How Is Crohn’s Disease Treated?

Crohn’s disease is a type of chronic inflammatory bowel disease (IBD) that causes inflammation in your gastrointestinal (GI) tract—which is the passageway that runs from your mouth to your anus. This inflammation can cause uncomfortable symptoms including abdominal pain, diarrhea, and unintentional weight loss. among many others.

While there is no cure for Crohn’s disease, a variety of medications, surgeries, and other procedures can help you manage your symptoms and reduce the frequency of flares—or periods of active or worsening symptoms. The goal of treatment is to limit inflammation and improve your overall quality of life.

If you receive a diagnosis of Crohn’s disease, it’s a good idea to keep in touch and establish regular care with your provider so they can monitor how treatment is working for you and make any changes to your treatment plan if necessary.

Medications

Healthcare providers use a variety of medications to treat and manage Crohn’s disease symptoms. Most of these medications are focused on minimizing inflammation, reducing symptoms, and improving overall gut health—which is sometimes also called mucosal healing.

There are several types of medications that can reduce symptoms. Which medication your healthcare provider recommends will depend on your symptoms, the severity of your condition, and your overall health. 

Corticosteroids

Corticosteroids are the first line of treatment for mild to moderate cases of Crohn’s disease. Budesonide and prednisone are generally the most common types of corticosteroids that your healthcare provider may prescribe you.

A typical prescription includes taking a corticosteroid tablet by mouth daily for approximately eight weeks or until symptoms go away. Your exact dosage will depend on how severe your symptoms are and what’s best for your overall health.

Potential side effects of corticosteroids include:

• Acne
• Bone mass loss
• High blood sugar or blood pressure 
• Weight gain

Corticosteroids are considered “induction therapy” which means that they help reduce symptoms and lower the frequency of flares. But, once you achieve remission (or, a period where symptoms go away), you may need additional medication to keep your symptoms in check as corticosteroids do not help maintain symptom remission.

Immunomodulators

Immunomodulators are a type of medication that many people with moderate or severe Crohn’s disease use to lower their symptoms. This medication reduces inflammation by decreasing your immune system activity. Generally, your provider may prescribe you this medication if your body hasn't reached or stayed in remission after a course of corticosteroids or other treatments.

Immunomodulator drugs not only help you reduce symptoms, but can also keep your symptoms at bay during periods of remission. This is known as “maintenance therapy.” But, it’s important to note that immunomodulators can often take up to three months to be effective before you notice substantial changes to your symptoms.

Imuran (azathioprine) and Purinethol (6-mercaptopurine) are the most common types of oral immunomodulators that people with Crohn’s disease use. However, other immunomodulators such as Otrexup (methotrexate) are injections that your provider can also use if you prefer to not take an oral pill.

Side effects of these medications may include:

• Feeling tired or fatigued 
• Nausea and vomiting
• Low white blood cell count which can increase your chance of developing other infections

Biologics

Like immunomodulators, biologics drugs directly target your immune system to reduce inflammation. The difference between biologics and immunomodulators is how they regulate the immune system. Immunomodulators affect the immune system across your whole body, while biologics target specific immune system proteins that cause inflammation.

Typically, biologics are not the first medication option for people with Crohn’s disease. If your provider recommends this medication, it may be because you have a severe case of Crohn’s disease or your body has not responded well to corticosteroids or immunomodulators. 

Your provider may recommend one of the following biologics, which come in a variety of injectable forms:

• Remicade (infliximab)
• Humira (infliximab)
• Cimzia (certolizumab)
• Stelara (ustekinumab) 
• Entyvio (vedolizumab)

Your dose and how often you need an injection will depend on your condition and the severity of your symptoms. Generally, your provider may schedule you for an injection once every two to four weeks during the first few injections and once every four to eight weeks for maintenance therapy.

Taking biologics isn’t risk-free, however. Because the medication directly targets your immune system, you may be at an increased risk of developing other infections. 

Surgery

Surgery can often help treat Crohn’s disease complications like ulcers, perforations (holes) in your intestines,  intestinal blockages, and life-threatening intestinal bleeding.

According to the American Academy of Family Physicians, more than 50% of people with Crohn's disease may require at least one surgery during their lifetime while they live with a severe case of the condition.

If you require surgery, the type of surgery you might need will depend on what part of your GI tract is most affected. Surgeries can take anywhere from four to eight weeks on average to heal. Common surgeries include:

• Small bowel resection: Removal of a part of the small intestine.
• Large bowel resection: Also known as a subtotal colectomy, this surgery is the removal of a part of the large intestine. 
• Proctocolectomy: A major surgery that involves the removal of the entire colon and rectum. People who receive this surgery will also have to get an ileostomy procedure which attaches a removable pouch to your anus in order to collect stool and other waste.

Fecal Transplantation

Recently, fecal transplantation has become an emerging area of research and a proposed treatment for inflammatory bowel diseases, such as Crohn’s disease.

A fecal transplantation procedure involves collecting a stool sample from a donor without an inflammatory bowel disease and introducing that stool to someone living with Crohn’s disease. The purpose of this procedure is to restore healthy bacteria in your gut and reduce inflammatory symptoms caused by Crohn’s disease. 

Keep in mind: research on this transplantation method is in the early stages. So far, clinical trials have shown promising results in people with ulcerative colitis—a related inflammatory bowel disease that shares some symptoms with Crohn’s disease.

According to a 2021 review published in the Journal of Gastroenterology and Hepatology, researchers found that fecal transplantation in people with ulcerative colitis have helped reduce symptoms in a safe and effective way.

However, more research is needed to understand the effectiveness of this procedure in people with Crohn’s disease. While this treatment is not widely available for most people, it’s good to know the possibility of future treatments, should you need them down the line. 

Treating Crohn’s Disease Complications

Another major part of Crohn’s disease treatment includes taking medicines to manage complications that you might experience due to Crohn’s disease symptoms or the side effects of any medications you are taking. 

That said, your provider may prescribe one or more of the following medications to address these complications:

• Tylenol (acetaminophen): Helps reduce stomach pain 
• Antibiotics: Treats potential infections and ulcers 
• Imodium A-D (loperamide): Reduces diarrhea symptoms 

My Experience

Gaylyn Henderson, MPH

Crohn's disease advocate

Diagnosed in 1998

Living and Thriving With Chronic Pain

IBD affects your entire life, physically, emotionally, mentally, and socially. 

I have physical limitations due to chronic pain associated with multiple pelvic surgeries. Although I may take a little longer or need accommodations, I am still able to enjoy my life and thrive. I don't let my physical limitations limit my possibilities and outlook on life.

How Can Chronic Pain Affect Your Relationships?

Learn more about our advocates

Living With and Managing Crohn’s Disease

Because Crohn’s disease is a life-long condition even under the best treatment conditions, its symptoms can significantly affect your quality of life. As a result, it’s important to work with your healthcare provider to develop a treatment plan that is right for you. 

Along with medications, surgeries, and other procedures, your provider will likely also recommend making dietary changes that can reduce symptoms and improve your gut health. These changes may include:

• Incorporating an anti-inflammatory diet that includes meals such as leafy green vegetables, nuts, fruits, and fatty fish 
• Avoiding carbonated drinks and alcoholic beverages 
• Eating small portions 
• Keeping a list of foods that trigger symptoms and removing them from your diet 

It's worth noting that you shouldn't drastically change your diet or try a liquid diet without the approval and recommendation from your provider. In some cases, if your symptoms are severe your provider may recommend you rest your bowels by eating very few meals or participating in a liquid diet. During this time, you may receive nutrients via a feeding tube or intravenously through an IV.

A Quick Review

Crohn’s disease is a life-long chronic condition that requires very specific symptom treatment and management. Doctors use a number of medications to help reduce intestinal inflammation, cause symptom remission, and keep symptoms from coming back again. 

In some severe cases, surgery might be required to deal with disease complications like intestinal blockage and bleeding. Luckily, emerging therapies like fecal transplantation have shown promising results, providing a positive outlook for the future of Crohn’s disease therapy. 

With the help of your doctor, medications and dietary adjustments can help you learn to manage your symptoms and improve your quality of life while living with Cronh’s disease.