Crohn's disease - Treating Crohn's disease

There is currently no cure for Crohn's disease, but treatment can help improve the symptoms.

The main aims of treatment are to:

• reduce symptoms, known as inducing remission (remission is a period without symptoms)
• maintain remission

In children, treatment also aims to promote healthy growth and development.

Your treatment will usually be provided by a range of healthcare professionals, including specialist doctors (such as gastroenterologists or surgeons), GPs and specialist nurses.

Reducing symptoms

If you have Crohn's disease and it's causing moderate or severe symptoms, this is known as "active disease". Treatment for active Crohn's disease usually involves medication, but surgery is sometimes the best option.

Initial treatment

In most cases, the first treatment offered is steroid medication (corticosteroids) to reduce the inflammation. Examples of corticosteroids used for Crohn's disease include prednisolone tablets or hydrocortisone injections.

These medications are often effective in reducing the symptoms of Crohn's disease, but they can have significant side effects, such as:

• weight gain
• swelling of the face
• increased vulnerability to infections
• thinning and weakening of the bones (osteopenia and osteoporosis)

Because of these possible side effects, your dose will be gradually reduced when your symptoms start to improve.

If you prefer, you may be able to choose to have a milder steroid called budesonide, or a type of medication called a 5-aminosalicylate (such as mesalazine), as an alternative initial treatment. These medications have fewer side effects, but they are less effective.

In children or young people where there are concerns about growth and development, a special liquid diet may be recommended as an initial treatment. This is known as an elemental or polymeric diet and it can help reduce inflammation by allowing your digestive system to recover while ensuring that you get all the nutrients you need.

Additional treatment

If your symptoms flare up twice or more during 12 months or return when your steroid dose is reduced, further treatment may be necessary.

In these cases, medicines to suppress your immune system (immunosuppressants) may be combined with your initial medication. Medicines called azathioprine or mercaptopurine are most commonly used.

These medicines aren't suitable for everyone, so a blood test should be carried out to check if you can use them. If they are not suitable, an alternative immunosuppressant medication called methotrexate may be used.

Side effects of these immunosuppressants can include:

• nausea and vomiting
• increased vulnerability to infection
• feeling tired, breathless and weak, which is caused by anaemia (a decrease in the number of red blood cells)
• liver problems

During the course of medication you will have regular blood tests to check for serious side effects.

The immunosuppressants azathioprine and mercaptopurine are considered safe in pregnancy and breastfeeding. Women can continue to use these drugs when trying to start a family and during pregnancy.

However, methotrexate must not be taken for at least six months before trying for a baby, as this drug is known to cause birth defects. This applies to both men and women. It must also be avoided while you are breastfeeding.

It's important to speak to your doctor if you are planning a pregnancy or if you become pregnant during your course of treatment for Crohn's disease.

Severe Crohn's disease

For people in poor general health with severe symptoms of Crohn's disease, medicines called biological therapies may be used to reduce your symptoms if corticosteroids and immunosuppressants are unsuitable or ineffective.

Biological therapies are a type of powerful immunosuppressant medication created using naturally occurring biological substances, such as antibodies and enzymes.

The two medicines used to treat Crohn's disease in the UK are called infliximab and adalimumab. They work by targeting a protein called tumour necrosis factor-alpha (TNF-alpha), which is believed to be responsible for the inflammation associated with Crohn's disease. Infliximab can be used for children over six years old and adults, but adalimumab should only be used for adults.

Infliximab is given as a drip into a vein in your arm (known as an infusion) in hospital. Adalimumab is given as an injection, and it may be possible for you, a family member or a friend to be taught how to give it so you don't need to visit hospital for every treatment.

Treatment will usually last at least 12 months, unless these drugs stop being effective sooner than this. After this time, your condition will be assessed to determine if further treatment is necessary.

There is a risk of these medicines causing an allergic reaction, which can cause symptoms such as:

• itchy skin
• a high temperature
• joint and muscle pain
• swelling of the hands or lips
• problems swallowing

You should seek immediate medical assistance if you experience these symptoms. Reactions can occur immediately after treatment, although they have been known to occur months later, even after treatment stops.

Surgery

Surgery may be recommended to reduce your symptoms if your healthcare team feel the benefits outweigh the risks.

In many cases, a type of surgery called a resection is used. This involves removing the inflamed area of the intestine and stitching the healthy sections together.

In some cases, your doctor may recommend a procedure called an ileostomy to temporarily divert digestive waste away from the inflamed colon (large intestine) to give it a chance to heal.

During this operation, the end of the small intestine (the ileum) is disconnected from the colon and re-routed through a hole made in the abdomen, which is known as a stoma. An external bag is attached to the opening to collect waste products.

Once the colon has sufficiently recovered – usually after several months – a second operation will be needed to close the stoma and re-attach the small intestine to the colon.

Maintaining remission

Remission is a period when you don't have any symptoms or your symptoms are mild. During these periods, you can choose whether or not to use medication to help maintain this.

If you decide not to have further treatment, you should be advised about attending regular follow-up appointments and which symptoms to look out for. These symptoms include unintended weight loss, abdominal pain and diarrhoea.

If you choose treatment, this will usually involve immunosuppressants. Corticosteroids are not recommended for maintaining remission.

Complications

If you develop complications of Crohn's disease, such as fistulas (channels that develop between two sections of the digestive system) or intestinal narrowing (stricture), these will also need to be treated. Surgery will be necessary in most of these cases. 

See complications of Crohn's disease for more information about this.