Patient information from BMJ

Crohn's disease: what treatments work?

Last published:Jun 23, 2020

Crohn's disease is a long-term condition that causes patches of inflammation on the wall of your gut. This can lead to uncomfortable symptoms like stomach pain and diarrhoea.

To read more about what happens in Crohn's disease, see the leaflet Crohn's disease: what is it?

The treatment you need will depend on what part of your gut is affected and how severe the disease is. Some people just need regular check-ups, while some people will need surgery at some point.

Tailored treatment

Crohn's disease is a complex condition that can affect any part of the digestive system. No one's symptoms are exactly like anyone else's.

This means that your treatment needs to be tailored to what works best for you.

Once diagnosed, you should be seen by a specialist, and the decisions about your treatment should involve you.

Treatment goals

The aim of treatment for Crohn's disease is to achieve what's called remission. This means that you don't have symptoms any more.

This isn't always possible, and some people have what are called flare-ups of symptoms. But you and your doctor should be able to find treatments that help relieve or stop your symptoms for much of the time.

The treatments you are offered will depend on several things, including:

• your age

• your experiences with any previous treatments you have tried

• which parts of your digestive system are affected, and

• your own preferences.

Treating pain and stomach problems

The main treatments for Crohn's are aimed at trying to reduce the inflammation (swelling) that causes your symptoms. But your doctor will probably suggest medications to help with these symptoms in the short term, or as they occur.

For example, most people with Crohn's get stomach cramps. Your doctor might suggest drugs called anti-spasmodics to help with these.

Your doctor might also recommend medications to help with pain and diarrhoea.

But you should talk to your doctor before taking anything for these symptoms, as they might not be suitable to take with other medications that you might need.

Treatments for mild symptoms

One widely used treatment for mild Crohn's is a type of medication called corticosteroids, often just called steroids for short.

Corticosteroids are similar to chemicals that your body makes naturally to help reduce inflammation.

These drugs can cause side effects, including fragile bones and thinning of the skin. So doctors usually suggest that you only take them for short periods. But this might be enough to make a big difference to your symptoms.

Diet

As with any illness that affects your digestive system, you might find that that cutting out certain foods helps relieve your symptoms.

There is plenty of dietary advice online for people with Crohn's. But it's not certain how well it works. And there isn't one special diet that will help everyone with Crohn's. So a good approach is to:

• eat as healthily as you can, and

• listen to what your own body is telling you about how different foods affect you. For example, you might find it helpful to keep a food diary.

Treatments for more severe symptoms

Several medications have been shown to help people with moderate or severe symptoms of Crohn's disease. These include:

• corticosteroids, to reduce inflammation

• immunomodulators. It's thought that, in people with Crohn's, the immune system can attack the digestive system by over-reacting to an infection. These drugs can help to calm down your immune system and relieve your symptoms

• biological medications. These drugs are another way of reducing inflammation. They are usually given as an infusion (drip) into a vein every few months.

Depending on your symptoms, your doctor might suggest a combination of several types of medication. And he or she should check on you regularly to see how well your treatment is working, and whether changing it might help.

All of the medications that can help people with Crohn's can have side effects in some people. For example, immunomodulators and biological drugs can reduce your body's ability to fight off infections.

Your doctor should discuss the side effects of these treatments with you before you decide to have any of them.

Surgery

If the inflammation in your bowel becomes severe, you might need surgery to treat complications, such as a blockage in your bowel, or to repair a hole in your bowel.

Inflammation can cause a narrow tunnel to gradually form between two parts of your body, such as your bowel and bladder. This is called a fistula.

Surgery can also be used to remove a damaged section of your bowel.

Your doctor should discuss with you the possible need for surgery, as well as how it might help you, and the possible complications and risks.