Crohn's Treatment Options
No drug or surgical procedure can cure Crohn's disease. Treatment for Crohn's is aimed at preventing and treating flare-ups and complications.Because eating can irritate an inflamed bowel, severe flare-ups usually require hospital treatment with intravenous nutrition and fluids to allow the bowel to rest.
You will also be given intravenous corticosteroids like methylprednisolone and mesalamine capsules (Pentasa) or tablets (Asacol or Apriso) or sulfasalazine (Azulfidine) tablets to reduce inflammation. Pentasa can be used to treat disease in both the small and the large intestine. If the disease is present only in the colon, Asacol or Azulfidine can be used.
If the disease responds to these treatments, you can switch from intravenous to oral corticosteroids such as prednisone or budesonide (Entocort EC). Eventually, you will likely be weaned off corticosteroids, but you will still take mesalamine or sulfasalazine.
When Crohn's disease is limited to the far end of the colon and the rectum, you may receive hydrocortisone (Colocort) or mesalamine (Rowasa) enemas in addition to the treatments just mentioned.
If Crohn's disease does not improve with corticosteroids and mesalamine or sulfasalazine, immunosuppressive medications may be tried. The most commonly used are mercaptopurine (Purinethol) and azathioprine (Imuran), both given orally.
The immunosuppressant infliximab (Remicade) is especially effective when fistulas are present. It is injected about once every two months and is usually tried only when you do not respond to conventional therapy. However, serious complications have been reported in people using Remicade, a drug that comes with an increased risk of infections and hypersensitivity reactions. In addition, because Remicade can allow latent (silent) tuberculosis to develop into full-blown tuberculosis, you should receive a tuberculin skin test before beginning therapy.
Adalimumab (Humira) is also available for the treatment of moderately to severely active Crohn's disease. Humira is also an immunosuppressant, but it does not require intravenous injection—the drug is packaged in an injection pen that can be self-administered once every two weeks. Humira is intended for people who cannot tolerate Remicade or who become resistant to it over time. Like Remicade, Humira carries a risk of infection, and it may increase your risk of lymphoma and leukemia.
Two newer immunosuppressants to treat Crohn's disease, natalizumab (Tysabri) and certolizumab pegol (Cimzia), are similar to Remicade and Humira. They are administered by injection at your doctor's office. The first three injections are given two weeks apart; if the medication appears to be helping, you'll receive additional doses every four weeks. Tysabri is a multiple sclerosis drug that has a risk of severe side effects, including a serious and potentially deadly brain infection called progressive multifocal leukoencephalopathy (PML).
Other drugs to treat Crohn's disease are currently in clinical trials: abatacept (Orencia), a rheumatoid arthritis drug, and an experimental stem-cell drug called Prochymal.
Surgical removal of a section of the bowel is required if you develop problems such as intestinal obstruction due to serious strictures or complications like fistulas or abscesses that won't heal. In this procedure, the affected portion of the small or large intestine is removed and the two ends are re-attached. This is not a cure for Crohn's disease, since the remaining bowel is still susceptible to the disease.