What is Crohn’s Disease? + Diagnosis, Treatment & Diet

Treatment for Crohn’s Disease | NIDDK

What is Crohn’s Disease? + Diagnosis, Treatment & Diet

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Many people with Crohn’s disease need medicines. Which
medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

  • balsalazide
  • mesalamine
  • olsalazine
  • sulfasalazine

Some of the common side effects of aminosalicylates include

  • diarrhea
  • headaches
  • heartburn
  • nausea and vomiting
  • pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

  • budesonide
  • hydrocortisone
  • methylprednisolone
  • prednisone

Side effects of corticosteroids include

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

  • 6-mercaptopurine, or 6-MP
  • azathioprine
  • cyclosporine
  • methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

  • a low white blood cell count, which can lead to a higher chance of infection
  • feeling tired
  • nausea and vomiting
  • pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

  • acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
  • antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
  • loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

  • ask you to drink a liquid that contains nutrients
  • give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
  • give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.8 Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

  • fistulas
  • bleeding that is life threatening
  • intestinal obstructions
  • side effects from medicines when they threaten your health
  • symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most ly stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

  • laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
  • open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

  • laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
  • open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum.

The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body.

The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

  • Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
  • Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
  • Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
  • Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
  • Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
  • Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
  • Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.

References

[8] Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). American Journal of Gastroenterology. 2012;107(11):1639–1701.

Source: https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/treatment

Crohn’s Disease Diagnosis and Testing

What is Crohn’s Disease? + Diagnosis, Treatment & Diet

Crohn’s disease has a wide range of symptoms that vary from person to person. We are by your side as you navigate the diagnostic process, letting you know what to expect each step of the way.

There is no single test to confirm a Crohn’s diagnosis, and Crohn’s disease symptoms are often similar to other conditions, including bacterial infection. Your healthcare providers should evaluate your current medical history and use information from diagnostic testing to exclude other potential causes of your symptoms. This process can take some time.

If you feel you or your loved one are experiencing symptoms that could be Crohn's disease, be sure to see your doctor as soon as possible.

Initial Testing and Evaluation

The first step to diagnosis and treatment is a standard physical exam of your body. Your doctor will speak to you and ask questions about your overall health, diet and nutrition, family history, and your daily routine.

What to Expect

  • Your doctor may order diagnostic testing to look for signs of Crohn’s disease and rule out other possible medical conditions.

  • Your first tests will ly include laboratory tests of your blood and stool.

  • Further testing could include X-rays of the upper and lower GI tract. Your doctor may recommend a test that uses a contrast chemical that helps your doctors see a more clear and detailed picture of your GI tract. The type of contrast used varies by test.

  • Consider bringing a trusted family member or close friend to your appointments. This may help ease your stress and help you later remember information from your doctor.

Endoscopy and Imaging

Your doctor may recommend additional testing to look inside your GI tract and intestine. While these tests are more invasive and may sound frightening,  they are often done in an outpatient setting and your health care providers will be careful to minimize any discomfort.

Endoscopy

Your doctor may recommend an endoscopy to get a detailed look at the inside of your  colon using a small camera mounted to the end of a lighted tube.

Endoscopies used in Crohn’s disease testing include:

  • A colonoscopy allows doctors to examine the colon, the lowest part of your large intestine, by inserting a flexible, lighted tube through the opening to your anus.

  • An upper endoscopy lets doctors see the gastrointestinal tract from the top down, using a flexible, lighted tube that’s inserted through your mouth, down the esophagus, into your stomach and as far down as the duodenum, which is the first section of your small intestine.

Colonoscopies require bowel preparation. Talk to your healthcare team about ways to prepare, and tips for making this preparation easier.

Biopsy

Your doctor may want to get a biopsy of your colon or another area of your GI tract while performing a colonoscopy or endoscopy. During the biopsy, a small piece of tissue is removed from the inside of the intestine for further testing and analysis.

  • Your biopsied tissue will be analyzed in a pathology laboratory and screened for disease. Biopsies are also used for colorectal cancer screening.

  • While a biopsy sounds scary, medical advances have made this procedure virtually pain-free.

Chromoendoscopy

Your doctor may want use this technique during a colonoscopy to look for polyps or precancerous changes.

  • During a chromoendoscopy, a blue liquid dye is sprayed into the colon to highlight and detect slight changes in the lining of your intestine.

  • Polyps can then be removed and/or biopsied.

  • It is common to have blue bowel movements following this procedure.  

Small Intestine Imaging

These tests are used to examine portions of your intestine that can’t be easily seen by colonoscopy or endoscopy. They work by using an oral contrast that you drink and that can be seen on a fluoroscopic X-ray, computed tomography (CT) scan or a magnetic resonance imaging scan (MRI).

  • You may also hear these tests referred to as enterography or enteroclysis.

  • Your doctor may a have you swallow a small, pill-sized camera, which will take pictures of the small intestine and bowel as it travels through your GI tract. The camera is later expelled during a bowel movement.

  • A balloon endoscopy may be needed to view hard-to-reach areas of the intestine.

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