A Physician's Guide to Treating Crohn's Disease
Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the intestinal tract, from the mouth to the rectum. Though there is no cure for Crohn’s disease, medications exist that can help manage the acute symptoms of the condition and bring it into long-term remission. Surgery may be beneficial in severe cases, but will not cure the disease. Additionally, lifestyle changes play an important role in keeping the disease in remission. Let’s discuss in further detail some treatment options for Crohn’s disease.
As with any chronic medical condition, making lifestyle changes is important. In the case of Crohn’s, these changes can reduce flares and help you recover from surgery more quickly. Reducing stress can improve active Crohn’s symptoms. Exercise can be beneficial to stress reduction as well as overall health. Some studies have shown that smoking can worsen symptoms; additionally, in individuals who must have surgery for the condition, it is the biggest indicator of symptoms returning after surgery. If you are currently smoking, it is important to stop immediately; ask your doctor for help if you have problems doing this on your own.
Some small studies suggest that diets high in fat, sugar, and processed foods can increase the risk of developing Crohn’s disease. And too much fiber can exacerbate Crohn's disease. There is a balance in the amount of fiber that can be consumed by an individual with this condition. It is recommended that vegetables and fruit be well cooked via steaming or baking. Fatty foods, dairy, and spicy foods may aggravate symptoms. It is therefore important to have a dietitian and your physician as an integral part of your care team to assist with dietary planning that is best for you.
There are several medications that are commonly used in the treatment of Crohn’s disease. Medications are prescribed based on the severity of the disease, and used to reduce symptoms and reduce recurrences of flares. There are a variety of medication types:
Aminosalicylates are a class of medications, including sulfasalazine (Azulfidine) and mesalamine (Asacol HD and others), that reduce inflammation during acute flare-ups and help prevent recurrences in mild cases of the condition.
Antibiotics, such as metronidazole (Flagyl) and ciprofloxacin (Cipro), have anti-inflammatory and anti-microbial properties; they can be used to treat fistulas in mild cases of Crohn’s.
Steroids, such as budesonide (Entocort EC), prednisone (Deltasone), and prednisolone (Flo-Pred), are anti-inflammatory medications that can be used to control and prevent flares. Though they may cause your Crohn’s to go into remission, they can’t make it stay in remission.
A class of medications called biologics is used in moderate-to-severe Crohn’s disease to reduce inflammation. They suppress your immune system, effectively helping you go into remission and stay in remission. Some of these medications include methotrexate (Trexall), adalimumab (Humira), azathioprine (Imuran), infliximab (Remicade), and certolizumab pegol (Cimzia). They are often used in conjunction with steroids, and can lower the dose of the steroid used and even make steroid withdrawal easier.
Surgical therapy may be an option for individuals with Crohn’s that is difficult to keep in remission or is more often active than in remission. Your doctor may also prescribe surgery if your bowel is obstructed, if an abscess is present, or if there’s excessive bleeding or damage to the intestinal lining. Surgical therapy can range from draining an abscess to correcting a stricture to partially removing the intestine. It is important to note that surgery will not cure Crohn’s disease. Surgery may allow one to have some relief of symptoms. But most patients have only a brief remission, even with surgery.
Some small studies show that alternative therapies, including acupuncture, homeopathy, herbs, and vitamin and mineral supplementation, may be beneficial and complement traditional treatment of Crohn’s disease. It is important to discuss with your doctor if alternative therapies are appropriate for you.