There's no cure for Crohn's disease. Medications or surgery is the treatment option for Crohn's disease.
Doctor can choose either "step-up" approach in which treatment starts with milder drugs or "top-down" approach in which stronger drugs are given initially to treat the Crohn's disease.
Treatment is aimed at reducing the inflammation, providing symptomatic relief, limiting complications and prolonging the period of remission.
Anti-inflammatory drugs
They are the first line agent in treating inflammatory bowel disease. Commonly used drugs are:
Oral 5-aminosalicylates
Drugs like sulfasalazine and mesalamine are recommended if your colon is affected since they aren't effective in treating disease in the small intestine.
These drugs, particularly sulfasalazine, cause several side effects, such as nausea, diarrhea, vomiting, heartburn and headache.
Corticosteroids
Corticosteroids like prednisone can reduce
- inflammation,
- relieve symptoms
- and prolong remission.
Side effects include
- a swollen face,
- excessive facial hair,
- sweating during night,
- sleeplessness
- and hyperactivity.
They may also cause severe side effects like
They are opted if you are unresponsive to other treatments. Budesonide, a newer type of corticosteroid, works rapidly than older ones and has fewer side effects.
Usually, corticosteroids are used for three to four months, not longer. A combination of corticosteroids and immunosuppressant may also be given to prevent the symptoms and sustain the preventive effect.
Immune suppressors
They reduce the inflammation by altering your immune function. They may be given alone or in combination. Immunosuppressant drugs are:
Azathioprine and mercaptopurine
They are commonly used in inflammatory bowel disease. While taking these drugs, your doctor monitors the side effects, such as increased risk of infection.
They may cause nausea and vomiting and serious. Severe side effects include liver or pancreatic inflammation and bone marrow suppression.
Long term side effects are rare and include certain infections and cancers, such as lymphoma and skin cancer.
Infliximab, adalimumab and certolizumab pegol
They are tumor necrosis factor (TNF) inhibitors which inhibit the inflammatory protein known as tumor necrosis factor (TNF).
They can provide relief from moderate to severe symptoms and may also induce remission. They can be prescribed if other drugs become ineffective, you are likely to develop severe Crohn's disease or if you have a fistula.
Combination of TNF inhibitors with an immunosuppressant is still controversial. Immunosuppressant can increase your risk of tuberculosis and other serious infections.
Discuss about these risks with your doctor. Your doctor may perform a skin test for tuberculosis, a chest X-ray and a test for hepatitis B prior to prescribing these medications. They can cause certain cancers, including lymphoma and skin cancers.
Methotrexate
It is usually prescribed to treat cancer, psoriasis and rheumatoid arthritis. It may be prescribed in Crohn's disease if other medications become ineffective.
Nausea, fatigue and diarrhea, and rarely, severe pneumonia are the short-term side effects. When used for longer period of time, it can cause bone marrow suppression, scarring of the liver and sometimes cancer. You will be closely monitored for side effects.
Cyclosporine and tacrolimus
These potent drugs are usually given to people who are not benefitted by other treatments. They can cure Crohn's-related fistulas.
Cyclosporine is associated with serious side effects, such as kidney and liver damage, seizures, and fatal infections. They are used for shorter period.
Natalizumab and vedolizumab
They inhibit the binding of integrins, certain immune cell molecules, to cells of your intestine.
Natalizumab is recommended for people with moderate to severe Crohn's disease with inflammation and who are unresponsive to other medications. Although rare, Natalizumab is associated with progressive multifocal leukoencephalopathy, a brain disease that usually leads to death or severe disability.
You must first be registered in a special restricted distribution program to obtain it. Vedolizumab has recently been approved for Crohn's disease. It also inhibits integrins but is not associated with a risk of brain disease.
Ustekinumab
Ustekinumab, used to treat psoriasis, has shown promising results while treating Crohn's disease.
Antibiotics
Antibiotics are likely to decrease the amount of drainage while sometimes can cure fistulas and abscesses in people with Crohn's disease.
The effectiveness of antibiotics for Crohn's disease has not been proved yet. Commonly prescribed antibiotics include:
Metronidazole
Metronidazole, once a drug of choice, is now rarely used because of side effects, such as numbness and tingling in your hands and feet and less commonly, muscle pain or weakness. Stop taking the medication if you experience these effects.
Ciprofloxacin
This drug is preferred over metronidazole and provides relief from symptoms in some people with Crohn's disease. Rarely, it can cause tendon rupture, especially when taken with corticosteroids.
Other medications
Some other medications are used to manage your signs and symptoms. Depending upon your condition your doctor may suggest.
Anti-diarrheals
Psyllium powder or methylcellulose adds bulks to your feces and relieves mild to moderate diarrhea. If you have severe diarrhea, loperamide may be prescribed. Anti-diarrheals should only be taken if your doctor approves them.
Pain relievers
Acetaminophen can relieve mild pain. Other common pain killers, such as ibuprofen, naproxen sodium can worsen your symptoms and disease.
Iron supplements
Iron supplements are recommended since you have increased risk of developing iron deficiency anemia due to chronic intestinal bleeding.
Vitamin B-12 shots
Crohn's disease can cause Vitamin B-12 deficiency. Vitamin B-12 is required for proper functioning of nerves, preventing anemia as well as promoting normal growth and development.
Calcium and vitamin D supplements
They are commonly prescribed as Crohn's disease and steroids used to treat it are can cause osteoporosis.
Nutrition therapy
You may be given parenteral nutrition (injecting nutrients into a vein) or suggested enteral nutrition (a special diet given via a feeding tube) to treat Crohn's disease.
This allows your bowel to rest which can reduce inflammation for short period. Enteral and parenteral nutrition are usually recommended to improve health before surgery or when people are unresponsive to other medications and symptoms can't be controlled.
If you have a narrowed bowel (stricture), a low residue or low-fiber diet is suggested that reduces risk of intestinal blockage,
Surgery
Surgery is the ultimate solution and provides short term relief. Nearly half of the cases will need at least one surgery.
But surgery cannot cure the disease. During surgery, the damage segment of gastrointestinal tract is removed and the healthy sections are reconnected.
Strictureplasty is a surgical procedure for widening the narrowed intestinal segments. Recurrence is common and may be minimized by medications after surgery.
