The following article explains Crohn’s Disease Treatments and what options are available.
As mentioned in a previous article, there is no cure for Crohn’s Disease. But, there are various treatments that aid in a patient living a functional life, outside of times in relapse. The most common treatment for Crohn’s Disease is prescription therapy. However, in some cases surgery might be necessary. The one sure thing though is, it’s not a one-size-fits-all treatment plan.
Some doctors prefer one of two strategies, either “step up”, or “top down”. Step up is when the strength of medicine is gradually increased, and top down is the opposite. Either way, the main goal of any treatment for Crohn’s is to reduce inflammation, which is the root of most complications associated with this disease.
Crohn’s Disease Treatments
So, let’s look at possible options that might be mentioned by your doctor…
To help reduce the inflammation, it’s highly likely your doctor will prescribe an anti-inflammatory. The first you might hear mentioned is Oral 5-aminosalicylates, such as sulfasalazine and mesalamine. especially if your colon is affected. However, they are not very helpful in treating the small intestine. The side effects can range from nausea to increased diarrhea, which is what most patients are battling in the first place. So, these drugs are not used as often as they once were.
Another option you will hear is corticosteroids, such as prednisone. These can be effective, but only used short-term, as the side effects are unpleasant, such as sweating, insomnia, puffy face, and hyperactivity. More serious side effects could be high blood pressure, osteoporosis, diabetes, glaucoma, cataracts, and increased risk of infections. While corticosteroids don’t work for everyone, they are typically prescribed when not responding to other treatments, with the hope of inducing remission.
Once in remission, immune system suppressants are used for maintenance.
Immune System Suppressors
Similar to anti-inflammatories, immune system suppressants also help reduce inflammation. But, they do more. They zero in on the immune system, to help fight what is causing the inflammation. They are often used in combination with other drugs, such as the anti-inflammatories mentioned above. Immunosuppressant therapy might include the following:
- Azathioprine and Mercaptopurine – Perhaps the most commonly used. But, you will need to be closely monitored by your doctor, along with frequent blood draws. The reason is because they might lower your resistance to infections, yet negatively affect the pancreas, liver, and bone marrow, in long term use. Short term use might produce nausea and vomiting.
- Infliximab, Certolizumab Pegol, and Adalimumab – Referred to as TNF inhibitors, their job is to neutralize the tumor necrosis factor, also known as the immune system protein. These are used more when the case of Crohn’s is moderate to severe, or after other therapies have failed.
- Methotrexate – Often used to treat cancer, rheumatoid arthritis, and psoriasis, it’s another option for those who aren’t responding well to other treatments. Side effects can include diarrhea, nausea, fatigue, and on a rare occasion, pneumonia. Long term use could affect bone marrow suppression, liver scarring, as well as cancer.
- Cyclosporine and Tacrolimus – Used to aid in healing fistulas, it could also lead to serious side effects such as damage to the liver and kidneys, lethal infections, and seizures. They should only be used short term, because of the serious effects.
- Natalizumab and Vedolizumab – These are used to halt integrins (immune cell molecules) from attaching to other cells found in the intestinal lining. Since Natalizumab is linked to possible brain disease, a patient must be registered with an exclusive and restricted distribution program to use it. However, Vedolizumab does not appear to have the same risk for brain disease.
- Ustekinumab – Often prescribed for psoriasis, it’s been shown to be helpful in also treating Crohn’s Disease, and is sometimes used when other therapies fail.
This is a list of some of the more popular immune system suppressants prescribed by doctors to help fight off the active stages of Crohn’s Disease.
Antibiotics are also used in conjunction with other meds.
Antibiotics Used for Crohn’s Disease
A patient can often experience drainage, fistulas, and abscesses with perianal Crohn’s stages. At this point, antibiotics are then prescribed as treatment. They are also used to eradicate harmful bacteria found in the intestines, which causes the inflammation.
The most common antibiotics prescribed are Metronidazole, also known as Flagyl, and Ciprofloxacin, or Cipro. Along with the more common side effect of nausea, Metronidazole can also cause muscle pain, tingling in the feet and hands, or numbness.
Cipro, although quite rare, can also cause a ruptured tendon. The risk for that increases, when used with corticosteroids.
Non-prescription Options and Supplements
The inflammation in a relapse of Crohn’s Disease isn’t just uncomfortable. It can also lead to diarrhea, bleeding, fatigue, and more complications that can alter a person’s functionality. In order to help reduce the effect of these, there are options that won’t need a prescription. The following are the more common ones:
- Pain Relievers – To help with pain, over the counter medicine can help, such as Tylenol, or an ibuprofen like Motrin or Advil. However, these can actually make the symptoms and disease worse.
- Anti-diarrhea Medicine – Using a fiber supplement like Metamucil (psyllium powder) or Citrucel (methylcellulose) will often help with a mild or moderate case of diarrhea. This works by adding bulk to the stool. More severe cases might benefit from Imodium (loperamide).
- Vitamin B12 – Crohn’s Disease can deplete your Vitamin B12, so taking a Vitamin B12 supplement can help prevent anemia. It also comes in the form of injections, which can be given by your doctor.
- Iron – Intestinal bleeding is another complication that could arise, so taking an iron supplement might be recommended.
- Calcium and Vitamin D – Osteoporosis is a possibility with Crohn’s. Adding Calcium and Vitamin D to your diet, or through a supplement will be helpful in fighting off osteoporosis.
While many of the above do not require a prescription, it’s very important to report the use of them to your doctor, preferably getting their approval before starting. Some could further complicate certain cases.
As with any chronic illness, nutrition plays a significant role in fending off symptoms and relapses. But there might come a time when you need more than just a healthy diet. If the active stage of Crohn’s Disease is severe, the doctor might suggest a feeding tube, providing your body with the proper nutrients. Not only will this restore the proper nutrients to the body, but it can also provide a necessary rest to the bowel.
This might be recommended during a severe relapse, or prior to surgery.
There might come a time when surgery is recommended if other treatments are not effective any longer. This occurs in about half of Crohn’s Disease patients.
A surgeon could eliminate part of the digestive tract, then connect the healthier parts together. Surgery might also be necessary to drain an abscess, or close a fistula.
However, surgery is not a cure. Unfortunately, none of the treatments above are, because one doesn’t exist. But, they can help bring back functionality to a person’s life.