The type of treatment that doctors use for Crohn’s disease depends on the part or parts of the digestive system involved, as well as the severity of the disease. The doctor also has to take into account other problems that the patient may have as a result of Crohn’s disease, which can range from skin rashes to cancer.
Mild to moderate disease
- Oral mesalazine (examples include Asacol, Pentasa, Salofalk, and Mezavant). This medication reduces inflammation. It has been used for a long time for patients with Crohn’s disease in the large or small intestines, or both. However, recent clinical research has shown that it is not very effective against Crohn’s disease. Because of this recent research there should be a very limited role for these medications.
- Oral sulfasalazine (Salazopyrin). This anti-inflammatory drug also reduces the activity of the immune system, and works against Crohn’s disease in the large and small intestines.
- Metronidazole (Flagyl) and ciprofloxacin (Cipro). These antibiotics are sometimes used for patients for treatment of Crohn’s disease or to manage complications relating to this disease (such as a pocket of infection called an abscess that can occur in patients who have fistulas as a result of their disease). These medications kill bacteria in the intestine. They do not seem to be very effective for Crohn’s disease. Flagyl can cause nerve damage if used for long periods of time, and Cipro can cause tendonitis.
- Controlled ileal release budesonide (Entocort). Budesonide is a steroid. Steroids are powerful drugs that reduce inflammation and slow the activity of the immune system. Entocort has a special coating that causes it to be released in the terminal ileum (the last portion of the small intestine) and the right colon. It works well against Crohn’s disease in the terminal ileum and the right colon.
Some people have mild to moderate Crohn’s disease only in the esophagus, the stomach or the first part of the small intestine. Doctors often treat these patients with the same medications that are used for moderate to severe disease. Proton pump inhibitors such as Nexium and Tecta may help some people.
Moderate to severe disease
- Systemic steroids. The standard treatment for moderate to severe Crohn’s disease is a steroid called prednisone. This is taken as a pill. It is carried all around the body by the bloodstream. Medicines that work this way are called systemic drugs. Because systemic prednisone can have side effects if taken for a long time, it is usually given for a limited amount of time (in general a patient should not be on this medication for more than 12 weeks).
- Elemental diet. An elemental diet consists of all the nutrients of a usual diet but in simple chemicals. Because it does not taste good, usually it is given using a tube going from the nose into the stomach. It can help people with Crohn’s disease go into remission. It can be used instead of systemic steroids to avoid side effects.
- Immune system suppressants. If the patient goes into remission after taking prednisone, azathioprine (Imuran) and 6-mercaptopurine (Purinethol) may be used to maintain the remission. Methotrexate injections can be used to maintain remission, or to treat patients who do not achieve remission with steroids.
- Biologic drugs. Infliximab (Remicade) and adalimumab (Humira) can be used if steroids and immunosuppressants don’t achieve remission. On rare occasion certolizumab pegol (Cimzia) is used although it is not approved by Health Canada to treat Crohn’s disease.
- Antibiotics. These are used if there are infections or abscesses.
Severe – fulminant disease
Patients who can’t achieve remission with drugs, and those who have serious symptoms may have to be admitted to hospital. If there is a blockage, bleeding that doesn’t stop, or an abscess, immediate surgery may be needed. Otherwise, the patient will usually be given steroid injections. Food may be given by tube or by intravenous, if necessary as keeping up with nutritional requirements is very important to avoid complications. A blood transfusion may be needed if the patient is very anemic or bleeding continuously.
Surgery to remove part of the intestine may be needed if the disease does not improve despite all of the other therapies, if there are parts of the intestines that are no longer inflamed but instead have been damaged with scar tissue, or if there is cancer in the intestine. Surgery can help a patient to regain a good quality of life if medical therapy is not effective.