Table of ContentsView AllTable of ContentsPrescriptionsDietOver-the-Counter RemediesSurgeryComplementary Alternative Medicine (CAM)Frequently Asked QuestionsNext in Crohn’s Disease GuideEverything to Know About Crohn’s Disease
Table of ContentsView All
View All
Table of Contents
Prescriptions
Diet
Over-the-Counter Remedies
Surgery
Complementary Alternative Medicine (CAM)
Frequently Asked Questions
Next in Crohn’s Disease Guide
Crohn’s diseaseis a chronic inflammatory bowel disease that primarily affects the lining of the digestive tract. While it cannot be cured, there are medications such as steroids and immune system suppressants that can slow the progression of the disease and help you achieve sustained periods of remission.
You can also treat symptom flares with diet, bowel rest, and an increased intake of soluble fiber. If Crohn’s disease causes injury to your intestines, such as a perforation or blockage,surgery may be needed.
Verywell / Ellen Lindner
For most people with Crohn’s disease, prescription treatment is necessary for long-term control of disease progression. A variety of medications may be used. They can be broken down into five classes, each of which has a different mechanism of action appropriate to different stages of the disease.
Here’s a snapshot of how each type of medication works.
Drug ClassAminosalicylatesAntibioticsCorticosteroidsImmunomodulatorsBiologicsActionControl inflammation in people with mild symptomsTreat bacterial infections or treatment of complications like fistula and abcessTemper the immune system to reduce inflammation; used temporarilyTemper the immune system on long-term basisTreat targeted parts of the immune response
Drug ClassAminosalicylatesAntibioticsCorticosteroidsImmunomodulatorsBiologics
Aminosalicylates
Antibiotics
Corticosteroids
Immunomodulators
Biologics
ActionControl inflammation in people with mild symptomsTreat bacterial infections or treatment of complications like fistula and abcessTemper the immune system to reduce inflammation; used temporarilyTemper the immune system on long-term basisTreat targeted parts of the immune response
Control inflammation in people with mild symptoms
Treat bacterial infections or treatment of complications like fistula and abcess
Temper the immune system to reduce inflammation; used temporarily
Temper the immune system on long-term basis
Treat targeted parts of the immune response
Aminosalicylates (5-ASA)
While experts don’t fully understand how they work, aminosalicylates are believed to temper the production of inflammatory chemicals known ascytokines.
Common side effects of the medications used to treat Crohn’s include diarrhea, headaches, and heartburn.
Antibiotics are used to treat bacterial infections common in people with Crohn’s disease.They may occur as a result of afissure(a cut or tear in the intestine) or afistula(the formation of a hole in the digestive tract through which fluid can seep). A broad-spectrum antibiotic able to kill multiple bacterial strains will usually be used.
The antibiotics most commonly prescribed for Crohn’s treatment include:
While oral antibiotics are typically used, severe cases may require intravenous antibiotics delivered in a hospital. Side effects include nausea, diarrhea, headache, dizziness, and a metallic taste in the mouth.
Options include:
Corticosteroids are only recommended for short-term use.
Corticosterioids are not effective in preventing flares and are, therefore, rarely used for maintenance therapy. In addition, long-term use can cause undesirable and potentially serious side effects, including high blood pressure, acne, mood swings, cataracts, glaucoma, diabetes, and osteoporosis.
For these reasons, corticosteroids are prescribed at the lowest possible dosage for the shortest period of time. Frequent short-term use is also not recommended.
These drugs also temper the immune system as a whole but are taken on an ongoing basis. These drugs are used to treat a wide range ofautoimmuneand immune-modulated disorders and are typically indicated for people with Crohn’s disease who have not responded to aminosalicylates or corticosteroids.
While corticosteroids and biologics are also potent modulators of the immune system, they are not considered part of this drug class.
Oral formulations generally take longer to take effect than intravenous ones.
Among the approved options:
A topical version of Prograf is also available to treat a rare ulcerative skin condition calledpyoderma gangreosum, which sometimes develops in people with severe Crohn’s disease.
Common Side Effects of ImmunomodulatorsFatigueNauseaVomitingPancreatitisKidney impairmentIncreased risk of infectionBone marrow suppression (and therefore decrease in blood counts)Increased liver enzymes
Common Side Effects of Immunomodulators
FatigueNauseaVomitingPancreatitisKidney impairmentIncreased risk of infectionBone marrow suppression (and therefore decrease in blood counts)Increased liver enzymes
Biologic Drugs
Biologicsare usually large proteins produced, often with advanced molecular techniques, in living organisms. They have revolutionized the treatment of Crohn’s disease. Unlike immune modulators, biologics only affect a specific part of the immune response rather the whole. As a result, they provide a more targeted form of therapy with a shorter ramping-up time (typically four to six weeks).
Biologics are typically used in people with moderate to severe Crohn’s disease who have not responded to the other forms of treatment. Some healthcare providers have begun to use biologics as first-line therapy in the hope that they may alter the course of the disease over the longterm. Several studies have showed a benefit from starting biologics early in disease course to minimize the risk of complications like need for surgery, and development of fistulas/abscesses.
Generally speaking, biologics may be used sooner rather than later for people who werediagnosed at a younger age, who are being treated with frequent corticosteroids, who required multiple surgeries, and whose disease is limited to the small intestines.
The biologics can be broken down into three classes: integrin antagonists, interleukin inhibitors, andtumor necrosis factor (TNF) inhibitors. Each block a certain protein associated with inflammation.
The biologics commonly used to treat Crohn’s disease include:
Common side effects include a headache, fatigue, stomach upset, diarrhea, upper respiratory tract infection, urinary tract infection, other infections, and rash.
Avoidance of any food or substance that can trigger or exacerbate symptoms is also key. This may involve anelimination diet, which entails methodically excluding and reintroducing certain foods to see how your body reacts. Doing so can not only help identify your specific dietary triggers but help you design a maintenance diet able to keep your disease in sustained remission.
2:07Identifying and Managing Crohn’s Disease Flare-Ups
2:07
Identifying and Managing Crohn’s Disease Flare-Ups
Low-Residue Diet
If you experience a sudden flare of symptoms, you will need to avoid placing any unnecessary stress on your digestive tract.
To this end, some healthcare providers will endorse the use of alow-residue diet, particularly if you have been diagnosed with astricture(narrowing) of the ileum (lower small intestine).
A low-residue diet involves the omission of all foods that remain largely undigested and get “dragged along” in the stool.
These include foods such as corn hulls, seeds, whole grains, raw vegetables, beans, cured meats, tough meat, popcorn, and crunchy peanut butter.
Among some of the foods you can eat on a low-residue diet:
While a low-residue diet can offer significant relief during an acute flare, current research suggests that is it should only be used as a short-term solution. The prolonged absence of dietary fiber can actually have an inverse effect on people with Crohn’s disease, increasing both the frequency and severity of symptoms.
Liquid Diet and Bowel Rest
This intervention may initially involve aliquid dietwith the appropriate nutritional supplements to place as little stress on the bowel as possible.
If your symptoms are especially severe, your healthcare provider may recommend bowel rest for anywhere from a few days to several weeks.
For the bowel rest period, your healthcare provider will structure a list of high-calorie liquid foods, starting initially with clear liquids and nutritional shakes (either made with whey protein or non-dairy elemental formulas). The shakes are especially important as they ensure you are getting enough fiber, protein, and minerals as part of an increased-calorie diet.
As the symptoms begin to ease, puréed and soft foods (like oatmeal and scrambled eggs) may gradually be introduced until you are able to tolerate solid foods again.
Full Liquid Diet Benefits: What to Know
While bowel rest is ideally performed at home, hospitalization may be needed if you are unable to stomach food of any sort. In some cases, nutrition may need to be delivered either through an intravenous drip or a feeding tube inserted into your stomach. However, this is not common.
Over-the-counter (OTC) drugs may be used to treat mild pain and resolve moderate to severe bouts of diarrhea.
For pain, Tylenol (acetaminophen) can often provide ample pain relief in people with mild Crohn’s disease. On the other hand,nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, Aleve (naproxen), and Advil (ibuprofen) should be avoided as they can often cause gastrointestinal bleeding and ulcers, as well as disease flares.
Diarrhea may be treated with a short course ofantidiarrheal medications. There are two OTC drugs commonly recommended for short-term use:
Overuse can lead to a rare but potentially life-threatening condition known astoxic megacolon, in which the colon suddenly dilates and is unable to contract, allowing gas and toxins to rapidly build up.
Vitamin Supplementation
People with Crohn’s disease often develop vitamin or mineral deficiencies due to chronic gastrointestinal malabsorption or bleeding. This is especially true with vitamin D, calcium, and vitamin B-12, each of which is absorbed in the small intestine.
To this end, a daily 800 IU supplement of vitamin D and a 1,500mg supplement of calcium may be used safely if a deficiency has been identified. Higher doses might be recommended if deficiency is severe.
Overuse of these supplements should be avoided as it may lead to kidney stones, abnormal heart rhythms, and even kidney damage.
People with a severe vitamin B-12 deficiency (usually those who have undergone bowel surgery or those with chronic disease involving the last part of the small bowel called the ileum) may benefit from a monthly intramuscular injection or a once-weekly nasal spray of vitamin B-12.
Folic acid deficiency can also develop in people who take Azulfidine or methotrexate. A daily, 1mg folate supplement can usually counteract this deficit. Iron deficiency also can be seen in people with chronic gastrointestinal blood loss from active disease. Iron supplements are recommended in this case either orally or intravenously depends on the severity of deficiency and anemia.
Speak with your healthcare provider to determine which vitamin supplement or dosage is right for you.
While surgery cannot cure Crohn’s disease, it can treat complications and often help restore normal bowel function. Indications for surgery may include bowel obstruction, excessive bleeding, anabscess, intestinal rupture, and toxic megacolon.
Approximately 70 percent of peoplewith Crohn’s disease require surgery within 10 years of their initial diagnosis.
Among the surgical options:
While these surgeries can often be extremely successful, half of the people who have one require another within three to five years.Oftentimes, the progression of the disease is such that a return of the disease, while not inevitable, is not unexpected. Age may also play a factor in disease recurrence, with some studies suggesting that younger people are at greater risk than older people.
When this narrowing occurs in damaged intestinal tissues, the reduced blood supply can make it harder to fight infection or deliver oxygen to vulnerable cells.
As such, smoking cessation is considered a must for anyone who has undergone surgery for Crohn’s disease or, frankly, anyone who is suffering symptoms of the disease.
A number of studies have also suggested that the post-operative use of aminosalicylates (like Asacol), immune modulators (like Imuran), or TNF inhibitors (like Humira) may reduce the risk of recurrence.
People with Crohn’s disease often support their therapy with complementary and alternative medicine (CAM), either to address nutritional deficiencies to or help ease symptoms.
It is important to speak with your healthcare provider about any supplement, traditional medicine, or herbal remedy you may be taking (or considering) to ensure that it does not interact with your prescribed drugs or inadvertently trigger a flare.
It is important to remember that supplements, herbal remedies, and traditional medicines are not researched or regulated in the same way as pharmaceutical drugs. As such, you need to be wary of anycurative claimthat a manufacturer makes and approach anecdotal evidence and testimonials with extreme caution.
There’s limited research on holistic therapies for Crohn’s disease. Some evidence shows thatwormwood(Artemisia absinthium) can ease symptoms. However, there are concerns about whether it’s safe to use because it can cause serious side effects and toxicity, so discuss this option with your healthcare provider.
Practical Tips for Living Well With Crohn’s Disease
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zenlea T, Peppercorn MA.Immunosuppressive therapies for inflammatory bowel disease. World J Gastroenterol. 2014;20(12):3146-52. doi:10.3748/wjg.v20.i12.3146Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACGClinical guideline: Management of Crohn’s disease in adults.Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27.De Mattos BR, Garcia MP, Nogueira JB, et al.Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm. 2015;2015:493012. doi:10.1155/2015/493012National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for Crohn’s disease.Owczarek, D.; Rodacki, T.; Domagala-Rodacka, R. et al.Diet and nutritional factors in inflammatory bowel disease.World J Gastroenterol.2015; 22(3):895-905. doi:10.3748/wjg.v22.i3.895Haskey N, Gibson D.An examination of diet for the maintenance of remission of inflammatory bowel disease.Nutrients.2017;9(3):250. doi:10.3390/nu9030259Sevim Y, Akyol C, Aytac E, Baca B, Bulut O, Remzi FH.Laparoscopic surgery for complex and recurrent Crohn’s disease. World J Gastrointest Endosc. 2017;9(4):149-152. doi:10.4253/wjge.v9.i4.149Gklavas, A.; Dellaportas, D.; and Papaconstantinou.Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors.Ann Gastroenterol.2017; 30(6): 598-612. doi:10.20524/aog.2017.0195Philip Vaughan, B. and Colm Moss, A.Prevention of post-operative recurrence of Crohn’s disease.World J Gastroenterol.2014 Feb 7; 20(5):1147-54. doi:10.3748/wjg.v20.i5.1147.Wan, P.; Chen, H.; Guo, Y. et al.Advances in treatment of ulcerative colitis with herbs: From bench to bedside.World J Gastroenterol.2014; 20(39):14099-104. doi:10.3748/wjg.v20.i39.14099Jia K, Tong X, Wang R, Song X.The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13792. doi:10.1097/MD.0000000000013792Barbalho SM, Goulart Rde A, Quesada K, Bechara MD, De carvalho Ade C.Inflammatory bowel disease: can omega-3 fatty acids really help?. Ann Gastroenterol. 2016;29(1):37-43.Picardo S, Altuwaijri M, Devlin SM, Seow CH.Complementary and alternative medications in the management of inflammatory bowel disease.Therap Adv Gastroenterol. 2020;13:175628482092755. doi:10.1177/2F1756284820927550
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zenlea T, Peppercorn MA.Immunosuppressive therapies for inflammatory bowel disease. World J Gastroenterol. 2014;20(12):3146-52. doi:10.3748/wjg.v20.i12.3146Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACGClinical guideline: Management of Crohn’s disease in adults.Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27.De Mattos BR, Garcia MP, Nogueira JB, et al.Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm. 2015;2015:493012. doi:10.1155/2015/493012National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for Crohn’s disease.Owczarek, D.; Rodacki, T.; Domagala-Rodacka, R. et al.Diet and nutritional factors in inflammatory bowel disease.World J Gastroenterol.2015; 22(3):895-905. doi:10.3748/wjg.v22.i3.895Haskey N, Gibson D.An examination of diet for the maintenance of remission of inflammatory bowel disease.Nutrients.2017;9(3):250. doi:10.3390/nu9030259Sevim Y, Akyol C, Aytac E, Baca B, Bulut O, Remzi FH.Laparoscopic surgery for complex and recurrent Crohn’s disease. World J Gastrointest Endosc. 2017;9(4):149-152. doi:10.4253/wjge.v9.i4.149Gklavas, A.; Dellaportas, D.; and Papaconstantinou.Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors.Ann Gastroenterol.2017; 30(6): 598-612. doi:10.20524/aog.2017.0195Philip Vaughan, B. and Colm Moss, A.Prevention of post-operative recurrence of Crohn’s disease.World J Gastroenterol.2014 Feb 7; 20(5):1147-54. doi:10.3748/wjg.v20.i5.1147.Wan, P.; Chen, H.; Guo, Y. et al.Advances in treatment of ulcerative colitis with herbs: From bench to bedside.World J Gastroenterol.2014; 20(39):14099-104. doi:10.3748/wjg.v20.i39.14099Jia K, Tong X, Wang R, Song X.The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13792. doi:10.1097/MD.0000000000013792Barbalho SM, Goulart Rde A, Quesada K, Bechara MD, De carvalho Ade C.Inflammatory bowel disease: can omega-3 fatty acids really help?. Ann Gastroenterol. 2016;29(1):37-43.Picardo S, Altuwaijri M, Devlin SM, Seow CH.Complementary and alternative medications in the management of inflammatory bowel disease.Therap Adv Gastroenterol. 2020;13:175628482092755. doi:10.1177/2F1756284820927550
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Zenlea T, Peppercorn MA.Immunosuppressive therapies for inflammatory bowel disease. World J Gastroenterol. 2014;20(12):3146-52. doi:10.3748/wjg.v20.i12.3146Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACGClinical guideline: Management of Crohn’s disease in adults.Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27.De Mattos BR, Garcia MP, Nogueira JB, et al.Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm. 2015;2015:493012. doi:10.1155/2015/493012National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for Crohn’s disease.Owczarek, D.; Rodacki, T.; Domagala-Rodacka, R. et al.Diet and nutritional factors in inflammatory bowel disease.World J Gastroenterol.2015; 22(3):895-905. doi:10.3748/wjg.v22.i3.895Haskey N, Gibson D.An examination of diet for the maintenance of remission of inflammatory bowel disease.Nutrients.2017;9(3):250. doi:10.3390/nu9030259Sevim Y, Akyol C, Aytac E, Baca B, Bulut O, Remzi FH.Laparoscopic surgery for complex and recurrent Crohn’s disease. World J Gastrointest Endosc. 2017;9(4):149-152. doi:10.4253/wjge.v9.i4.149Gklavas, A.; Dellaportas, D.; and Papaconstantinou.Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors.Ann Gastroenterol.2017; 30(6): 598-612. doi:10.20524/aog.2017.0195Philip Vaughan, B. and Colm Moss, A.Prevention of post-operative recurrence of Crohn’s disease.World J Gastroenterol.2014 Feb 7; 20(5):1147-54. doi:10.3748/wjg.v20.i5.1147.Wan, P.; Chen, H.; Guo, Y. et al.Advances in treatment of ulcerative colitis with herbs: From bench to bedside.World J Gastroenterol.2014; 20(39):14099-104. doi:10.3748/wjg.v20.i39.14099Jia K, Tong X, Wang R, Song X.The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13792. doi:10.1097/MD.0000000000013792Barbalho SM, Goulart Rde A, Quesada K, Bechara MD, De carvalho Ade C.Inflammatory bowel disease: can omega-3 fatty acids really help?. Ann Gastroenterol. 2016;29(1):37-43.Picardo S, Altuwaijri M, Devlin SM, Seow CH.Complementary and alternative medications in the management of inflammatory bowel disease.Therap Adv Gastroenterol. 2020;13:175628482092755. doi:10.1177/2F1756284820927550
Zenlea T, Peppercorn MA.Immunosuppressive therapies for inflammatory bowel disease. World J Gastroenterol. 2014;20(12):3146-52. doi:10.3748/wjg.v20.i12.3146
Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACGClinical guideline: Management of Crohn’s disease in adults.Am J Gastroenterol. 2018;113(4):481-517. doi:10.1038/ajg.2018.27.
De Mattos BR, Garcia MP, Nogueira JB, et al.Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm. 2015;2015:493012. doi:10.1155/2015/493012
National Institute of Diabetes and Digestive and Kidney Diseases.Treatment for Crohn’s disease.
Owczarek, D.; Rodacki, T.; Domagala-Rodacka, R. et al.Diet and nutritional factors in inflammatory bowel disease.World J Gastroenterol.2015; 22(3):895-905. doi:10.3748/wjg.v22.i3.895
Haskey N, Gibson D.An examination of diet for the maintenance of remission of inflammatory bowel disease.Nutrients.2017;9(3):250. doi:10.3390/nu9030259
Sevim Y, Akyol C, Aytac E, Baca B, Bulut O, Remzi FH.Laparoscopic surgery for complex and recurrent Crohn’s disease. World J Gastrointest Endosc. 2017;9(4):149-152. doi:10.4253/wjge.v9.i4.149
Gklavas, A.; Dellaportas, D.; and Papaconstantinou.Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors.Ann Gastroenterol.2017; 30(6): 598-612. doi:10.20524/aog.2017.0195
Philip Vaughan, B. and Colm Moss, A.Prevention of post-operative recurrence of Crohn’s disease.World J Gastroenterol.2014 Feb 7; 20(5):1147-54. doi:10.3748/wjg.v20.i5.1147.
Wan, P.; Chen, H.; Guo, Y. et al.Advances in treatment of ulcerative colitis with herbs: From bench to bedside.World J Gastroenterol.2014; 20(39):14099-104. doi:10.3748/wjg.v20.i39.14099
Jia K, Tong X, Wang R, Song X.The clinical effects of probiotics for inflammatory bowel disease: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13792. doi:10.1097/MD.0000000000013792
Barbalho SM, Goulart Rde A, Quesada K, Bechara MD, De carvalho Ade C.Inflammatory bowel disease: can omega-3 fatty acids really help?. Ann Gastroenterol. 2016;29(1):37-43.
Picardo S, Altuwaijri M, Devlin SM, Seow CH.Complementary and alternative medications in the management of inflammatory bowel disease.Therap Adv Gastroenterol. 2020;13:175628482092755. doi:10.1177/2F1756284820927550
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