Crohn’s Disease is considered to be one major category of Inflammatory Bowel Disease (IBD). Inflammatory Bowel Disease affects millions of Americans and can run in families.
For people with IBD, the body’s immune system mistakes food and bacteria as foreign invading substances. The body therefore sends out white blood cells into the lining of the intestines, producing inflammation and ulcers leading to various uncomfortable symptoms.
A chronic inflammatory condition of the gastrointestinal (GI) tract, Crohn’s disease can affect any part of the GI tract, from mouth to anus. The location of inflammation affects the symptoms presented as well as what treatments may be needed.¹ There are 5 types of Crohn’s Disease, based on the region of the GI tract that is affected:
- Gastroduodenal Crohn’s: affects the stomach and the duodenum, or the first part of the small intestine.
- Jejunoiletitis: affects the middle portion of the small intestine (jejunum) and the last part of the small intesine, known as the ileum.
- Ileitis: affects the ileum.
- Ileocolitis/ Ileoceceal Crohn’s: affects the the first part of the colon and the ileum. Ileocolitis is the most common form of Crohn’s Disease affecting about 40% of individuals diagnosed.2
- Crohn’s Colitis: affects some or all of the large intestine, or colon.
Signs and Symptoms of Crohn's Disease
The most common symptoms of Crohn’s disease are:
• Weight loss
• Abdominal Pain
• Abdominal cramping
• Diarrhea (with or without blood)
Other symptoms include:
• Nausea or vomitting
• Joint pain or soreness
• Poor appetite
• Floating stools
• Eye redness or pain
Symptoms may vary depending on the location and severity of the disease. Crohn’s disease has also been associated with other medical conditions, including arthritis, osteoporosis, eye infections, blood clots, liver disease, and skin rashes.
Treatments for Crohn's Disease
Currently, there is not a cure for Crohn’s disease, and there is not a standard treatment that works for everyone. Therefore, there are numerous treatment options and combinations that may help to combat the signs and symptoms of Crohn’s disease. The goal of these treatments is to reduce the inflammation that triggers those symptoms, limit complications and flare-ups, and to achieve and maintain long-term remission.
Treatments, in partnership with a medical team, will be tailored to the individual patient, as every person with Crohn’s faces a different situation. Several factors will help to determine what treatment options will be best for the patient. Those factors are the severity of the disease, the location of the disease, other medical conditions (comorbidities), the bodies response to past medications, and the side effects of medications.
Always consult a doctor before beginning treatment.
Many people with Crohn’s disease need medications. These medications are designed to suppress the body’s immune response to abnormal inflammation. This immune suppression offers relief from many of the common symptoms of Crohn’s disease.
There are 5 major categories of medicine used to treat Crohn’s disease, and other IBD.
Antibiotics are used to prevent or treat complications that involve infection, such as abcesses and fistulas. Antibiotics can help to reduce the amount of drainage produced by, and sometimes heal, fistulas and abcesses. Many medical professionals also think that antibiotics can help reduce harmful intestinal bacteria that may play a role in the body’s abnormal immune response, that leads to inflammation.
The most commonly prescribed antibiotics are Ciproflaxin (Cipro) and Metronidazole (Flagyl).
Typically prescribed to individuals newly diagnosed with Crohn’s disease who present mild to moderate symptoms, aminosalicylates contain 5-aminosalicylic acid (5-ASA), which helps to control imflammation. Given orally or rectally, they work best when the disease is present in the colon, but are not particularly effective if the disease is present in the small intestine.
The most commonly prescribed aminosalicylates are sulfasalazine (Azulfidine) and mesalamine (Asacol HD, Delzicol, Pentasa, & others). These medications have been widely used in the past but are now considered to have limited benefit.
Unlike corticosteroids, which affect the entire body, biologic treaments act more selectively. Designed to target proteins made by the immune system, biologic therapies, or biologics, neutralize those proteins by introducing antibodies into the body to decrease inflammation. Biologics help to place patients in remission, particularly when other treatments haven’t worked.
Biologics are divided into additional categories based of the type of protein targeted by the medications. Those categories are anti-tumor necrosis factor (TNF) therapies, anti-integrin therapies, and anti-interleukin-12 and interleukin-23 therapy.
The most commonly prescribed therapies for each category are listed below:
- Anti-TNF therapies – Adalimumab (Humira), Certolizumab Pegol (Cimzia), and Infliximab (Remicade).
- Anti-integrin therapies – Natalizumab (Tysabri) and Vedolizumab (Entyvio).
- Anti-interleukin therapy – Ustekinumab (Stelara).
Corticosteroids, commonly known as steroids, help decrease inflammation and to help reduce the immune system’s activity. Doctors often prescribe steroids for individuals with moderate to severe symptoms, however, not for long-term use.
The most commonly prescribed corticosteroids are budesonide (Entocort EC), hydrocortisone, methylprednisolone (Solu-medrol), prednisolone, and prednisone.
Immunomodulators are designed to reduce immune system activity, which results in less gastrointestinal inflammation. Doctors prescribe these medications to help patients maintain remissision or if they do not respond to other treatments. Immunomodulators can take up to 3 months to start working.
The most common immunomodulators are 6-Mercaptopurine (Purinethol, Purixan), Azathioprine (Azasan, Imuran), Methotrexate (Trexall), and Cyclosporine (Sandimmune).
Note: Cyclosporine is most often prescribed to those with severe Crohn’s disease symptoms due to the medicines serious side effects. Consult a doctor to learn about the risks and benefits of Cyclosporine before beginning treatment.
Other medications such as anti-diarrheals, pain relievers, and supplements (iron, calcium, vitamin B-12 and D) may be prescribed, or recommended, as needed. For mild pain, a doctor may recommend acetaminophen, such as Tylenol, because other common pain relievers, like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), can make symptoms worse.
If symptoms are severe, it may be necessary for the patient to rest their bowels for a few days to several weeks. This can involve drinking only approved liquids or not eating or drinking anything.9 Doctors will often, during sustained bowel rest, ask patients to drink nutritional supplements or begin nutrition therapy.
Nutrition therapy is when a doctor recommends altering the nutrients an individual takes in or how those nutrients are taken in. This can be through recommending a specific diet to reduce the size and number of stools, recommending a feeding tube be inserted into the stomach or small intestine (enteral nutrition), or by recommending that nutrients be injected directly into a vein (parenteral nutrition). Doctors may require this treatment be administered during a hospital stay or may allow treatment to be given via at-home medical care.
Enteral and Parenteral nutrition are typically used to prep an individual for surgery or if medications are failing to control symptoms. Whereas, a low residue or low-fiber diet may be recommended to reduce the risk of intestinal blockage, as well as reduce the size and frequency of bowel movements, to avoid hospitalizations, surgeries, and further complications.6
In most cases, with or without nutrition therapy, the instestines will heal during bowel rest.
Even with medications, diet and lifestyle changes, and other treatments, many people with Crohn’s disease eventually require surgery. One study suggest that approximately 60% of people had surgery within 20 years of being diagnosed with Crohn’s disease.10 While surgery will not cure Crohn’s disease, it can treat complications and relieve symptoms. Doctors often recommend surgery to treat instestinal obstructions, fistulas, bleeding that is life threatening, negative side effects from medications, or symptoms when other treatments do not work. A surgeon will perform different types of operations depending on the symptoms and area affected.
Many people with Crohn’s have used lifestyle modifications, such as dietary changes and exercise, and forms of complimentary and alternative medicine. However, there are few well-designed studies that help to confirm the safety and effectiveness of complimentary and alternative medicine.
There is no evidence to support that certain foods actually cause Crohn’s disease, however certain foods and beverages can aggravate the signs and symptoms of Crohn’s disease, especially during a flare-up. For individuals affected by Crohn’s, it can be useful to keep a food diary, cataloging what food and beverages have been consumed each day. This can help them pinpoint what foods are causing symptoms and thus eliminate them. Below are a list of common foods that may cause adverse symptoms:
• Dairy • High-fat foods
• High-fiber foods • Spicy foods
• Alcohol • Caffeine
• Nuts • Seeds
Other dietary changes, such as eating smaller meals, drinking plenty of fluids, and taking multivitamins, may help limit flare-ups and reduce symptoms. Consult a doctor or registered dietitian before making changes to ones diet or before taking any vitamins or supplements.
Complimentary and Alternative Medicine
The majority of Complimentary and Alternative therapies aren’t regulated by the Food and Drug Administration (FDA), nor have there been many well-designed studies to determine their effectiveness. Despite this, many people with Crohn’s have tried some form of alternative therapy.
Some commonly used therapies include:
• Prebiotics • Probiotics
• Fish oil • Acupuncture
• Hypnosis • Homeopathy
• Herbal & nutrional supplements
- Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465-483.
- Freeman HJ. Application of the Montreal classification for Crohn’s disease to a single clinician database of 1015 patients. Can J Gastroenterol. 2007;21:363-366.
- “Symptoms & Causes Of Crohn’s Disease | NIDDK”. National Institute Of Diabetes And Digestive And Kidney Diseases, 2020, https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/symptoms-causes.
- “Crohn Disease Information | Mount Sinai – New York”. Mount Sinai Health System, 2020, https://www.mountsinai.org/health-library/condition/crohn-disease.
- Valderas, Jose M et al. “Defining comorbidity: implications for understanding health and health services.” Annals of family medicine vol. 7,4 (2009): 357-63. doi:10.1370/afm.983
- “Crohn’s Disease – Diagnosis And Treatment – Mayo Clinic”. Mayoclinic.Org, 2020, https://www.mayoclinic.org/diseases-conditions/crohns-disease/diagnosis-treatment/drc-20353309.
- “Treatment For Crohn’s Disease | NIDDK”. National Institute Of Diabetes And Digestive And Kidney Diseases, 2020, https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/treatment.
- Fact Sheet: News From The IBD Help Center. Crohn’s & Colitis Foundation, 2018, pp. 1-4, https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/biologic-therapy.pdf. Accessed 25 Sept 2020.
- “Enteral And Parenteral Nutrition – American College Of Gastroenterology”. American College Of Gastroenterology, 2020, https://gi.org/topics/enteral-and-parenteral-nutrition/#:~:text=What%20do%20Enteral%20and%20Parenteral,of%20a%20person’s
- Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). American Journal of Gastroenterology. 2012;107(11):1639–1701