Crohn's Disease

Treatment

Treatment for Crohn's disease depends on its location and severity, the presence of complications and the patient's response to medications. The goal of treatment is to reduce the inflammation that triggers symptoms. Treatment relieves symptoms and results in long-term remission. Treatment for Crohn's disease usually involves medication and/or surgery.

Drug Therapy

Drug therapies must be custom-designed for each patient. Finding which medications best alleviate the symptoms may take time. When a patient with Crohn's disease undergoes surgery, it is important that the health care team (including the surgeon, anesthesiologist, and the primary treating physician) know which medications the patient is taking.

Aminosalicylates (Mesalamine)

Many patients with mild to moderate disease are treated with medications containing mesalamine. These medications differ based on what parts of the bowel are treated. The use of mesalamine to treat Crohn's disease, either to achieve or maintain remission, is sometimes controversial because not all studies have consistently shown that mesalamine is effective for Crohn's disease. Mesalamine is usually well-tolerated and has no serious side effects. Patients may experience nausea, headache and diarrhea.

Corticosteroids

Some patients who have severe active disease or do not respond to mesalamine therapy may need corticosteroids such as prednisone to control inflammation and induce remission. These drugs are effective but have significant side effects, such as increased susceptibility to infection, mood swings, anxiety, depression, elevated blood pressure, glaucoma, cataracts and osteoporosis. Physicians may use different strategies to administer these drugs in order to reduce side effects. Budesonide is a corticosteroid that is rapidly broken down by the liver, resulting in a much lower frequency of side effects. These medications are gradually reduced once remission is achieved — and mesalamine or a drug that suppresses the immune system is used to maintain remission.

Antibiotics

Antibiotics such as metronidazole are sometimes used to treat Crohn's disease. They are particularly helpful in patients with fistulas and are often combined with other medications. The use of metronidazole to treat active Crohn's disease or to delay the recurrence of Crohn's for the first two to three years after an ileum resection surgery is often controversial because not all studies have consistently shown that metronidazole and other antibiotics are effective in these patient groups. Metronidazole can be effective in managing perineal Crohn's disease (involving the pelvic area).

Immunosuppressives

Immunosuppressives (drugs that suppress the immune system) such as azathioprine, 6-mercaptopurine and methotrexate are also used to block inflammation. They are effective but may cause side effects such as nausea, vomiting, liver problems or inflammation of the pancreas. They work over the long term by suppressing the bone marrow and, as a result, the immune response. Because of their potential side effects, frequent monitoring, including blood tests and doctor visits, are important. These medications take on average eight to 12 weeks to begin working. Usually the physician uses other medications to induce remission. Despite their limitations, these medications can allow patients to wean themselves from corticosteroids. Most patients tolerate them well.

Tacrolimus and cyclosporine, which are used in patients who have undergone organ transplantation, may be effective in patients with active Crohn's disease who are also receiving steroids, but only when given at high doses. Tacrolimus and cyclosporine are also prescribed as alternative medications when fistulas fail to close.

Biologic Therapy

A relatively new addition to medical treatments for Crohn's disease is infliximab. This is the first medication approved by the U.S. Food and Drug Administration specifically for the treatment of Crohn's disease. It is an antibody that blocks tumor necrosis factor (TNF), an important cause of inflammation in Crohn's disease. Infliximab is given intravenously initially as a series of three injections. In most cases it is followed by maintenance dosing every eight weeks. It is effective in inducing and maintaining remission. Several other biologic agents for Crohn's disease are being studied in clinical trials currently.

Surgery

Many patients require surgery because medical therapy does not control their symptoms or because complications such as blockage, abscess, perforation or bleeding into the intestines have developed. Read more about surgery.