Question: What are the treatments for Crohn's Disease ?
Answer: A health care provider treats Crohn's disease with
- medications - bowel rest - surgery
Which treatment a person needs depends on the severity of the disease and symptoms. Each person experiences Crohn's disease differently, so health care providers adjust treatments to improve the person's symptoms and induce, or bring about, remission.
Medications
While no medication cures Crohn's disease, many can reduce symptoms. The goals of medication therapy are
- inducing and maintaining remission - improving the person's quality of life
Many people with Crohn's disease require medication therapy. Health care providers will prescribe medications depending on the person's symptoms:
- aminosalicylates - corticosteroids - immunomodulators - biologic therapies - other medications
Aminosalicylates are medications that contain 5-aminosalicyclic acid (5-ASA), which helps control inflammation. Health care providers use aminosalicylates to treat people newly diagnosed with Crohn's disease who have mild symptoms. Aminosalicylates include
- balsalazide - mesalamine - olsalazine - sulfasalazinea combination of sulfapyridine and 5-ASA
Some of the common side effects of aminosalicylates include
- abdominal pain - diarrhea - headaches - heartburn - nausea and vomiting
Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include
- budesonide - hydrocortisone - methylprednisone - prednisone
Side effects of corticosteroids include
- acne - a higher chance of developing infections - bone mass loss - high blood glucose - high blood pressure - mood swings - weight gain
In most cases, health care providers do not prescribe corticosteroids for long-term use.
Immunomodulators reduce immune system activity, resulting in less inflammation in the GI tract. These medications can take several weeks to 3 months to start working. Immunomodulators include
- 6-mercaptopurine, or 6-MP - azathioprine - cyclosporine - methotrexate
Health care providers prescribe these medications to help people with Crohn's disease go into remission or to help people who do not respond to other treatments. People taking these medications may have the following side effects:
- a low white blood cell count, which can lead to a higher chance of infection - fatigue, or feeling tired - nausea and vomiting - pancreatitis
Health care providers most often prescribe cyclosporine only to people with severe Crohn's disease because of the medication's serious side effects. People should talk with their health care provider about the risks and benefits of cyclosporine.
Biologic therapies are medications that target a protein made by the immune system. Neutralizing this protein decreases inflammation in the intestine. Biologic therapies work quickly to bring on remission, especially in people who do not respond to other medications. Biologic therapies include
- adalimumab - certolizumab - infliximab - natalizumab - vedolizumab
Health care providers 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 medication and a higher chance of developing infections, particularly tuberculosis.
Other medications to treat symptoms or complications may include
- acetaminophen for mild pain. People with Crohn's disease should avoid using ibuprofen, naproxen, and aspirin since these medications can make symptoms worse. - antibiotics to prevent or treat infections and fistulas. - loperamide to help slow or stop severe diarrhea. In most cases, people only take this medication for short periods of time since it can increase the chance of developing megacolon.
Bowel Rest
Sometimes Crohn's disease symptoms are severe and a person may need to rest his or her bowel for a few days to several weeks. Bowel rest involves drinking only clear liquids or having no oral intake. To provide the patient with nutrition, a health care provider will deliver IV nutrition through a special catheter, or tube, inserted into a vein in the patient's arm. Some patients stay in the hospital, while other patients are able to receive the treatment at home. In most cases, the intestines are able to heal during bowel rest.
Surgery
Even with medication treatments, up to 20 percent of people will need surgery to treat their Crohn's disease.1 Although surgery will not cure Crohn's disease, it can treat complications and improve symptoms. Health care providers most often recommend surgery to treat
- fistulas - bleeding that is life threatening - bowel obstructions - side effects from medications when they threaten a person's health - symptoms when medications do not improve a person's condition
A surgeon can perform different types of operations to treat Crohn's disease:
- small bowel resection - subtotal colectomy - proctocolectomy and ileostomy
Patients will receive general anesthesia. Most patients will stay in the hospital for 3 to 7 days after the surgery. Full recovery may take 4 to 6 weeks.
Small bowel resection. Small bowel resection is surgery to remove part of a patient's small intestine. When a patient with Crohn's disease has a blockage or severe disease in the small intestine, a surgeon may need to remove that section of intestine. The two types of small bowel resection are
- laparoscopicwhen a surgeon makes several small, half-inch incisions in the patient's abdomen. The surgeon inserts a laparoscopea thin tube with a tiny light and video camera on the endthrough the small incisions. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the 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 the intestine. - open surgerywhen a surgeon makes one incision about 6 inches long in the patient's 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 the intestine.
Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of a patient's large intestine. When a patient with Crohn's disease has a blockage, a fistula, or severe disease in the large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by
- laparoscopic colectomywhen a surgeon makes several small, half-inch incisions in the abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of the large intestine. The surgeon will reconnect the ends of the intestine. - open surgerywhen a surgeon makes one incision about 6 to 8 inches long in the abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove that section. The surgeon will reconnect the ends of the intestine.
Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient's entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileumthe last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient's abdomen and attaches it to the skin, creating an opening outside of the patient's body. The stoma is about three-fourths of an inch to a little less than 2 inches wide and is most often located in the lower part of the patient's abdomen, just below the beltline.
A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects intestinal contents outside the patient's body. Intestinal contents pass through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract.
People who have this type of surgery will have the ileostomy for the rest of their lives.