The main treatment for Crohn's disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery. The type of symptoms you have and how bad they are will determine the treatment you need.

Initial treatment

Your doctor will most likely start with the traditional first-line treatment for Crohn's disease. He or she will then add or change medicines if you are not getting better.

Mild symptoms may respond to an antidiarrheal medicine such as loperamide (Imodium A-D, for example), which slows or stops the painful spasms in your intestines that cause symptoms.

For mild to moderate symptoms, your doctor will probably have you take:

• Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohn's disease.
• Antibiotics such as ciprofloxacin and metronidazole. These may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon. Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped.²
• Corticosteroids (such as budesonide or prednisone). These may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection.
  • Budesonide causes remission in mild or moderate Crohn's disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.
  • Prednisone may help if budesonide does not.
• Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.
• Tumor necrosis factor (TNF) antagonists, such as infliximab (Remicade). Your doctor may have you try these medicines if you have not had success with other medicines for Crohn's disease. In some cases, these medicines are tried before some of the other medicines that are listed above. Infliximab is also used to treat fistulas if antibiotics do not heal them. Other TNF antagonists may be used to treat Crohn's disease. They may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.