There is not yet a cure for Crohn’s disease so the primary goal of treatment is reduce the inflammation in the affected areas of your digestive tract. (Why hasn't a cure been found for Crohn's disease?) Doctors typically use drug therapy to achieve relief of symptoms and control of inflammation. Depending on your unique situation, you may receive one or more of the drugs mentioned below. In the best cases, this drug therapy might also help facilitate long-term remission. In more severe cases, surgery may be needed. The type of treatment you will need depends on the location and severity of your inflammation.
Here are the most common drugs currently used to treat Crohn’s disease.
Mild Crohn's Disease
Antidiarrheal medicines may slow or stop the painful intestinal spasm that cause symptoms. Some of these medicines, such as loperamide (Imodium), are available without a prescription while others, such as diphenoxylate (Lomotil) are available only by prescription. It is important to note that antidiarrheal medicines can be dangerous if you use them when you have moderate or severe inflammation of the colon. They can cause a serious complication called toxic megacolon where the colon swells to many times its normal size.
Advanced Crohn's disease
These drugs are used to treat symptoms of Crohn's disease that range from mild to moderate:
Mesalazine or mesalamine (Asacol, Rowasa, Pentasa, Salofalk). This anti-inflammatory medication is designed to reduce inflammation. It has a long history of being used in patients with Crohn’s disease but over time clinical research has shown that it is only nominally effective in treating inflammation in the large intestine and not effective in treating inflammation in the small intestine. It can be taken orally or in the form of a enema or suppository.
Sulfasalazine (Azulfidine, Salazopyrin). This drug also reduces inflammation but has not shown promising results in treating Crohn’s disease, which can affect the entire gastrointestinal tract. It has shown to be somewhat effective when used for treating inflammation in the colon.
- Metronidazole (Flagyl) and ciprofloxacin (Cipro). These drugs are can help reduce harmful intestinal bacteria and suppress the immune system. They can also reduce the amount of drainage and heal fistulas and abscesses that are common in Crohn’s disease.
- Budesonide (Entocort) and prednisone. Budesonide is a steroid used to reduce inflammation . Entocort works faster than traditional steroids (such as prednisone) and appears to have fewer side effects. It has shown to be effective in treating inflammation in the lower small intestine and the first part of the large intestine, typically known as the is ileum. Prednisone is also a steroid but attacks inflammation throughout the body and acts as an immune suppressant. Those taking prednisone typically only stay on it for is several weeks because it is known to have unpleasant side effects.
Immune system suppressor drugs
- Azathioprine (Imuran) and mercaptopurine (Purinethol). These are two of the most widely used immune system suppressants. Immune suppressants reduce inflammation by making the immune system less active. Though a less robust immune system helps with inflammation, it also puts you at higher risk for infection, so use of these drugs need to be closely monitored by your doctor.
- Methotrexate (Rheumatrex). This drug, which is most often used to treat cancer, psoriasis and rheumatoid arthritis, is sometimes used for those with Crohn's disease who don't respond well to other medications.
- Infliximab (Remicade). This drug is typically used for adults and children with moderate to severe Crohn's disease. It may be prescribed shortly after a diagnosis is made if there is evidence of severe Crohn’s disease or if you have a fistula. It's also used after other drugs have failed. Remicade works by neutralizing a protein that your immune system produces called tumor necrosis factor (TNF) before it can cause inflammation in your intestinal tract.
- Adalimumab (Humira). Humira works similarly to Remicade by blocking the TNF protein. It is also prescribed shortly after diagnosis for those with moderate to severe Crohn's disease and for those who may have fistula.
- Certolizumab pegol (Cimzia)
- Vedolizumab (Entyvio)
- Ustekinumab (Stelara)
In some cases, your doctor may recommend a special type of nutrition therapy that supplies you with the needed nutrients but allows your bowel and digestive system to rest. This type of nutrition is given through a feeding tube inserted through the nose directly into the digestive tract (called enterel nutrition) or it can also be injected into a vein (parenteral nutrition). Giving your bowel a rest can help reduce inflammation. This type of nutrition therapy is often used to help prepare for surgery or control symptoms that aren’t responding to medications.
If the above treatments don’t sufficiently relieve your symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract (called a bowel resection) and reconnect the healthy sections. Surgery may also be necessary to close fistulas or drain abscesses. Surgery may also be used to widen a segment of intestine that has become too narrow in a procedure called strictureplasty.