Crohn’s Treatments

Treatment

There is currently no cure for Crohn’s disease, and there is no single treatment that works for everyone. However, there are several medicines that have been approved for treatment of Crohn’s disease. One goal of medical treatment is to reduce the inflammation that triggers symptoms. Another goal is 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.

Anti-inflammatory medicines

Anti-inflammatory medicines 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 the body, but they don’t work for everyone with Crohn’s disease. Sometimes, intravenous steroids are used in the hospital setting for short duration.Corticosteroids may be used for short term (3 to 4 months) symptom improvement and to induce remission. Corticosteroids also may be used in combination with an immune system suppressor to induce the benefit from other medicines. They are then eventually tapered off.
• Oral 5-aminosalicylates. These medicines are sometimes used for mild to moderate Crohn’s disease. They include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Delzicol, Pentasa, others). Oral 5-aminosalicylates work best for Crohn’s disease in the colon but don’t work as well if the disease is in the small intestine.

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 a healthcare professional and have your blood checked regularly. This is to look for side effects, such as a lowered resistance to infection and inflammation of the liver. These medicines also may cause nausea and vomiting.
• Methotrexate (Trexall). This medicine is sometimes used for people with Crohn’s disease who don’t respond well to other medicines. 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:

• Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Also known as TNF inhibitors, these medicines work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
• Ustekinumab (Stelara). This treats Crohn’s disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
• Vedolizumab (Entyvio). This is a type of medicine known as a monoclonal antibody. It works by stopping certain immune cell molecules — integrins — from binding to other cells in the intestinal lining. Vedolizumab is a gut-specific agent and is approved for Crohn’s disease.
• Risankizumab (Skyrizi). Risankizumab also is a monoclonal antibody. This medicine acts against a molecule known as interleukin-23. Risankizumab was recently approved for treating moderate to severe Crohn’s disease.
• Mirikizumab (Omvoh). Mirikizumab is a biologic medicine recently approved to treat Crohn’s disease.
• Guselkumab (Tremfya). This is the latest approved therapy in the same class as risankizumab and mirikizumab.

Synthetic versions of biologics, called biosimilars, are available to treat Crohn’s disease. These medicines work like the original versions of biologics, and they may cost less.

Janus kinase (JAK) inhibitors

JAK inhibitors are a type of medicine known as small molecules. These newer medicines help reduce inflammation by targeting parts of the immune system that cause inflammation in the intestines. They are taken by mouth. JAK inhibitors may be recommended for Crohn’s disease that hasn’t responded to other therapies. The U.S. Food and Drug Administration has approved the JAK inhibitor upadacitinib to treat Crohn’s disease. JAK inhibitors are not recommended for use in pregnancy.

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. Commonly prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medicines

In addition to controlling inflammation, some medicines may help relieve symptoms. But talk to a healthcare professional before taking any medicines you can buy without a prescription. Depending on the severity of Crohn’s disease, a health professional may recommend one or more of the following:

• Anti-diarrheals. A fiber supplement, such as psyllium husk (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.These medicines could be ineffective or even harmful in some people with strictures or certain infections. Please consult a healthcare professional before taking these medicines.
• Pain relievers. For mild pain, a health professional may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These medicines are likely to make symptoms worse and can make the disease worse as well.
• Vitamins and supplements. If you’re not absorbing enough nutrients, your health professional may recommend vitamins and nutritional supplements.

Nutrition therapy

A health professional may recommend a special diet given by mouth or a feeding tube, called enteral nutrition. Nutrients also can be delivered into a vein, called parenteral nutrition. This can improve overall health and allow the bowel to rest. Bowel rest may reduce inflammation in the short term.

Your care professional may use nutrition therapy short term and combine it with medicines, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier before surgery or when other medicines fail to control symptoms.

Your care professional also may recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel, called a stricture. A low residue diet is designed to reduce the size and number of your stools.

Surgery

If diet and lifestyle changes, medicines, or other treatments don’t relieve symptoms, a healthcare professional may recommend surgery. Nearly half of those with Crohn’s disease might require at least one surgery. However, surgery does not cure Crohn’s disease.

During surgery, the surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery also may be used to close fistulas and drain abscesses.

The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, often near the reconnected tissue. The best approach is to follow surgery with medicine to reduce the risk of recurrence.