Crohn's Disease Treatment

Crohn's disease can turn your life into a gastrointestinal nightmare, but there is hope.

Crohn's disease is an inflammatory bowel disease that causes chronic inflammation of the GI tract. And without treatment, the consequences can be life-threatening.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), more than half a million Americans have Crohn's disease, which can affect any part of your GI tract, including your esophagus, small and large intestine, and rectum.

While there is no cure for Crohn's disease, there are treatments that can help ease its Crohn's disease symptoms, which can include diarrhea, abdominal pain, rectal bleeding, tiredness and unexpected weight loss. Scott Dolejs, MD, a board-certified colon and rectal surgeon at Franciscan Health Mooresville, explains how doctors decide the best treatment for Crohn’s disease for a patient.

What Are Common Crohn’s Disease Treatments?

Common Crohn's disease treatments can include lifestyle changes, diet changes, medication and potentially surgery.

"Treatment is really variable based on the severity of Crohn's disease and where it's located in your body," Dr. Dolejs said. "Because patients need a combination of medical treatment, lifestyle changes, such as dietary changes and smoking cessation and potentially surgery, taking care of patients with Crohn's disease requires a team. This will usually include gastroenterologists, colorectal surgeons like myself, nutritionists, primary care providers, support groups, and at times psychiatrists or psychologists.”

Lifestyle Changes for Crohn’s Disease

Because of its impact on the digestive tract, Crohn’s disease treatment can include certain lifestyle changes, including:

• Stop smoking: “The biggest thing a patient with Crohn's disease can do to help their disease is to not smoke. And if they are smoking, to quit, really, I can't stress enough,” Dr. Dolejs said. "This is the number one factor that will impact a patient's disease course so strongly.”
• Reviewing medications with your provider: Patients with Crohn's disease should avoid medicines like NSAIDs, including ibuprofen and naproxen, which have been shown to trigger flares of Crohn's disease.
• Stress management: Find ways to manage stress, like exercise, breathing, relaxation techniques or biofeedback.

Diet Changes For Crohn's Disease

“Some patients, dietary-wise, will have issues with different types of foods," Dr. Dolejs said. "Some patients have issues with fiber, and some patients find that too much alcohol or caffeine may make their symptoms worse. Finding the right diet can be tricky, and it's different really for everyone. So working with a dietician can really help solidify and figure this out."

The Crohn’s and Colitis Foundation says research suggests that certain foods and drinks may aggravate Crohn’s disease symptoms, such as:

• Alcohol
• Caffeinated drinks
• Sugars and artificial sweeteners
• High-lactose foods
• Fiber-rich foods
• High-fat, spicy or processed foods
• Red meat
• Coconut and palm oils

• Leafy greens
• Sweet potatoes
• Potatoes
• Rice
• Oatmeal
• Bananas
• Applesauce
• Raspberries
• Fatty fish
• Chia seeds
• Flaxseed oil and meal

Medications For Treating Crohn’s Disease

Crohn’s disease treatment typically involves medications that help calm the immune system. These may include pills called immunomodulators or small molecules, infusions or shots called biologics.

"In general, we first try to treat patients with medicines to help decrease the inflammation,” Dr. Dolejs said. "These medications also can suppress the immune system so they can have some side effects. These can range from pills to more powerful infusions and injections. And it's common to have to try a few medications before finding one that will work."

Medications to treat Crohn’s disease symptoms include:

• Immunomodulators to reduce immune system activity
• Biologics to reduce proteins made by the immune system that cause inflammation
• Aminosalicylates to reduce inflammation
• Corticosteroids to reduce inflammation and immune system activity
• Loperamide for diarrhea
• Acetaminophen for pain.

Surgery For Crohn’s disease

Many patients with Crohn's disease eventually need surgery.

“Sometimes the medicines are not working well enough or other complications develop and surgery is needed,” Dr. Dolejs said. ”There's been some estimates that after about 10 years of having Crohn's disease, half of patients will require surgery to remove some of the inflamed intestine.”

Surgeries for Crohn's disease depend on where the Crohn’s is impacting the digestive system. These procedures can include:

• Small bowel resection to remove part of the small intestine
• Large bowel resection to remove part of the colon
• Proctocolectomy and ileostomy to remove the entire colon and rectum and attach the end of the small intestine to an opening outside the abdomen

What Happens If Crohn’s Disease Is Not Treated?

"Unfortunately, there can be complications from Crohn's disease," Dr. Dolejs said. "Because Crohn's disease can involve the whole thickness of the intestine, it means that Crohn's disease can cause the bowel to do things like perforate or form strictures or narrowing of the intestines. These strictures can result in blockages of the bowel. And because it can involve the whole thickness of the bowel, Crohn's disease can result in fistulas, which causes connections to other organs. An example of this would be Crohn's disease can cause a small bowel to become connected to the bladder. So contents from the bowel enter into the bladder and eventually in the urinary stream. Sometimes these complications can be treated with medicines, but often they do require surgery.”

HealthDay News contributed information to this article.

Can Crohn’s Disease Be Cured?

While there isn't a definitive cure for Crohn's disease, a significant number of patients have their symptoms managed or even eliminated with effective treatments, including medication and surgery.

"A lot of people want to know, ‘Hey, is this ever going to go away? I don't want the diagnosis because what am I going to do with it,’” Dr. Dolejs said. “The first thing to understand is that it certainly is tricky because the presentation of Crohn's disease can be so variable.

"In fact, about one in five patients, who gets treated for an initial flare of Crohn's disease, never have problems with it again. So in those patients, pretty much it is gone. But that means that 80% of patients, do require ongoing treatment. But with treatment, patients can live normal and full lives. Many patients may have mild flares that come and go, but they are very well controlled with medications.

"It is very important to remember that surgery does not cure Crohn's disease. It can help patients feel better, return to normal activities, and may help keep Crohn's disease in check. Because Crohn's disease can happen anywhere along the length of the gastrointestinal tract, it is not a cure by itself.”

Dr. Dolejs cautions that many patients may need another surgery later in life.

“About 30 to 50% of patients who have had a surgery for Crohn's disease will need another at some point during their life,” he said. “Because it's so different for each patient, it's difficult to predict how an individual will do. In general, we say younger age at diagnosis, using tobacco, having that rectal or perianal involvement with abscesses and needing long-term steroids are risks for worse and progressive disease.

“But we have new medications that are coming out every year. Better surgical techniques that have been developed even in the last couple years. And, with all that, we can get patients back to their lives, get their lives on track and give patients a great future.”