Treatment Options for Crohn's Disease
The Crohn’s Disease Diaries
Treatment has come a long way for people with inflammatory bowel diseases (IBDs) such as Crohn’s. A variety of medical and surgical methods are now available to help manage your disease.
While there is still no cure for Crohn’s disease, finding the right treatment plan can help you better control the condition while enjoying a productive, fulfilling life. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms, such as abdominal pain, diarrhea, and rectal bleeding.
There is no standard treatment for people with Crohn’s. Individualized treatment plans are based on the location and severity of your disease, complications, and your previous response to medical treatments.
The main goals of medical treatment for Crohn’s are to achieve remission, or the absence of symptoms, and to prevent flare-ups. Medications do this by controlling the intestinal inflammation that causes many symptoms of IBD. There are currently five categories of drugs being used.
The aminosalicylates are first-line drugs for both achieving and maintaining remission. These drugs help the body control inflammation and are effective in treating mild to moderate episodes and preventing relapses.
Corticosteroids, or steroids for short, are powerful, fast-acting anti-inflammatory drugs that have been a mainstay for treating Crohn’s flare-ups since the 1950s. Most patients notice improvement in their symptoms within days of starting steroids.
Steroids are generally used for short-term therapy at the lowest dose possible. They do not prevent flare-ups. Corticosteroids are rarely used for maintenance therapy since long-term use can lead to many side effects, including high blood pressure, increased risk for infection, weight gain, high blood sugar levels, and weakened bones (osteoporosis).
Drugs that weaken or change the body’s immune system are also used to treat Crohn’s disease. They work because Crohn’s appears to be caused by an overactive immune system. These drugs decrease the body’s inflammatory response.
Immunomodulators tend to be used in Crohn’s patients who:
Do not respond to aminosalicylates, antibiotics, or corticosteroids
Have steroid-dependent disease or frequently require steroids
Have experienced side effects with corticosteroid treatment
Need to maintain remission
4. Biologic Therapies
Biologics are the newest class of IBD drugs and are genetically engineered medications. They are made from the products of living organisms, including proteins, genes, and antibodies. Biologics interfere with the IBD inflammatory response by targeting specific proteins that play a role in increasing or decreasing inflammation.
The advantage of biologic therapies is that they are targeted to specific players. Unlike steroids, which tend to suppress the entire immune system, biologics act selectively.
5. Antibiotics and Antidiarrheals
Antibiotics are commonly used to treat bacterial overgrowth in the small intestine of Crohn’s patients. Reducing bacteria caused by fistulas, strictures, abscesses, or prior surgery can also help suppress the intestinal immune system.
Several medications are used to relieve diarrhea and crampy abdominal pain. Crohn’s patients who become dehydrated due to diarrhea may also be treated with fluids and electrolytes when needed.
Despite all the advances in medical therapies, most patients with Crohn’s will eventually require surgery at some point in time. Surgery may be used to help control or relieve symptoms of your disease or to correct complications.
One type of surgery involves removing part of the intestine. This often helps people with Crohn’s disease, but like medical therapy, it’s not a cure. Surgery doesn’t eliminate the disease, so it’s not uncommon for people with Crohn’s to have more than one operation.
Finding the Right Plan
It’s important to remember that Crohn’s disease usually recurs at various times throughout a person’s life. The changing pattern of Crohn’s means you may need to modify treatment plans at different points in your life. But with the right treatment plan in place, people with Crohn’s can benefit from long periods of remission when they are symptom-free.
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- “Strategies to Improve Quality of Life in Adolescents with Inflammatory Bowel Disease.” C.A. Karwowski et al. Inflammatory Bowel Diseases. November 2009, vol. 15, no. 11, pp. 1755−64;
- Living with Crohn’s Disease. Crohn’s and Colitis Foundation of America, May 2010; Managing Flares and Other IBD Symptoms. Crohn’s and Colitis Foundation of America, June 2009;
- Chron's and Colitis Foundation of America (http://www.ccfa.org/media/pdf/youngadultfacts.pdf);