Crohn’s disease medications & treatments
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Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract. It is named after American gastroenterologist Dr. Burrill Crohn (1884-1983). He was one of the first doctors to describe the illness in 1932. According to the Crohn’s & Colitis Foundation, it affects approximately 780,000 Americans with men and women being equally likely to have Crohn’s disease. This disease can occur at any age but is most often diagnosed in adolescents and adults between the ages of 15 and 35.
What is Crohn’s disease?
Crohn’s disease is a chronic inflammatory disease that can affect any part of your digestive tract from your mouth to your rectum. It most commonly affects the end of your small intestine (ileum) and the beginning of your large intestine (colon). This inflammation can lead to long-term damage to your GI tract including infections, fistulae (an abnormal connection between different body parts), fissures (tears), strictures (blockages), ulcers, malnutrition, and abscesses.
Experts are not sure of the exact cause of Crohn’s disease, but they think genetics plays a part. Smoking cigarettes, diet, and stress are also risk factors for developing this disease or causing flare-ups.
Crohn’s disease symptoms such as abdominal pain, diarrhea, and fatigue usually begin gradually and can worsen over time. You can have periods of remission that can last for weeks or years.
While there is not a cure for Crohn’s disease, treatments can reduce its symptoms and bring about long-term remission and healing of the inflammation. This can greatly improve your quality of life living with Crohn’s disease.
How is Crohn’s disease diagnosed?
Your health care provider will use your medical and family history, a physical exam, and several tests and procedures to diagnose Crohn’s disease as the cause of your signs and symptoms.
Some common symptoms of Crohn’s disease include:
- Abdominal cramping and pain
- Reduced appetite and weight loss
- Blood in your stool
- Eye redness or pain
- Joint pain
- Rectal bleeding
If your doctor suspects you have Crohn’s disease, some tests and procedures they may use to confirm the diagnosis include:
- Blood test. Used to check for anemia or infections.
- Stool test. Used to check for bacterial or parasitic infections that could cause chronic diarrhea.
- Colonoscopy. Using a small lighted tube (endoscope), your doctor can look at your colon using a small, lighted tube as well as take a biopsy to help with the diagnosis.
- Computerized tomography (CT). A CT scan is a specialized X-ray that can examine the whole bowel and other portions intestine that can’t be easily seen by colonoscopy.
- Capsule endoscopy. In this procedure, you will swallow a capsule-sized video camera that takes pictures as it travels through your digestive tract for your doctor to view. It exits harmlessly during a bowel movement.
Once you’re diagnosed with Crohn’s disease, it is important to know what part of your digestive system is affected. This will determine which type of Crohn’s disease you have and include:
- Ileocolitis. This is the most common type that affects the small intestine and part of the large intestine.
- Ileitis. Only affects the end of the small intestine (ileum).
- Gastroduodenal. Affects the stomach and the beginning of the small intestine (duodenum).
- Jejunoileitis. This inflammation occurs in the upper half of the small intestine, called the jejunum.
What are some treatment options for Crohn’s disease?
Since there is no cure for Crohn’s disease, the goal of treatment is to reduce the inflammation that triggers your symptoms, which can improve your quality of life and prognosis by limiting complications. This can also lead to symptom relief as well as long-term remission. This can be accomplished by a combination of the following:
- Medications. Using meds such as anti-inflammatory drugs, immune system suppressors, antibiotics, and biologics can reduce inflammation, give you symptom relief, and allow your intestinal tissues to heal.
- Nutritional therapy. Nutritional therapy may be used during flare-ups to help reduce symptoms and avoid malnutrition. This therapy can include a special diet, dietary supplements, or intravenous feeding.
- Surgery. Even with proper medication and diet, as many as one-half of people with severe Crohn’s disease will require surgery at some point. Surgery involves bowel resection, in which they will remove the damaged portion(s) of your digestive tract and then reconnect the healthy sections. It also is used to close fistulas and drain abscesses. Surgery does not cure Crohn’s disease and it frequently will reoccur at a later time. It can also cause short bowel syndrome, a condition where the body may not be able to digest and absorb some vitamins, foods, and nutrients.
What is the best medication for Crohn’s disease?
The best medication to treat Crohn’s disease will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with Crohn’s disease medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter Crohn’s disease medications approved by the Food and Drug Administration (FDA).
Best medications for crohn’s disease
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Azulfidine (sulfasalazine)||5-aminosalicylate||Oral||2g to 4g per day in divided doses.||Nausea, vomiting, headache, upset stomach|
|Asacol HD (mesalamine)||5-aminosalicylate||Oral||1.6g three times a day.||Abdominal pain, stomach discomfort, headache, gas, nausea|
|Deltasone (prednisone)||Corticosteroid||Oral||Up to 60mg daily. Usually tapered off over a couple of weeks.||Increased heart rate, mood changes, increased appetite, fluid retention,|
|Uceris (budesonide)||Corticosteroid||Oral||9mg once daily in the morning for 8 weeks.||Headache, dizziness, nausea, upper abdominal pain,|
|Trexall (methotrexate)||Immunomodulator||Injection||Up to 25mg intramuscularly per week.||Bone marrow suppression, nausea, fever, mouth sores|
|Imuran (azathioprine)||Immunosuppressant||Oral||2mg-3mg/kg of body weight once daily.||Low white blood cell count, infection, nausea, abdominal pain|
|Purixan (6-mercaptopurine)||Immunomodulator||Oral||1mg to 1.5mg per kg of body weight at bedtime.||Elevated liver function tests, nausea, vomiting, rash, diarrhea|
|Cimzia (certolizumab pegol)||Tumor necrosis factor inhibitor (TNF inhibitor)||Injection||400mg under the skin every 4 weeks.||Rash, upper respiratory infection, bladder infection|
|Humira (adalimumab)||TNF inhibitor||Injection||400mg under the skin every 4 weeks.||Injection site reaction, rash, infection, headache|
|Remicade (infliximab)||TNF inhibitor||Injection||5mg/kg of body weight via IV infusion every 8 weeks.||Stomach pain, nausea, headache, infection|
|Entyvio (vedolizumab)||Integrin receptor blocker||Injection||300mg via IV infusion every 8 weeks.||Headache, itching, joint pain, nausea, fever|
|Stelara (ustekinumab)||Interleukin inhibitor||Injection||The initial dose is a weight-based infusion, then 90mg under the skin every 8 weeks.||Headache, sore throat, infection, drowsiness, dizziness, injection site reaction|
Your healthcare provider will determine the right dosage for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.
What are the most common side effects of Crohn’s disease medications?
As with all medicines, those used for Crohn’s disease treatment will have some side effects depending on the class you are taking.
- Aminosalicylates are generally well tolerated but may cause nausea, vomiting, headaches, and rash.
- Corticosteroids can cause mood changes, aggressiveness, weight gain, acne, increased heart rate, increased blood sugar, and increased risk of infections even if only taken for a short term.
- Immunomodulators can weaken your immune system and will increase your risk of infections and cancer. Some other common side effects include nausea and abdominal pain.
- Monoclonal antibodies such as TNF inhibitors, interleukin inhibitors, and integrin receptor blockers also suppress your immune system, leaving you at an increased risk of infections and cancer. You also may experience injection site reactions, headaches, nausea, stomach pain, joint pain, and fever.
What are some home remedies for Crohn’s disease?
If you want to keep your Crohn’s disease flare-ups in remission, you will have to work at it through lifestyle and dietary changes. Some of these changes will include:
- Avoid foods and drinks that may trigger flare-ups. While these affect everyone differently, the foods that most commonly cause symptoms are foods high in fiber, spicy foods, dairy if you’re lactose intolerant, caffeine, and alcohol.
- Stop smoking. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries.
- Eat small, nutritious meals. Small, healthy meals can help correct any nutritional deficiencies and reduce symptoms.
- Take multivitamins or other dietary supplements. Crohn’s disease can interfere with your ability to absorb nutrients such as proteins, carbohydrates, water, vitamins, and minerals. And since your diet may be limited, multivitamins and supplements can be helpful to replenish some of these nutrients.
- Drink plenty of fluids, especially if you have diarrhea.
RELATED: What foods to avoid with Crohn’s disease
Frequently asked questions about Crohn’s disease
What causes Crohn’s disease?
While the exact cause of Crohn’s disease is not known, it’s thought to be the result of a combination of genetics, immune system abnormalities, and your environment.
Can Crohn’s disease be prevented?
There is no test to predict who will get Crohn’s disease. Early detection is the key to getting your symptoms into remission and preventing flare-ups.
Can Crohn’s disease be cured?
While you can have periods of remission when the disease is not active, there is no cure.
What is the life expectancy for people with Crohn’s disease?
While this disease increases your risk of infections and cancer, your life expectancy is not much different than those without it.
Are there any OTC medications I can take to help with my symptoms?
Yes, some medicines are available without a prescription that may help relieve some of your mild symptoms. These can include antidiarrheals such as Imodium A-D (loperamide) and pain relievers such as Tylenol (acetaminophen). It is best to avoid NSAIDs such as ASA (aspirin), Motrin (ibuprofen), and Aleve (naproxen) as they can cause or worsen ulcers or bleeding.
Do I need to keep taking medications when I am not having symptoms?
Yes, it’s important to keep taking your maintenance medicines because they reduce the recurrence of flare-ups.
What is the difference between Crohn’s and ulcerative colitis?
They are both inflammatory bowel diseases and share some of the same symptoms such as stomach cramps and pain, diarrhea, reduced appetite, and fever. Ulcerative colitis, however, only occurs in the large intestine while Crohn’s disease can occur at any point in the digestive tract. Ulcerative colitis also only affects the innermost lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls.
Related resources for Crohn’s disease
- What is Crohn’s disease? Crohn’s and Colitis foundation
- Crohn’s disease basics. MedlinePlus
- Crohn’s disease health information. National Institute of Diabetes and Digestive and Kidney Diseases
- Crohn’s disease overview. ClevelandClinic
- Crohn’s disease overview. MayoClinic
- FAQ about Crohn’s disease. John Hopkins Medicine