which can affect their ability to receive the daily nutrition needed for good health and healing. In addition, Crohn’s disease is associated with diarrhea and poor absorption of necessary nutrients. Foods do not cause Crohn’s disease, but foods such as bulky grains, hot spices, alcohol, and milk products may increase diarrhea and cramping. The health care provider may refer a person with Crohn’s disease to a dietitian for guidance about meal planning.