There is currently no cure for Crohn’s disease. However, medication can improve your symptoms and in many cases surgery can also help.
Your treatment plan
If you are diagnosed with Crohn’s disease, your care team will draw up a treatment plan for you. There are three goals in treating the condition. These are:
- to treat the active disease to relieve your symptoms
- to prevent your symptoms returning using maintenance therapy
- to treat any returning symptoms with relapse therapy
Corticosteroids
Corticosteroids, or steroid medications, are a type of hormone medication. Hormones are groups of powerful chemicals that have a wide range of effects on the body, such as helping to reduce inflammation.
Corticosteroids are usually only used to treat active Crohn's disease because their long-term use causes side effects.
Budesonide and prednisolone are two steroid medications used to treat Crohn’s disease.
Budesonide
Budesonide is usually the first steroid medication prescribed. If you take budesonide on a short-term basis (less than 12 weeks), you may experience the following side effects:
- acne
- swelling of the face
- swelling of the hands, arms, feet and legs due to a build-up of fluid (oedema)
- mood changes, such as feeling irritable or anxious
- difficulty sleeping (insomnia)
- indigestion
If you take budesonide for more than 12 weeks, you may experience:
- thinning of the bones (osteoporosis)
- increased vulnerability to infection
- cataracts (a type of eye condition)
- muscle cramps and stiffness
If you need to take budesonide for more than 12 weeks, you may be given vitamin D and calcium supplements to help strengthen the bones and protect against osteoporosis.
Due to your increased vulnerability to infections, you should avoid close contact with people who are known to have infections, particularly those with chickenpox, measles and shingles.
You should not suddenly stop taking budesonide. When you no longer need to take budesonide, your dose will be gradually reduced over time.
Prednisolone
Prednisolone is used if budesonide hasn't helped or your symptoms are more severe.
Prednisolone has the same type of short-term and long-term side effects as budesonide. It has also been known to cause mental health problems in an estimated 5% of people. These include:
- feeling depressed and thinking about suicide
- feeling very excited and happy
- experiencing sudden and severe mood changes (happy one minute, very depressed the next)
- feeling anxious
- problems thinking clearly and feeling particularly confused
- memory loss
- hallucinations (seeing and hearing things that are not real)
If you experience any of these symptoms, you should contact your GP because your dose may need to be adjusted.
As with budesonide, you should avoid close contact with people who are known to have infections, particularly those with chickenpox, measles and shingles.
You should not suddenly stop taking prednisolone. Speak to your GP and your dose will be gradually reduced over time.
Aminosalicylates
Sulfasalazine
Sulfasalazine belongs to a group of medicines called aminosalicylates. Aminosalicylates are known to reduce inflammation inside the colon. Sulfasalazine may be used as an alternative to steroid medications to treat mild cases of Crohn’s disease.
Depending on exactly where the inflammation is, you may be given sulfasalazine as a tablet or as a suppository (a capsule that you insert into your anus).
Common side effects of sulfasalazine include:
You should tell your GP if you have side effects that become particularly troublesome because your dose may need to be adjusted.
Immunosuppressants
Immunosuppressants are a type of medication used to suppress the immune system to help reduce inflammation on a long-term basis.
Immunosuppressants are used in maintenance therapy and in combination with corticosteroids when symptoms relapse.
Azathioprine and mercaptopurine are two immunosuppressants often used to treat Crohn’s disease.
Azathioprine
Depending on the severity of your symptoms, you may be given azathioprine as a tablet or as an injection.
Common side effects of azathioprine include:
- increased vulnerability to infection
- bleeding and bruising more easily
Due to your increased vulnerability to infection, you should avoid people with a known chickenpox or shingles infection.
Less common side effects of azathioprine include:
- headaches
- shortness of breath and dizziness when exercising
- feeling sick (nausea)
- being sick (vomiting)
Mercaptopurine
Mercaptopurine was originally developed to treat leukaemia (cancer of the blood cells), but it has since proved effective in treating Crohn’s disease.
Common side effects of mercaptopurine include:
- nausea (feeling sick)
- vomiting (being sick)
Less common side effects of mercaptopurine include:
- loss of appetite
- feeling tired, breathless and weak, which is caused by anaemia (a decrease in the number of red blood cells)
Mercaptopurine can also temporarily affect the quality of a woman’s eggs and a man’s sperm, which could increase the risk of birth defects. It is therefore very important to use effective contraception if you are sexually active and taking mercaptopurine.
Biological therapies
Biological therapies are a new type of medication. They are created using naturally occurring biological substances, such as antibodies and enzymes.
There are currently two biological therapies licensed for use in England. They are:
Infliximab
Infliximab is usually only recommended in severe cases of Crohn’s disease that have not responded to other treatments or surgery.
For example, if a person has had surgery to remove a section of bowel, they may not be suitable for more surgery. Alternatively, a person’s overall health may be too poor to withstand the effects of surgery.
Infliximab works by targeting the tumour necrosis factor (TNF) antibodies responsible for most of the inflammation associated with Crohn’s disease.
Infliximab is given through a drip in your arm over the course of two hours. This is known as an infusion.
An initial dose of infliximab is followed by a second dose two weeks later. If there is no response then treatment with infliximab will stop. If there is a response to the infliximab, there will be further treatment 6 weeks after the initial dose, followed by infusions every 8 weeks.
Around 1 in 4 people have an allergic reaction to infliximab and experience symptoms such as:
- joint and muscle pain
- itchy skin
- high temperature
- rash
- swelling of the hands or lips
- problems swallowing
- headaches
These symptoms can range from mild to severe and usually develop in the first two hours after the infusion has finished. However, in a minority of cases, people have experienced a delayed allergic reaction that occurs days or even weeks after having an infusion. If you begin to experience any of the side effects of infliximab, you should seek immediate medical assistance.
Your health will be closely monitored following your first infusion, due to the significant risk of having a severe allergic reaction.
There have been several cases where infliximab has reactivated a previously dormant tuberculosis (TB) infection. Therefore, it may not be suitable for you if you have a previous history of TB. Infliximab is also not recommended for people with a history of heart disease.
Infliximab makes you more vulnerable to infection so you should avoid contact with people who have a known chickenpox or shingles infection.
Adalimumab
Another biological therapy available for people with severe Crohn's disease is a medication called adalimumab. Adalimumab works in a similar way to infliximab, by targeting TNF antibodies.
Adalimumab is given by injection. Most people will need to have an injection every two weeks. Your GP or practice nurse will be able to teach you how to administer the injections yourself at home.
Like infliximab, adalimumab makes you more vulnerable to infection, so if you are taking it you should avoid coming into contact with people with chickenpox or shingles, and you should always report any symptoms of a possible infection to your GP.
Adalimumab can cause reactivation of the hepatitis B virus in people who were previously infected. You should let your GP know if you've been previously infected with hepatitis B.
Common side effects of adalimumab include:
- pain, swelling, redness and itching at the site of the injection
- headache
- nausea (feeling sick)
- vomiting (being sick)
- skin rash
- muscle, joint and bone pain
- respiratory tract infections, such as colds, a runny nose and pneumonia (lung infection)
Surgery
Surgery is often required when the symptoms of Crohn’s disease cannot be controlled using medication alone. An estimated 60-75% of people with Crohn’s disease will need to have surgery at some point. Surgery may also be required to treat complications such as fistulas (abnormal channels that develop between two sections of the digestive system).
Read more about the complications of Crohn’s disease.
Surgery cannot cure Crohn’s disease, but it can ease the symptoms for long periods of time. During surgery, the inflamed section of the digestive system is removed and the remaining part is reattached.
Diet and self-help
Some people with Crohn’s disease find that certain foods make their symptoms worse and decide to try a different a diet. In cases where the symptoms of Crohn’s disease are severe, a liquid diet (elemental diet) may be recommended by a GP.
Read more about diet and self-help.
