Even though there is currently no cure for Crohn’s disease, there is a wide range of treatment options available that can help control Crohn’s symptoms and even help you achieve and maintain remission (having few or no symptoms over a period of time) as long as you stay on your treatment as prescribed. In fact, achieving and maintaining remission is the main goal of Crohn’s disease treatment.
It’s important to set treatment goals with your doctor
Often, the time with your doctor may be limited, so make it a priority to talk to your doctor about what you can expect from treatment and whether your treatment plan is working for you at every check-up. Talk to your doctor about finding a treatment that can help you reach these goals:
- Controlling inflammationImmune response to tissue injury that causes redness, swelling, and pain. that triggers your symptoms
- Achieving remission
- Maintaining remission
Remember, if you still experience a flare-up of symptoms and are taking your treatment as prescribed, you may want to talk to your doctor about whether your treatment is right for you. Your doctor may reassess your medication depending on the severity of your symptoms (whether they are mild, moderate, or severe).
Treatment options for IBD
Gastroenterologist Dr. Millie Long discusses treatment options and the importance of setting treatment goals.
Millie Long, M.D., M.P.H., is an Associate Professor at the University of North Carolina Chapel Hill School of Medicine.
How severe are your Crohn’s disease symptoms?
Mild to Moderate
You may have symptoms such as:
- Frequent diarrhea
- Abdominal pain (but can walk and eat normally)
No signs of:
- High fever
- Abdominal tenderness
- Painful mass
- Intestinal obstruction
- Weight loss of more than 10%
Moderate to Severe
You may have symptoms such as:
- Frequent diarrhea
- Abdominal pain or tenderness
- Significant weight loss
- Significant anemia (a few of these symptoms may include fatigue, shortness of breath, dizziness and headache)
Persistent symptoms despite appropriate treatment for moderate to severe Crohn’s, and you may also experience:
- High fever
- Persistent vomiting
- Evidence of intestinal obstruction (blockage) or abscess (localized infection or collection of pus). A few of these symptoms may include abdominal pain that doesn’t go away or gets worse, swelling of the abdomen, nausea or vomiting, diarrhea, and constipation.
- More severe weight loss
Using this information, along with certain other tests and additional information, your doctor can help develop a treatment plan that works for you.
Prescription medications that treat Crohn’s
Medications that treat Crohn’s disease strive to help control the inflammation that plays a role in your Crohn’s symptoms and induce remission. It’s quite possible that you may try multiple medications before finding the one that works best. So talk to your doctor if you feel like your medication isn’t meeting your treatment goals.
It’s also important to note that the medication your doctor prescribes may depend on whether you have mild, moderate, or severe Crohn’s and/or where in your GI tract your disease is active.
The following are the categories of drugs prescribed to treat Crohn’s:
Metronidazole, ciprofloxacin, and other antibiotics may be used when infections occur, or to treat complications of Crohn’s disease.
- Aminosalicylates (5-ASAs)
Given either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines and are usually used to treat mild to moderate Crohn’s symptoms.
- Corticosteroids (Steroids)
Given orally, as an injection, rectally, or intravenously, these medications help reduce inflammation by suppressing the immune system and are usually given to help with moderate to severe Crohn’s symptoms. Steroids are not intended for long-term use; they are best suited for short-term control of IBD symptoms and disease activity. If not used appropriately, patients can become steroid dependent or resistant.
- Immune modifiers (Immunomodulators)
Given orally or injected, these medications suppress the body’s immune response so that it cannot cause ongoing inflammation.
- Biologic therapies (Biologics)
Given intravenously or injected, this class of drugs suppresses the immune system to reduce inflammation by targeting a specific pathway, and is usually given to people who have not responded to conventional therapy.
Depending on your Crohn’s disease symptoms, your doctor may recommend over-the-counter (OTC) medications for you, such as:
- Pain relievers
- Nutritional supplements
Over-the-counter medications are often suggested to be taken as a supplement to your prescription—not instead of it.
You may also be familiar with “natural” medicine—alternative treatments, therapies, or medicine to supplement or use in place of prescription medications. Make sure you have an honest dialogue with your doctor before using alternative treatments, as they can impact the effects of traditional therapies.
When surgery is necessary
Treatment with medication is the first therapeutic option for people with Crohn’s disease. However, surgery may be a consideration if the disease doesn’t respond to medication—although surgery is not a cure for Crohn’s disease, as it is sometimes considered to be in ulcerative colitis. In fact, about 60%-75% of Crohn’s patients may require surgery at some point to correct potential complications of Crohn’s disease—such as clearing an intestinal blockage or repairing damage to the intestines. Damage to the intestines can include a perforation or abscess (a pus-filled area caused by infection).
Certain types of surgery for Crohn’s disease may result in a patient needing an ostomy. The United Ostomy Associations of America is a good place to find information.
Several different types of surgical procedures may be performed, depending on the type and severity of the disease, or the location of the disease in the intestines:
Widening of a narrow passage that doesn’t remove any portion of the small intestine
Removal of a portion or portions of the intestines
Proctocolectomy or Colectomy
Removal of the rectum together with part or all of the colon, or all or part of the colon only, respectively
It’s important to keep in mind that after surgery, Crohn’s symptoms can reappear in approximately 30% of patients within 3 years—and in up to 60% of patients within 10 years. So it's essential to remember to work with your doctor to keep up with the management of your disease after surgery.
Find out about a treatment option for moderate to severe Crohn’s disease. Learn more.