Crohn’s Disease Treatment

Key points

  • There are many ways to manage Crohn’s and what works for someone else may not work for you. Learning how to maximise your own wellbeing can be a long process but it’s worth it.
  • The main goal of Crohn’s disease treatment is to reduce inflammation and symptoms.
  • Research into Crohn’s disease has led to more treatment options in both medication and diet.
  • In some cases Crohn’s disease complications may be treated with surgery.

What kind of treatments are there for Crohn’s disease? 

Crohn’s disease cannot currently be cured but for most people it can be well managed through medication, lifestyle choices and sometimes surgery. 

The aim of treatment is to reduce symptoms, control inflammation and heal the bowel. Since Crohn’s disease affects everyone differently, each person will need to work with their healthcare team to discover what works best for them. Treatment may also need to change over time if they become less effective.

Medications

Medications for Crohn’s disease are mainly used to reduce inflammation. The main types include: 

Aminosalicylates (5-ASAs): Used to reduce inflammation in the lining of the gut. Sometimes used to treat mild flares of Crohn’s disease and maintain remission. They are most effective in the large intestine and can be taken orally as tablets or rectally as enemas or suppositories. Examples include mesalazine, olsalazine, sulphalazine and balsalazide. 

Corticosteroids (steroids): Usually used to treat moderate-to-severe Crohn’s disease they block the body’s inflammatory response. They are effective for short-term control of the disease during flare-ups and are not suggested for long-term use because of side effects.  

Examples include prednisolone, prednisone, methylprednisolone, budesonide, hydrocortisone and beclometasone dipropionate. 

Immunosuppressants: Used to suppress the body’s immune response which decreases inflammation. Usually used for people who aren’t responding to aminosalicylates or are having difficulty coming off steroids without the inflammation coming back.  

Examples include azathioprine, mercaptopurine, methotrexate, mycophenolate mofetil, ciclosporin, and tacrolimus. 

Biologics: These are a newer class of drugs for Crohn’s disease that are specially made antibodies, which selectively bind to inflammatory signaling proteins to reduce inflammation. 

Biologics are currently given through an injection under the skin (subcutaneous) or by an intravenous (IV) infusion that delivers the medication into your veins over time, usually in a clinic. 

Antibiotics: Used in Crohn’s disease to treat abscesses or fistulas, and after some types of surgery. Examples include metronidazole and ciprofloxacin. 

For more detailed information see Medication and IBD

Diet

Diet has an important role to play in of many aspects of Crohn’s disease, including treating active disease, managing symptoms, ensuring nutritional adequacy and often complications of Crohn’s disease.  Diet may also potentially support remission. 

Diet is important to treat many different aspects of Crohn’s disease.  There are dietary treatments that may be used to treat malnutrition, symptoms related to active inflammation, symptoms related to bowel sensitivity rather than inflammation and for certain complications of Crohn’s disease. 

It is important that you discuss with your medical treating team, including dietitian, diets that may be appropriate for your circumstance to ensure you are not over-treating with diet. Often, objective markers, such as blood tests, stool tests and/or imaging may be applied to work out whether symptoms are from active inflammation or bowel sensitivity to guide advice on diet. Always seek advice from a gastrointestinal dietitian before trying a new diet.  

Examples of dietary treatments include:

Exclusive Enteral Nutrition (EEN): this diet is recommended first-line treatment for inducing remission in children with Crohn’s disease, but is also frequently used in adults. The diet is a liquid-only diet that comprises only a nutritionally-complete formula instead of food for 2-8 weeks, usually instead of steroids. The EEN regimen is prescribed and monitored by a dietitian, as part of an IBD team.  

Crohn’s Disease Exclusion Diet (CDED): this diet has shown to be comparable to EEN in children with mild Crohn’s disease, but is also sometimes applied in adults. It involves using a nutritionally-complete formula for half nutritional requirements in addition with a small list of foods. Like EEN, the CDED is applied for a short period, usually instead of steroids, and is prescribed and monitored by a dietitian. 

Low or moderate FODMAP diet: used to treat symptoms from bowel sensitivity, but not active inflammation.

Moderate, low fibre or low residue diet: used usually short term if you have a stricture and you are at risk of developing a blockage (obstruction).

High energy and protein diet: used to treat malnutrition or to optimise nutritional stores before planned surgery for improved recovery.

Oral vitamin and mineral supplementation: often used to treat deficiencies.

For more detailed information see Nutrition. 

Surgery

Surgery for Crohn’s disease is a treatment not everyone will need. Sometimes parts of the bowel are too damaged to be healed by medications and the best way to return you to health is with an operation. Many operations are done laparoscopically now (keyhole) with quick recovery. The goal of surgery is to keep as much of the bowel as possible while restoring quality of life.

There are two main reasons why surgery may be an option for you. One, when current therapies are no longer effective and two, when complications like strictures develop. Common types of surgery include:

Resection: When a diseased section of the bowel is removed and the healthy ends joined together. This is not a cure because the disease will usually appear again in the area where the surgery happened, but with effective treatments this can often be prevented or significantly reduced.

Stricturoplasty (also known as strictureplasty): A stricture is the narrowing of the intestine and makes it hard for food and waste to pass through. The procedure involves widening the narrowed part of the intestine without removing any of the bowel. 

Creating a stoma: After a diseased section of the bowel is removed, surgeons may connect the intestine to the skin where a pouch or ostomy bag will be attached to collect waste. This can be temporary or permanent. 

For more detailed information see Surgery. 

Even while in remission you may still experience some symptoms. Tiredness and fatigue are common, and some people can still have increased bowel discomfort even when the inflammation is well controlled. Make sure to discuss any symptoms you may have with your doctor and let them know what medication you are taking. Some over-the-counter drugs such as anti-inflammatory drugs (e.g. ibuprofen) can affect Crohn’s disease or interfere with the medication you are on. Always speak with your doctor or healthcare team before making changes to your treatment or if you have any worries about your current treatment.

Complementary and alternative medicine

Complementary and alternative medicine (CAM) for Crohn’s disease can be used alongside conventional treatment to reduce symptoms and improve wellbeing.  

Research is still ongoing in many areas of CAM so it is important to always talk about your options with your doctor. Some areas in which research are exploring include: 

Mind and body wellbeing: Studies have shown a connection between gut health and mental health. Improving your psychological health through certain lifestyle changes can positively affect your gut health and may reduce disease symptoms. 

Supplements: It is common for people with Crohn’s to have lower levels of certain vitamins and minerals. If this happens your doctor may recommend taking nutritional supplements like vitamin D, vitamin B12 or iron tablets. There are many different brands of supplements so always follow what your doctor prescribes. 

Microbiome: The microbiome is a hot topic for researchers of gut health and is important for finding new ways of treating Crohn’s disease. Currently, there have not been treatments consistently shown to benefit Crohn’s disease but there are several areas of interest. This is still for research studies only and not ready for the clinic.  

  • Probiotics: Research into how probiotics can help treat Crohn’s is still limited but taking them may help you stay in remission. Probiotics can improve the environment of your microbiome by encouraging healthy diversity of good bacteria in your gut. 
  • Faecal Microbiota Transplant (FMT): Research is still ongoing to find out if transferring faecal material from a healthy donor to a patient can help treat Crohn’s. 
  • Mycobacterium avium paratuberculosis (MAP): Research is still ongoing to find out if this bacteria has a relationship to Crohn’s disease. If it does, anti-MAP antibiotics may be made to treat Crohn’s. 

Medical Cannabis: More research is needed before using medical cannabis to treat Crohn’s is recommended. Small studies have shown that cannabis can reduce symptoms like nausea and pain but there are also possible side effects like impaired judgment and anxiety. 

For more detailed information see Complementary and alternative therapies.