Treatment of Crohn’s Disease
While there is no cure for Crohn’s disease, treatment includes various medications and therapies to manage symptoms and maintain a healthy life.
Main Treatment Goals
Treatment Approach
There is no one-fits-all treatment for Crohn’s disease. Treatment is individual and depends on:
- Patient age
- Overall health and other health issues
- Extent and severity of the disease
- Patient preferences
- Social support system available to the patient
Nutrition as Treatment
Exclusive Enteral Nutrition (EEN) is a formula-only diet, usually for 6 to 8 weeks. It is often the first treatment used to bring Crohn’s into remission.
Crohn’s Disease Exclusion Diet (CDED) can be combined with a formula diet as partial enteral nutrition (PEN). A nutritionist guides you through either one.
Types of Crohn’s Medication
Medications in Crohn’s Disease
Corticosteroids
Corticosteroids reduce inflammation and symptoms by decreasing the immune response. They work non-specifically and can be taken orally, topically, or intravenously.
- Budesonide, a type of corticosteroid with fewer side effects. Taken orally, it is released in the last part of the small intestine and the beginning of the large intestine.
Possible short-term side effects can include increased appetite and weight gain, a puffier face, mood changes or irritability, difficulty sleeping, and acne.
Biologics
Biologics are targeted medications that block specific parts of the immune response involved in Crohn’s.
They are sometimes the first medication used, for example when the inflammation is widespread, when there are deep ulcers, when the area around the anus is affected, or when growth has slowed down.
Anti-TNF (anti–tumor necrosis factor)
Used to get into remission and to stay in remission, including when corticosteroids have not worked, and as a first treatment in more severe Crohn’s.
- Infliximab (Remicade), infusion
- Adalimumab (Humira), injection
Other biologics
- Vedolizumab (Entyvio), infusion. Not a first-line therapy, mainly for patients who haven’t responded to standard care medication.
- Ustekinumab (Stelara), injection. Used in moderate to severe Crohn’s disease.
JAK Inhibitors
These are tablets that block inflammation signals inside cells. They are used in moderate to severe Crohn’s, mainly when other treatments haven’t worked.
- Upadacitinib (Rinvoq), taken by mouth
Immunomodulatory Medication
These medications adjust the immune system by either increasing or decreasing its response. In Crohn’s, they decrease the immune response.
They can be taken orally or by injection, and are usually prescribed in moderate to severe cases when other medications haven’t helped sufficiently, or in case of medication intolerance.
- Thiopurines and methotrexate, older medications that may take months to become effective.
5-ASA & Sulfasalazine
These medications work best in the large intestines and are not primarily recommended for Crohn’s disease today. Sulfasalazine may still be used in some mild cases where the disease is mainly in the colon.
Antibiotics
Antibiotics aren’t a main Crohn’s treatment on their own, they don’t treat the inflammation that causes Crohn’s. They’re sometimes prescribed when complications develop, like infections, abscesses, or fistulas, where they treat the complication rather than the underlying Crohn’s.
Surgery
The strategy in Crohn’s disease is to avoid surgery when possible. Surgery is usually considered when medications haven’t worked or when complications develop. If surgery is ever recommended for you, your medical team will walk you through what to expect.
Supplements
Supplements aren’t Crohn’s medications, but they’re often part of daily care if blood work shows deficiencies. Common ones in Crohn’s include vitamin D, vitamin B12, folate, and iron. Your medical team will check your levels regularly and recommend supplements only if you actually need them.
Stress Relief & Relaxation
Stress doesn’t cause flare-ups, but it can make them worse. Finding ways to reduce stress can help you manage symptoms and feel more balanced.