How is Crohn's disease treated? All you need to know.

Crohn's disease is an inflammatory bowel disease (IBD) that can affect the entire digestive tract. Because Crohn’s causes flare-ups, it is common to take medication permanently in order to prevent relapses (prophylaxis). Medication can greatly improve quality of life and everyday functioning.

Crohn's disease treatment at a glance:

• Although Crohn's disease has no cure, it can be managed well in most cases.
• There is no single treatment. Doctors create personalized treatment plans based on disease course and risk factors.
• Treatment is different for acute relapses and preventative long-term therapy.
• Abstinence from nicotine and nutritional therapy can positively affect the disease course.
• Alternative medical treatments outside of conventional medicine are not useful for treating Crohn’s and could cause complications.

How is Crohn's disease treated?

Generally, Crohn's disease can be managed with a balanced diet and abstinence from nicotine. Taking certain dietary supplements can also be beneficial. If a flare-up is particularly severe, a hospital stay, liquid food, or artificial nutrition via infusion may be necessary.

Medication can prevent Crohn’s flare-ups and lengthen remission phases. There are also medications called glucocorticoids—like prednisolone or budesonide—that treat acute flare-ups by suppressing the immune system. These medications save many from hospital stays, complications, and operations.

Unlike ulcerative colitis, Crohn's disease cannot be cured with surgery. Sometimes, a procedure or surgery is necessary to address Crohn’s complications, such as the narrowing of the intestine (intestinal stricture). Careful assessment of risks, benefits, and other treatment options should occur before an operation.

How is Crohn’s treatment different for each person?

Doctors create treatment plans based on an individual’s age, disease course, and risk factors. Flare-up severity is determined by how far the inflammation has spread. Mild to moderate flare-ups often only cause inflammation in the last part of the small intestine (terminal ileum) and half of the large intestine (colon). If the disease course is more severe, inflammation may appear in other sections of the intestine or on other parts of the digestive tract.

For a mild disease course, doctors use a bottom-up strategy, in which better-tolerated medication is given first. If this is not sufficient to lessen symptoms, more aggressive drugs are used.

For a severe disease course with more complications, doctors use a top-down strategy, starting treatment with more aggressive drugs. If the patient improves, the doctor can gradually reduce the dosage (tapering). If necessary, the doctor could also switch to better-tolerated medications with fewer side effects.

Acute Crohn’s treatment with glucocorticoids

Glucocorticoid _medication is used in response to an acute Crohn’s episode. Some glucocorticoids cause a _systemic effect, meaning they work throughout the entire body. Others work locally on the intestinal wall and have a topical effect. The following glucocorticoids are commonly used:

• Prednisolone is often used with Crohn's disease for severe episodes. Patients swallow a tablet or receive an intravenous infusion. It causes anti-inflammatory effects throughout the body, and the digestive tract absorbs the medication. Possible side effects include:

  • Water retention
  • Food cravings
  • High blood pressure
  • Influence on hormonal balance
• Budesonide is another glucocorticoid mainly used for mild flare-ups; it is better-tolerated and has fewer side effects than prednisolone. The drug primarily acts locally in the intestines and is absorbed in small amounts in other parts of the body.

If symptoms improve, the glucocorticoid dose is slowly tapered down. If glucocorticoids are not enough to treat the flare-up, drugs that suppress the immune system (immunosuppressants)—normally used in long-term therapy—are introduced. Glucocorticoids are not suitable for long-term therapy because they have many side effects and are not beneficial for remission maintenance.

Long-term Crohn’s treatment: immunosuppressants

After acute therapy decreases the inflammation, there is usually a discussion between doctor and patient about whether long-term therapy is needed to maintain remission and to prevent flare-ups.

The decision about long-term therapy should be made on an individual basis after exploring the pros and cons with the doctor. Unfortunately, there is no research to date that characterizes which people benefit most from long-term therapy.

Long-term therapy is likely needed after:

• Early-onset Crohn’s disease in childhood, adolescence, or young adulthood
• Nicotine use
• Reappearance of inflammation symptoms after tapering off medication

Immunosuppressants are typically used for long-term therapy. Common immunosuppressants are azathioprine, 6-mercaptopurine, and antibodies that affect mechanisms of the immune system, such as Infliximab (Remicade®) or Adalimumab. These drugs are given as an infusion or with a syringe at regular time intervals. It is also important to note that these drugs can increase cancer risk and cause side effects, such as intolerances.

Can Crohn's disease be treated without medication?

Very mild flare-ups do not necessarily require medication. For these mild flares, prioritize physical rest and eating a light, easily tolerated diet. Many also find pain relievers helpful.

Anti-inflammatory medication is necessary if there is no improvement, if inflammation increases, or if the disease spreads to other intestinal sections. It is very important to address Crohn’s flare-ups with adequate therapy. If left untreated,_ complications can occur, such as abscesses_, the accumulation of pus.

Crohn’s disease nutrition

Adequate, balanced nutrition is very important for those with Crohn's, especially during a flare-up. Flare-ups often occur alongside indigestion and lack of appetite. If someone is unable to eat, a feeding tube can also be used.

Over time, Crohn’s can weaken the body by causing significant weight loss and nutrient deficiencies. In children, severe flares are known to affect growth and development; as a result, long-term therapy is especially important for children with Crohn’s.

Those with Crohn’s often cannot tolerate lactose, a sugar found in dairy products (lactose intolerance). If you suspect this, test yourself at home, and consult a doctor. If you are lactose intolerant, avoiding dairy products can positively affect the course of Crohn's disease. Lactose-free products are also a good option.

New therapy for fistulas

There is new research on therapies that target a complication of Crohn's, the formation of abnormal passageways (fistulas) _from the intestinal wall to the outside of the body. Inflammation can cause this abnormal passageway to form, posing a risk for abscesses and infection. Fistulas sometimes prevent people from having control over their bowel movements (incontinence_). Surgery for fistulas is complicated and only successful sometimes; new fistulas also may quickly form.

A promising new drug, Darvadstrocel, treats fistulas, even without surgery. This medication contains stem cells from the fatty tissue of healthy people.

Complementary and alternative medicine for Crohn’s disease

More evidence is needed on the safety and application of complementary and alternative medicine—herbal remedies, probiotics, and mind-body practices—for Crohn's disease. You can find a table of evidence for these methods in our article on flare-ups.

Larger, well-designed research studies are needed to determine the efficacy of complementary and alternative medicines, for Crohn's and to allow doctors to integrate them into treatment plans. If disease management efforts are not sufficient to reduce inflammation, conventional medicines—such as anti-inflammatories and if necessary, surgery—are very important.