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Living Well with Inflammatory Bowel Disease

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3 Options Your Doctor May Recommend Before Starting a Biologic for Crohn’s Disease

Medically Reviewed By Youssef (Joe) Soliman, MD

Some medication and lifestyle change options may help ease inflammatory bowel disease (IBD) symptoms, including those from Crohn’s disease. Consider the options before taking a biologic for Crohn’s.

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Biologics are a newer treatment type for Crohn’s disease, a type of IBD. Manufacturers produce these complex drugs from living sources, like bacteria or animal cells.

These medications work by blocking specific proteins involved in Crohn’s disease, stopping inflammation at its source. They can reduce symptoms like diarrhea and abdominal pain and decrease future flare-ups.

Biologics can be a safe and effective treatment for moderate to severe Crohn’s disease, but as with all medications, there are potential risks. Because biologics act on your immune system, they may make it harder for your body to clear infections. They can be expensive, and they might not work for everyone.

Sometimes, doctors prescribe biologics as a first-line therapy. Other times, they may suggest trying the following options first.

1. Making dietary changes

Dietary changes alone may not treat Crohn’s disease, but your food choices can influence how you feel. It may be a good idea to keep a food diary to help pinpoint certain foods that cause your symptoms. What causes your disease to flare up may not be the same as someone else.

Your doctor may recommend some general changes. These can include:

  • eating small, more frequent meals
  • increasing your liquid intake, especially water
  • limiting high fiber foods, like nuts and popcorn, and carbonated beverages
  • reducing ultra-processed foods and dairy products

Incorporating dietary changes that can work for you is important, so work with your doctor to personalize your approach. If Crohn’s disease prevents your body from absorbing enough nutrients, vitamins or supplements may also be necessary.

2. Trialing other medications

Doctors can prescribe several medications to treat Crohn’s disease. Typical treatments include:

  • Aminosalicylates: Sulfasalazine and similar drugs may help reduce gut inflammation for mild to moderate Crohn’s disease cases.
  • Corticosteroids: Doctors don’t usually prescribe steroids long term due to their side effects, but they can be effective anti-inflammatory medications. Budesonide is an example.
  • Immunomodulators: These medications, such as azathioprine, decrease your immune response and improve inflammation. Because they take some time to take effect, doctors may prescribe them with another drug, like a steroid.

Depending on your symptoms and disease severity, you may also need antibiotics for infections, acetaminophen for discomfort, or anti-diarrheal medications.

3. Incorporating healthy lifestyle changes

A 2020 research review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggested that some lifestyle factors can influence the progression and outcome of Crohn’s disease. So, making lifestyle changes that can benefit your overall health may also improve your disease. For example, consider making an effort to:

  • exercise regularly
  • maintain a moderate weight
  • prioritize your sleep
  • manage stress levels
  • quit smoking, if you smoke

Are you ready to try a biologic?

Crohn’s disease treatment aims to improve your symptoms, prevent recurrences, and help you avoid complications by allowing your intestines to heal. Your doctor can suggest a biologic if the disease doesn’t respond to other medications or lifestyle changes. This is the “step-up” approach to treating Crohn’s disease.

Some doctors choose a “top-down” approach, prescribing biologics earlier in the disease progression. A different 2020 review suggested that this may stop the inflammation before more serious damage occurs to your digestive tract.

Talk with your doctor about what to expect before starting a biologic. Because of biologics’ effects on your immune system, your doctor may want to check you for asymptomatic infections, like tuberculosis, and ensure you’re up to date on your vaccinations.

Expect to discuss potential side effects, like skin reactions at the injection or infusion site, and how to monitor for allergic reactions. Though rare, research shows that biologics may link to liver conditions and a higher risk of lymphoma.

With several biologics available, your doctor may consider several factors, like safety, cost, and your preference, when selecting a treatment. Options include:

  • anti-tumor necrosis factor agents, such as infliximab (Remicade)
  • anti-integrin agents, such as natalizumab (Tysabri)
  • anti-interleukin agents 12 and 23, such as ustekinumab (Stelara)

Your doctor may closely monitor your condition after starting biologic treatment. Sometimes, a drug may work for you initially but stops working over time. Communicate with your doctor as you work together to bring your Crohn’s disease into remission.

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  1. Crohn’s disease. (2023). https://medlineplus.gov/crohnsdisease.html
  2. Crohn's disease. (n.d.). https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease
  3. Fact sheet: Biologics. (2018). https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/biologic-therapy.pdf
  4. Frasca JD, et al. (2020). A practical review on when and how to select first-line biologic therapy in patients with inflammatory bowel disease. https://practicalgastro.com/2020/09/15/a-practical-review-on-when-and-how-to-select-first-line-biologic-therapy-in-patients-with-inflammatory-bowel-disease/
  5. Rozich JJ, et al. (2020). Effect of lifestyle factors on outcomes in patients with inflammatory bowel diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274876/
  6. What should I eat? (n.d.). https://www.crohnscolitisfoundation.org/diet-and-nutrition/what-should-i-eat

Medical Reviewer: Youssef (Joe) Soliman, MD
Last Review Date: 2023 Nov 16
View All Living Well with Inflammatory Bowel Disease Articles
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