Crohn's disease is a condition that can cause swelling and irritation in any part of the digestive tract, from the mouth all the way to the rectum. While there is no cure for Crohn's disease, there are ways to control the swelling and other symptoms.
In Crohn's disease, inflammation or swelling of the digestive tract can lead to pain in the abdomen and severe diarrhea. It can even lead to malnutrition.
If the disease goes untreated, patients may face a variety of complications, including ulcers, fistulas (tunnels into other tissue caused by ulcers), infection and fissures (tears in the mucus membrane of the anus).
The goal of treatment for Crohn's disease is to control the inflammation that causes disease symptoms and complications. Preventing complications improves your outcomes in the future. In some people, treatment even leads to long-term remission, or long periods without symptoms.
If you have Crohn's disease, treatment will likely involve drug therapy. In some cases, patients need surgery. Nutrition and lifestyle have a place in every patient's effort to control Crohn's disease.
Medications
Anti-Inflammatory Drugs
Since Crohn's disease is an inflammatory disease, the first line of drug treatment often involves anti-inflammatory drugs. These include:
- Azulfidine (sulfasalazine). This drug is often used to treat Crohn's that affects the colon. However, like many medications, Azulfidine does not work for everyone. In some patients, Azulfidine can lead to side effects such as nausea, vomiting, heartburn and headache.
- Asacol or Rowasa (melamine). Even though this anti-inflammatory drug has a lower risk of side effects, patients taking melamine may experience nausea, vomiting, heartburn, diarrhea and headache. Melamine can be taken orally or rectally. Generally, melamine does not work for Crohn's affecting the small intestine.
- Corticosteroids. While these drugs can reduce inflammation anywhere in the body, they are associated with some serious side effects. Steroids can increase the risk of infection and osteoporosis (weakening of the bones). They also may cause puffy face, insomnia, hyperactivity and night sweats. Your doctor may prescribe steroids if you have moderate to severe Crohn's disease that did not respond to other medications. Steroids are not for long-term use. Examples of steroids used in Crohn's disease include prednisone and budesonide.
Immune System Suppressors
Inflammation in Crohn's disease occurs because the immune system mistakenly attacks healthy tissues. To calm this overactive immune system, a doctor may prescribe immune system suppressors.
Instead of directly treating inflammation, immune system suppressors reduce inflammation by targeting the immune system. They block the immune reaction that leads to inflammation. These drugs may be prescribed alone, but are often used in combination.
Examples of immune system suppressors include:
- Imuran (azathioprine) and Purinethol (mercaptopurine). These drugs are the most commonly used immunosuppressants for inflammatory bowel disease, which includes Crohn's disease. Because these drugs can increase the risk of infection, patients taken either Imuran or Purinethol need to have regular blood tests. Other side effects include nausea and vomiting.
- Remicade (infliximab). This drug may be prescribed soon after you have been diagnosed with Crohn's disease, especially if your doctor thinks you may have severe disease or if you have a fistula. Remicade works by blocking a protein called tumor necrosis factor (TNF), which contributes to inflammation. If you have a history of heart failure, multiple sclerosis, or cancer, you should not take Remicade or other similar drugs.
- Humira (adalimumab). Like Remicade, this drug blocks TNF. Humira may be used in those with a fistula or severe Crohn's disease. Humira reduce symptoms and, in some cases, put Crohn's disease into remission. Side effects of Humira include skin irritation and pain at injection site, nausea, runny nose and upper respiratory infection. Humira may also increase the risk of tuberculosis and serious fungal infections.
- Cimzia (certolizumab pegol). This drug also blocks TNF. It may be prescribed instead of Remicade or Humira or in cases where Remicade and Humira stop working. Side effects include headache, abdominal pain, nausea, injection site reactions, and an increased risk of infection.
- Rheumatrex (methotrexate). While this drug is used to treat cancer, psoriasis and rheumatoid arthritis, it can also be used to treat Crohn's disease, particularly when other medications do not work. Short-term use can lead to side effects such as nausea, fatigue and diarrhea. In some cases, it may cause severe pneumonia. Long-term use of Rheumatrex may scar the liver or lead to cancer.
- Gengraf, Neoral or Sandimmune (cyclosporine). In Crohn's disease, this drug is used mainly to heal fistulas. Normally, patients are prescribed cyclosporine only if other medications have not worked. Side effects of cyclosporine include kidney damage, liver damage, seizures and deadly infections. Patients should not take cyclosporine for long periods of time.
- Tysabri (natalizumab). This drug is thought to reduce inflammation by blocking certain molecules (integrins) from binding to other cells in the intestinal lining. Tysabri has been linked to a rare and deadly brain infection called multifocal leukoencephalopathy. Because of this risk, patients prescribed Tysabri must enroll in a special program.
These immune system suppressors are associated with a small cancer risk. Despite this risk, many people with Crohn's disease need these drugs to avoid surgery and hospitalization and to improve their quality of life. Talk with your doctor to see which drug will work best for you.
Antibiotics
Antibiotics are also used in people with Crohn's disease. While antibiotics are mainly used to heal fistulas and other open wounds, they may help reduce harmful bacteria in the intestine. Researchers also believe that antibiotics may suppress the intestine's immune system, which can set off Crohn's symptoms.
Two examples of antibiotics prescribed to Crohn's disease patients include:
- Flagyl (metronidazole). This drug used to be the most commonly used antibiotic in Crohn's disease. However, Flagyl can lead to some dangerous side effects, including numbness and tingling in the hands and feet, muscle pain and muscle weakness.
- Cipro (ciprofloxacin). This drug has been shown to improve symptoms in some Crohn's disease patients. It is now used in place of Flagyl.
Other Drugs
Doctors prescribe a variety of other drugs to control the signs and symptoms of Crohn's disease. These include:
- anti-diarrheals - which thicken your stool
- laxatives - which relieve constipation
- pain relievers
- iron supplements - used in patients with intestinal bleeding, which can lead to anemia (lack of iron)
- vitamin B-12 - used to prevent anemia
- calcium and vitamin D - used to lower risk of osteoporosis caused by Crohn's disease and steroid use
Surgery
About two-thirds of Crohn's disease patients will need surgery at some point in their lives, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Surgery is used when medications do not work or to fix complications of Crohn's disease. Surgery may be used to correct blocked, punctured, bleeding, or abscessed intestines.
In some cases, surgery is used to remove part of the intestine. While this type of surgery does not rid patients of the disease, it can provide some relief.
Examples of surgeries used in Crohn's disease include:
- proctocolectomy - surgery to removes the rectum and part of the colon or entire colon
- ileostomy - a part of proctocolectomy that allows patients with a removed rectum to pass stools
- intestinal resection - a surgery in which the affected portion of intestine is removed and the remaining intestine is reconnected
Even after surgery, Crohn's disease often returns. As such, patients thinking about undergoing surgery should carefully weigh the risks and benefits of surgery compared to other treatments.
Ask your doctor if surgery is right for you.
Nutrition and Lifestyle
Certain foods and drinks can worsen the signs and symptoms of Crohn's disease. For some patients, it can be hard to tell which foods worsen symptoms. If this is your situation, you may find it helpful to keep a food diary to track what you eat and how you feel afterward.
If you have Crohn's disease, here is some diet advice:
- Eat less dairy products to improve symptoms like diarrhea, abdominal pain and gas.
- Avoid high-fat foods such as butter, margarine, cream sauces and fried foods.
- Even though high-fiber foods are part of a healthy diet for many people, they can make certain symptoms of Crohn's disease. Eat less fiber if it is making your symptoms worse.
- Stop eating foods if you feel like they make your symptoms worse.
- Eat small meals.
- Drink lots of liquids, but avoid alcoholic and caffeinated beverages.
- Try taking multivitamins, as Crohn's disease can make it harder for your body to absorb nutrients.
- Work with a dietician to regain weight and find a diet that works for you.
Certain lifestyle habits can make Crohn's disease worse. Smoking is especially bad if you have Crohn's disease. Patients who smoke are more likely to have relapses (when disease symptoms return), need drug treatment and need multiple surgeries. Quit smoking to improve symptoms of Crohn's disease and your overall health.
Stress also may trigger flare-ups of Crohn's disease. When you get stressed, your digestive system works differently. Your stomach and intestines may work more slowly.
Exercise, meditation and breathing exercises all can help reduce stress.
Work with Your Doctor
When it comes to dealing with Crohn's disease, the most important thing you can do is work with your doctor. Tell your doctor if you feel your symptoms get worse. Keep track of how you feel after certain meals or if you are experiencing side effects of your medications. Working with your doctor can help you find the treatment plan that works best for you.
