Possible Treatments for Crohn’s Disease

Treatment for Crohn’s disease usually involves medication, nutritional support and, in some cases, surgery. The aim of treatment is to reduce inflammation, control symptoms, achieve remission and help prevent future flare-ups. There is currently no cure for Crohn’s disease, but modern treatments can allow many people to remain well for long periods.

The most appropriate treatment depends on which part of the digestive system is affected, how severe the inflammation is, whether complications are present and how the individual responds to treatment. More information is available from the NHS guidance and NICE guidance.

Medication

Several different types of medication may be used to treat Crohn’s disease.

Corticosteroids such as prednisolone or budesonide can be used to reduce inflammation and help bring a flare-up under control. Steroids are generally used for relatively short periods because longer-term use can cause significant side effects.

Aminosalicylates, such as mesalazine, have a more limited role in Crohn’s disease than was previously thought. NICE states that they may be considered in certain circumstances, particularly when corticosteroids are unsuitable, declined or cannot be tolerated. They are generally less effective than corticosteroids for Crohn’s disease.

Immunomodulators, including azathioprine, mercaptopurine and methotrexate, reduce the activity of the immune system. They may be used to help maintain remission or alongside other treatments in people who experience repeated flare-ups.

Biologic medicines target specific parts of the immune system involved in inflammation. Treatments used for Crohn’s disease can include infliximab, adalimumab, ustekinumab, vedolizumab and risankizumab. These medicines have significantly expanded the treatment options available to people with moderate to severe Crohn’s disease.

 

There are also newer targeted medicines. For example, upadacitinib is an oral targeted treatment recommended by NICE for certain adults with moderately to severely active Crohn’s disease. Other newer options available in appropriate circumstances include mirikizumab and guselkumab.

The choice of medicine depends on the severity of the disease, previous treatments, possible side effects and the person’s individual circumstances. Crohn’s & Colitis UK provides a useful medicine guide.

Antibiotics

Antibiotics are not generally used as a routine treatment for the underlying inflammation caused by Crohn’s disease. However, they may be prescribed when complications such as infections, abscesses or some types of fistula are present.

Treatment for fistulas can involve a combination of antibiotics, biologic medicines, drainage procedures and surgery, depending on the individual case.

Nutritional Treatment

Nutrition can also play an important role in Crohn’s disease treatment. Some people, particularly children and young people, may be offered enteral nutrition, where a specially formulated liquid diet provides the nutrients and energy the body requires.

Nutritional treatment may also be used when someone is struggling to absorb enough nutrients, is losing weight or has particular complications.

Surgery

Surgery remains an important treatment for Crohn’s disease, but it is no longer accurate to assume that most people will inevitably require an operation.

Crohn’s & Colitis UK reports that around one in five people with Crohn’s disease will need major surgery within the first five years after diagnosis. The likelihood of needing surgery varies considerably between individuals.

Surgery may be considered when medication is not adequately controlling the disease or when complications such as strictures, bowel obstruction, abscesses or fistulas develop.

One common operation is a bowel resection, where the damaged section of bowel is removed, and the healthy ends are joined together. In some cases, surgeons can treat a narrowing using a procedure called a strictureplasty without removing that section of bowel.

Some people may require an ileostomy or colostomy, where part of the bowel is brought through an opening in the abdomen called a stoma. Waste is then collected in a stoma bag. A stoma may be temporary or permanent depending on the type of Crohn’s disease and the operation required.

Many Crohn’s operations can now be carried out using keyhole surgery, which may offer advantages such as smaller incisions and faster recovery. The surgery guide has more information.

Diet and Crohn’s Disease

Crohn’s disease is not caused by eating a particular food, and there is no single diet that has been proven to cure the condition.

However, food can affect symptoms differently from person to person. Some people notice that particular foods make symptoms such as diarrhoea, bloating or abdominal discomfort worse.

People with Crohn’s disease should generally aim to eat a varied, nutritionally balanced diet unless their specialist or dietitian advises otherwise. Restrictive diets can result in vitamin, mineral or calorie deficiencies and should not usually be followed without professional advice.

People who have a narrowing of the bowel, known as a stricture, may need different dietary advice. Anyone considering major dietary changes should discuss them with their IBD team or a registered dietitian. Crohn’s & Colitis UK provides detailed food advice.

Complementary Treatments and Neurofeedback

Some people with Crohn’s disease also explore complementary approaches alongside conventional medical treatment.

Neurofeedback is a non-invasive form of brain training that uses real-time information about brain activity. It is sometimes used to support areas such as stress regulation, anxiety and emotional wellbeing.

Stress does not cause Crohn’s disease, but living with a long-term condition can affect emotional wellbeing, and some people find that stress affects their symptoms.

At present, however, neurofeedback is not an established medical treatment for the intestinal inflammation caused by Crohn’s disease, and there is insufficient evidence to suggest that it can replace medication, nutritional therapy, or surgery. However it should therefore be regarded as a possible supportive or complementary approach expecially around pain managment, rather than a treatment for Crohn’s disease itself. Sarah Smith Neurointegra Ltd

Anyone considering complementary therapies should continue with their prescribed Crohn’s treatment and discuss any changes with their gastroenterologist, GP or IBD team.

About the Author

Sarah is a writer on medical and health-related matters and has written extensively on subjects including Attention Deficit Disorder, infectious diseases and Crohn’s disease.