There is currently no cure for Crohn’s disease, and there is no single treatment that works for everyone. One goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms and to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission. The various treatment options for Crohn’s disease include the following:
Anti-inflammatory drugs
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in your body, but they don’t work for everyone with Crohn’s disease. Corticosteroids may be used for short-term (3 to 4 months) symptom improvement and to induce remission. Corticosteroids may also be used in combination with an immune system suppressor to induce the benefit from other medications. They are then eventually tapered off.
Immune system suppressors
These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone. Immune system suppressors include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting.
- Methotrexate (Trexall). This drug is sometimes used for people with Crohn’s disease who don’t respond well to other medications. You will need to be followed closely for side effects.
Biologics
This class of therapies targets proteins made by the immune system. Types of biologics used to treat Crohn’s disease include:
- Vedolizumab (Entyvio). This drug works by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Vedolizumab is a gut-specific agent and is approved for Crohn’s disease. A similar medication to vedolizumab known as natalizumab was previously used for Crohn’s disease but is no longer used due to side effect concerns, including a fatal brain disease.
- Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Also known as TNF inhibitors, these drugs work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
- Ustekinumab (Stelara). This was recently approved to treat Crohn’s disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
- Risankizumab (Skyrizi). This medication acts against a molecule known as interleukin-23 and was recently approved for treatment of Crohn’s disease.
Antibiotics
Antibiotics can reduce the amount of drainage from fistulas and abscesses and sometimes heal them in people with Crohn’s disease. Some researchers also think that antibiotics help reduce harmful bacteria that may be causing inflammation in the intestine. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
Other medications
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. But always talk to your doctor before taking any nonprescription medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:
- Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.These medications could be ineffective or even harmful in some people with strictures or certain infections. Please consult your health care provider before you take these medications.
- Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These drugs are likely to make your symptoms worse and can make your disease worse as well.
- Vitamins and supplements. If you’re not absorbing enough nutrients, your doctor may recommend vitamins and nutritional supplements.
Nutrition therapy
Your doctor may recommend a special diet given by mouth or a feeding tube (enteral nutrition) or nutrients infused into a vein (parenteral nutrition) if you have Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest may reduce inflammation in the short term.
Your doctor may use nutrition therapy short term and combine it with medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.
Your doctor may also recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel (stricture). A low residue diet is designed to reduce the size and number of your stools.
Surgery
If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. Nearly half of those with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease. During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.
Lifestyle and home remedies
Sometimes you may feel helpless when facing Crohn’s disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
Diet
There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up. It can be helpful to keep a food diary to track what you’re eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them. Here are some general dietary suggestions that may help to manage your condition:
- Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help.
- Eat small meals. You may find that you feel better eating five or six small meals a day rather than two or three larger ones.
- Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
- Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
- Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Smoking
Smoking increases your risk of developing Crohn’s disease. And once you have Crohn’s disease, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Stress
Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms worse and may trigger flare-ups. Although it’s not always possible to avoid stress, you can learn ways to help manage it, such as:
- Exercise. Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.
- Biofeedback. This stress-reduction technique may help you decrease muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
- Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
Alternative medicine
Many people with Crohn’s disease have used some form of complementary and alternative medicine to treat their condition. However, there are few well-designed studies of the safety and effectiveness of these treatments.