Treatment for Crohn’s Disease

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines and surgery.

There is no single way to treat every person who has Crohn’s disease. The goals of treatment are to lower inflammation in your intestines, prevent flares of your symptoms, and keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms, where Crohn’s disease is causing inflammation, and other factors.

Medicines do not cure Crohn’s disease. However, medicines can reduce inflammation and bring on and maintain remission—a time when your symptoms disappear. Crohn’s disease medicines include

• corticosteroids, also called steroids, which should only be used short term
• immunosuppressants
• biologics
• a new small molecule medicine, which doctors may prescribe for adults with Crohn’s disease who don’t respond to other medicines

Many people with Crohn’s disease need medicines.

Bowel rest

If you are in the hospital with complications from Crohn’s disease, you may need to rest your bowel. Your doctor may suggest resting your bowel for a few days to several weeks.7,8 Bowel rest may involve drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

• ask you to drink a liquid that contains nutrients
• give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
• give you nutrients through a special tube inserted into a vein in your arm

In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. Between 30% and 55% of people with Crohn’s disease will require surgery within 10 years after diagnosis.9 Surgery will not cure Crohn’s disease. However, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

• fistulas
• abscesses
• colorectal cancer
• dysplasia, or precancerous cells that increase the risk for developing colorectal cancer
• bleeding that is life-threatening
• intestinal obstructions caused by scarring
• inflammation and symptoms that don’t improve or stop after treatment with medicines

A doctor may also recommend surgery if medicines do not improve your symptoms. A surgeon can perform different types of operations to treat Crohn’s disease.

Small bowel resection

Small bowel resection is surgery to remove part of your small intestine. A small bowel resection may be needed if you have an intestinal obstruction or severe Crohn’s disease in your small intestine.

Large bowel resection

A large bowel resection is surgery to remove part of your large intestine. A large bowel resection may be needed if you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine.

Proctocolectomy and ileostomy

Your doctor may recommend a proctocolectomy and ileostomy.

A proctocolectomy is surgery to remove your entire colon and rectum. In an ileostomy, surgeons bring the ileum—the end part of your small intestine—through the abdominal wall and create a stoma.

A stoma is a surgical connection between an internal organ and the skin on the outside of your body. After an ileostomy, waste will pass through the stoma. You’ll wear a removable pouch, called an ostomy pouch, that is attached to the skin around your stoma to collect the waste.

If you have this type of surgery, you will have the stoma for the rest of your life.

How do doctors treat symptoms and complications of Crohn’s disease?

Doctors may recommend or prescribe other ways to treat symptoms or complications of Crohn’s disease. Talk with your doctor before taking any over-the-counter medicines.

Doctors may recommend

• acetaminophen for mild pain. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs), which can make your symptoms worse.
• antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
• loperamide to help slow or stop severe diarrhea. In most cases, people take this medicine only for short periods of time and not when inflammation in the intestines is high, because it may increase the chance of developing megacolon.
• medicines to treat inflammation in your joints, eyes, or skin.
• calcium and vitamin D supplements or medicines to prevent or slow bone loss and osteoporosis.

For safety reasons, talk with your doctor before using dietary supplements or any other complementary or alternative medicines or practices.

Doctors may also suggest

• changes in what you eat and drink
• warm baths and ointments to treat anal fissures

Doctors most often treat severe complications in a hospital. Doctors may

• perform surgery for intestinal obstruction, which can be life-threatening. Surgery may also be necessary for severe fistulas.
• give you intravenous (IV) fluids for severe malnutrition.
• give you antibiotics for abscesses and drain abscesses as needed.

References

7] Hashash AL, Regueiro M. Overview of medical management of high-risk, adult patients with moderate to severe Crohn disease. UpToDate. Updated March 11, 2024. Accessed April 18, 2024. [www.uptodate.com/contents/medical-management-of-moderate-to-severe-crohn-disease-in-adults

8] Gade AK, Douthit NT, Townsley E. Medical management of Crohn’s disease. Cureus. 2020;12(5):e8351. Accessed April 18, 2024. [https://assets.cureus.com/uploads/review_article/pdf/30854/1612430166-1612430162-20210204-18268-6vrcid.pdf (PDF, 670 KB)

9] Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn’s disease in adults. The American Journal of Gastroenterology. 2018;113(4):481–517. Accessed April 5, 2024. [https://journals.lww.com/ajg/fulltext/2018/04000/acg_clinical_guideline__management_of_crohn_s.10.aspx

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