How to treat Crohn's disease

There are several treatments for Crohn's disease which can help symptoms of flares to resolve, and can reduce how often the condition flares. Most treatments are with medicines, but some people with Crohn's disease may need surgery.

If you think you may have Crohn's disease find out what to do here. This will tell you if you need to see a doctor.

In this series of articles centred around Crohn's disease you can read about symptoms of Crohn's disease, causes of Crohn's disease, and treatments for Crohn's disease - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatment of Crohn's disease as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

How to treat Crohn's disease

There are several different treatments for Crohn's disease and which ones are suitable varies from person to person. Treatments are usually given by a gastroenterologist - a doctor who specialises in gut conditions - working alongside other professionals, including surgeons, specialist nurses, and dieticians.

Stopping smoking

Smoking makes Crohn's disease worse - including making flare-ups more frequent, and increasing the chance of needing surgery. Stopping smoking can help treat Crohn's disease, and has lots of other benefits.

Steroids

Steroid medicines reduce inflammation - steroids used to treat Crohn's aren't the same as anabolic steroids, which some people use for sports or bodybuilding. Many people diagnosed with Crohn's disease will need steroid treatment at some point. Steroids are useful for quickly settling down inflammation during a flare. Steroids are usually given as tablets but sometimes are given though a drip into the veins, if someone is in hospital with a severe flare.

Steroids are useful, but have lots of side-effects, especially when used long-term, so this prolonged use is avoided.

Using other medicines regularly can reduce how often flare-ups happen, and therefore reduce how often steroids are needed.

Special diets

Sometimes, for children and young adults with Crohn's, special liquid diets - exclusive enteral nutrition - are used. These can be given as drinks or through a feeding tube in the nose - especially for younger children. It can help to settle down inflammation in the gut and also give enough nutrition to allow children to grow.

Immunosuppressants

Immunosuppressant medicines reduce the activity of the immune system. These can be used to help treat flares if steroids alone aren't working, and are also often used long-term to control Crohn's disease and reduce how often flares happen. These are usually taken as tablets, but sometimes can be given as injections under the skin. Commonly used medicines include:

• Azathioprine.

• Mercaptopurine.

• Methotrexate.

Biologic treatment

These are specially-designed antibodies which also reduce the activity of the immune system, and treat inflammation. These are used for people with severe flares not responding to other treatments, and can also be used as a long-term treatment to control the condition and help reduce how often symptoms come back.

They can also be used to treat Crohn's disease that has caused fistulas - abnormal connections between the gut and other organs. These are given as infusions through a drip or sometimes by injections just under the skin. Examples include:

• Infliximab - sold under different brand names, such as Remicade.

• Adalimumab - sold under different brand names, such as Humira.

• Ustekinumab - Stelara.

• Vedolizumab - Entyvio.

Aminosalicylates (5-ASAs)

These are used a lot in ulcerative colitis, but less often in Crohn's disease. However, they can sometimes be used as an alternative to steroids, particularly if the symptoms are mild. Examples include:

• Mesalazine.

• Sulfasalazine.

Other medicines

Other medicines that are sometimes used in Crohn's disease include:

• Antibiotics - for some complications due to infection, such as abscesses and fistulas.

• Antidiarrhoea medicines, like loperamide - sometimes used for short-term symptom relief of diarrhoea. However, always check with your inflammatory bowel disease (IBD) team before taking these, as they can cause megacolon - a rare but serious complication of Crohn's - if used in the wrong situation.

• Pain relief, such as paracetamol - can help symptoms of tummy pain.

Surgery

Medicines are the first-line treatment for Crohn's disease. There are some situations where surgery might be recommended as a treatment option, particularly if medicines haven't worked, or if complications of Crohn's disease have developed. The exact surgery depends on which part of the digestive tract is affected. Examples of surgery for Crohn's disease include:

• Operations to drain abscesses.

• Operations to treat a narrowing in the bowel (stricture) - such as a strictureplasty, cutting open the bowel and sewing it back up in a way that widens the stricture, or a resection - cutting out the narrowed bit of bowel entirely, and joining the two cut ends together.

• Operations to remove inflamed parts of the bowel.

• Emergency operations - for problems such as a hole in the bowel (perforation), a complete blockage in the bowel (obstruction), or a severely inflamed and swollen colon that might burst (toxic megacolon).

Psychological support

Crohn's disease can have a big effect on people's lives and their mental health. Depression and anxiety are more common in people with Crohn's disease. People who are struggling with their mental health might find the following helpful:

• Support from groups of people who are also living with Crohn's disease¹.

• Talking therapies.

• Medication, such as antidepressants.

See depression and anxiety for more detail.

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In the UK, there are approximately 13.9 million people living with a disability. But only a small percentage have illnesses that can actually be seen. Those living with an invisible disability, like Crohn's disease or multiple sclerosis, suffer from symptoms every day and, because these aren't visible, they're often subjected to discrimination and misunderstanding when they use disabled bathrooms, parking spaces or priority seats.

by Karen Gordon

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Coeliac disease

Coeliac disease (also spelled celiac disease) mainly affects the part of the gut called the small intestine. It can occur at any age. Coeliac disease is caused by a reaction of the gut to gluten. (For this reason it is sometimes also called gluten-sensitive enteropathy). Gluten is part of certain foods - mainly foods made from wheat, barley and rye. Various symptoms can develop including tummy (abdominal) pains, tiredness and weight loss. Symptoms go if you do not eat any foods that contain gluten.

by Dr Colin Tidy, MRCGP

Can Crohn's disease be cured?

At present, there is no known way to cure Crohn's disease. Treatments aim to control symptoms and reduce how often Crohn's flare-ups happen. Treatments for Crohn's have expanded a lot over the last twenty years, and there are new treatments under development that may be even more effective.

Further reading

1. Crohn's and Colitis UK.

2. Local Networks; Crohn's and Collitis UK.

3. Crohn's disease; NICE CKS, August 2020 (UK access only).