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While there is no known cure for Crohn’s disease, treatment can reduce its signs and symptoms and even bring long-term remission. Treatment typically involves either drug therapy or surgery. The goal of treatment is to reduce inflammation and the risk of complications. With drug therapy, there are two common approaches: “step-up,” in which the health provider prescribes milder drugs first, or “top-down,” which uses stronger drugs earlier in the treatment process.
Additional treatments can include anti-diarrheal medications or fiber supplements to add bulk to the stool; over the counter pain relievers for mild pain; iron supplements for those who have anemia due to chronic intestinal bleeding; and calcium and vitamin D supplements to combat the risk of osteoporosis, particularly in those who are taking steroids.
For more severe Crohn’s disease, the damaged part of the intestine may be removed surgically and the healthy sections reconnected. Up to half of people with Crohn’s disease will require surgery, though it is not a cure.
It’s important to manage stress when you have Crohn’s disease, as stress can worsen symptoms. Biofeedback is a stress-reduction technique that uses a machine to help you enter a relaxed state and slow your heart rate. Exercise, along with relaxation and breathing exercises, such as meditation, also can help you reduce stress in your life.
Often anti-inflammatory drugs are the first step in treating Crohn’s disease. These include aminosalicylates like sulfasalazine, and 5-aminosalicylates including mesalamine and balsalazide, which come in both oral and suppository form. Corticosteroids such as prednisone and hydrocortisone can help reduce inflammation, but come with numerous side effects, including night sweats, insomnia and hyperactivity, and more serious side effects like diabetes and osteoporosis. Also, corticosteroids don’t work for everyone with Crohn’s disease. Doctors generally use them only if the person does not respond to other treatments.
Immune system suppressors reduce inflammation by targeting the immune system. Some people require a combination of these drugs rather than taking just one. They include azathioprine and mercaptopurine, which require close monitoring due to the increased risk of lowered resistance to infection or, more rarely, cancer. Cyclosporine also has the potential for serious side effects such as kidney and liver damage, seizures and fatal infections.
(TNF)-alpha inhibitors, or “biologics,” typically given to people with arthritis, may be used for people with moderate to severe Crohn’s disease who don’t respond to or can’t tolerate the side effects of other treatments. These medicines suppress a protein produced by the immune system and may be combined with other immunosuppressants. Methotrexate, used mainly to treat cancer, is sometimes given to people with Crohn’s disease who don’t respond to other medications. Because its long term use is associated with serious side effects such as bone marrow suppression, people taking methotrexate must be monitored closely by their doctor.
Antibiotics are sometimes given to people with Crohn’s disease who have infection, and they can heal abscesses in the intestine. They may also reduce the number of harmful bacteria in the intestines. Additional medications may be used as a supplement to stronger pharmaceuticals, such as anti-diarrheal medications and over-the-counter pain relievers like acetaminophen. Ibuprofen and naproxen sodium should be avoided as they can worsen Crohn’s disease symptoms.