Treatment Options for Crohn's Disease

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Living with Crohn's disease today means having more options to treat it than ever before. Your doctor will tailor your treatment just for you.

Your treatment plan will depend partly on where and how severe your Crohn's is and whether it is causing other health problems. It may involve more than one approach and may change over time as your needs do.

"A patient and physician have to weigh the risks and benefits of each treatment together, based on the patient's comfort level and the doctor's expertise and experience," says Edward Loftus, MD, professor of medicine at the Mayo Clinic in Rochester, MN. The more you learn about your options, the better you and your doctor can pick what is right for you.

Drugs for Crohn's

There are two phases of treatment for Crohn's. The goals of the first are to stop your gut from being inflamed and to relieve symptoms. The goal of the second is to keep symptoms from coming back.Many Crohn's drugs are used for both.

There are five main drug classes used to treat Crohn's disease.

Aminosalicylates (5-ASA drugs). These treat mild to moderate Crohn's disease. They help control inflammation in the lining of the gastrointestinal (GI) tract.

Antibiotics. These treat symptoms and help heal infections.

Corticosteroids. These strong and fast-acting drugs can often relieve flares in moderate to severe Crohn's within a few days. You usually take them in small doses for a short time because they can cause serious side effects.

Immunomodulators. If you have moderate to severe Crohn's, and you have not had luck with aminosalicylates or corticosteroids or have side effects from them, your doctor may suggest one of these. They can help your body respond better to corticosteroids during a flare and help you stay flare-free longer. They may take 3 months or more to work.

Biologics. These drugs treat people with moderate to severe disease, often if other drugs have not worked well. They don't affect your whole immune system, so they tend to cause fewer side effects, although some side effects can be serious.

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Surgery

If drugs stop easing your symptoms or if your Crohn's causes other health problems, your doctor may advise surgery. It can be the best option to relieve your symptoms long-term.

"Sixty to 80% of people with Crohn's will need at least one surgery," Loftus says. "Half of those people will need a second surgery."

Surgery may be used to remove part of your intestine, rectum, or colon or to treat other problems. Your doctor will aim to relieve your symptoms and still preserve as much of your intestine as he can.

Surgery does not cure Crohn's. About half the people who have surgery do have Crohn’s symptoms again in about 5 years. But for others, surgery can relieve symptoms for much longer. Taking some Crohn's drugs after surgery can lower the chance that it will return. And if it does, drugs can often treat it.

Drugs to Stay Flare-Free

Once your symptoms have stopped, taking Crohn's drugs can help keep them away -- hopefully, for a long time. Antibiotics, 5-ASA drugs, immunomodulators, and biologics are all used for this.

It is much easier to stay symptom-free than it is to get Crohn's under control in the first place. Try these tips:

  • Take drugs as prescribed. Don't take less or skip doses. If cost is a problem, your doctor can refer you to programs that offer free or low-cost prescription drugs.
  • If you smoke, stop. It makes Crohn's more active.
  • Avoid aspirin and pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve), which can trigger flares.
  • Don't take any drug, nutritional supplement, or natural aid before talking with your doctor. You want to make sure nothing interacts with your treatment plan, which could put you at risk for a Crohn’s flare.

Communication: Key to Your Treatment

To help ensure that your treatment works effectively, it's very important to take all medications as directed by your doctor. You should never stop taking a medication without consulting your doctor, as that could cause symptoms to return.

Because some drugs may cause serious side effects, your doctor may monitor you as you undergo treatment. So be sure you go to all follow-up doctor appointments and have all recommended laboratory tests.

If you have any questions about your treatment options or concerns about side effects, be sure to discuss these with your doctor.

WebMD Feature Reviewed by Arefa Cassoobhoy, MD, MPH on December 03, 2013

Sources

SOURCES:

Edward Loftus, MD, professor of medicine, Mayo Clinic, Rochester, MN.

Joshua Korzenik, MD, assistant professor of medicine, Harvard Medical School; director, Crohn's and Colitis Center, Brigham and Women’s Hospital, Boston.

Crohn's and Colitis Foundation of America: "About Crohn's Disease," "Living With Crohn's Disease," "Managing Flares and Other IBD Symptoms," "Types of Medications," "Antibiotics," "Aminosalicylates," "Corticosteroids," "Immunomodulators," "Biologic Therapies," "Surgery."

National Digestive Diseases Information Clearinghouse: "Crohn's Disease," "Maintenance Therapy," "Diet and Nutrition."

Shafran, I. Digestive Diseases and Sciences, April 2010.

Feller, M. Clinical Infectious Diseases, Feb. 15, 2010.

American College of Gastroenterology: "Management of Crohn's Disease in Adults."

Doherty, G. Alimentary Pharmacology and Therapeutics, April 31, 2010.

Morris, J. The Journal of the Louisiana State Medical Society, May-June 2009.

Chiba, M. World Journal of Gastroenterology, May 28, 2010.

Rajendran, N. World Journal of Gastroenterology, March 28, 2010.

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