How to Find the Right Crohn’s Disease Treatment Option for You

What is Crohn’s disease?

Crohn’s disease is an autoimmune condition: In Crohn’s, the body’s own immune system causes inflammation in the gastrointestinal (GI) tract. Crohn’s disease can affect any part of the GI tract, from mouth to anus. The exact cause is not known, but Crohn’s disease runs in families and genetics play a role.

To treat Crohn’s, you often need to take medication. There are lots of options, depending on how severe your condition is and which part of the GI tract is involved. Read on to find out more.

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Michael Dreis, MD

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Michael Dreis, MD, is a practicing physician. He received his Doctor of Medicine from the University of Wisconsin–Madison, and finished training in emergency medicine at Henry Ford Hospital in Detroit, MI. He practices medicine in Milwaukee, WI, where he teaches medical students and medical residents. He considers providing a clear explanation of medicine to be one of the most important parts of caring for people.

Do you have Crohn’s disease?

Crohn’s disease can be challenging to diagnose. It can affect many parts of your body, so the symptoms don’t always obviously point to Crohn’s. The symptoms can change over time, too. Sometimes, it can take time and a lot of effort to figure it out. Because Crohn’s tends to run in families and in communities, it can be a big clue if someone close to you has Crohn’s. If you’re worried about Crohn’s, tell your provider because that might speed up getting the right diagnosis.

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Symptoms of Crohn’s disease

Depending on what part of the body is involved, Crohn’s disease can have various symptoms, such as:

• Abdominal pain

• Weight loss

• Diarrhea

• Pain after eating 

• Nausea 

• Vomiting

• Bloating

• Skin rashes

• Joint pain

• Eye pain

Diagnosis of Crohn’s disease

Work with your healthcare provider to make sure you get the right diagnosis. Tell them about your symptoms. They will probably take blood and stool samples, which can help them make a diagnosis. Depending on which part of your GI tract is involved, you might need a colonoscopy, in which a camera is inserted into the colon. Or you could need an upper endoscopy, in which a camera is inserted into the stomach. You might need to have imaging done, such as a CT scan or an MRI, to get a Crohn’s diagnosis or to find complications it could be causing. You and your providers will use all of this information to reach the right diagnosis.

Goals of Crohn’s disease treatment

Crohn’s disease is a chronic condition. This means it is never fully cured. It's quite normal for people with Crohn's to have periods of active disease (called flare-ups) and periods of remission, when symptoms and inflammation are improved.

The goals of treatment for people living with Crohn's disease include:

• Treating flare-ups to improve symptoms, lower inflammation, and get into remission

• Staying in remission once achieved

• Improving quality of life, so symptoms don’t interfere with daily activities

• Preventing serious complications

Medication for treating Crohn’s disease

There are many medications used to treat Crohn’s disease. Which medications are right for you will depend on which part of the GI tract is affected and how serious your systems are at any given time. What has — or hasn’t — worked for you in the past will also factor into the decision.

Aminosalicylates

Corticosteroids

Immunomodulators

Biologics

Do insurance plans cover Crohn’s disease medications?

Most insurance plans cover medications for Crohn’s disease, but because all plans are different, you should contact your insurance company to get the details. Sometimes, they’ll need you to try older medications before they approve a newer one. Or they might need a prior authorization or coinsurance.

Typical treatment plans for Crohn's

The choice of medication for Crohn’s disease depends on what part of the GI tract is involved and how active the inflammation is. If you’re having a flare-up, you’ll need treatment to get you into remission. If you’re in remission, you’ll want the lowest amount of medication needed to keep you there. Sometimes, finding the right balance can take some time and some expert guidance from your specialist.

Typical treatments for a Crohn’s flare-up

When you are having worsening symptoms, you are in a flare-up and will need to take medications to lower the inflammation:

• If your Crohn’s disease is only located in the colon, you might take sulfasalazine to treat your flare-up.

• If your flare up involves other parts of the GI tract, you will probably start with a corticosteroid. Usually, people start with prednisone, though if your Crohn’s is in only a specific part of the GI tract (the cecum and the ileum) you might start with budesonide.

• If your flare-up is not improving with corticosteroids, the next step is usually a biologic agent with or without an immunomodulator.

• In severe cases, you may need to be admitted to the hospital for intravenous therapy.

Typical treatments to maintain remission

Once you are in remission, you will most likely need medications to keep you in remission:

• If taking a corticosteroid got you into remission, you might take an immunomodulator to keep you there. Corticosteroids shouldn’t be used long term to keep you in remission due to their side effects, so you and your providers will look for other options.

• If you needed a biologic agent to get you into remission, you will probably continue to take that biologic to keep you in remission.

Surgery for Crohn’s disease

Surgery is sometimes needed to improve quality of life or treat severe complications of Crohn's disease that cannot be cured by medication alone. Some reasons why people with Crohn’s need surgery include:

• Abscesses: pockets of infection in the abdomen that may need to be drained

• Fistulas: tunnels or connections between the intestines and other organs, such as the bladder

• Strictures: tight narrowings of the intestines that may lead to blockages

• Preventing the spread of bowel cancer

• Severe disease that treatment doesn’t improve

The type of bowel surgery that is best for you will depend on what needs to be treated. Your provider might insert a plastic tube into an abscess to drain it, or in more severe cases, part of your bowel might be removed. Depending on which part of the bowel is removed and how, there are different names for this surgery. Some examples are:

• Small bowel resection

• Ileostomy

• Colectomy

• Colostomy

Non-medication options for treating Crohn's

Although medications are important for treatment of Crohn’s disease, there are some other approches that may be helpful.

Stop smoking

Smoking tobacco can cause Crohn’s flare-ups, so it’s important that you avoid smoking. Talk to your healthcare provider if you are having trouble quitting.

Dietary changes

A diet high in fiber, fruits, and vegetables may improve Crohn's disease. However, certain foods seem to contribute to Crohn’s flare-ups and are best avoided:

• Foods that are hard to digest, such as fruits with skins, nuts, raw green vegetables, and whole grains

• Dairy

• Artificial sweeteners

• Sugary foods

• High-fat foods

• Spicy foods

Alcohol might increase symptoms of Crohn’s disease, so it's best to cut back.

Avoid NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin) and naproxen (Aleve), can make Crohn’s flare-ups more likely — so it’s best to avoid them.

Change your birth control 

Birth control pills may increase your risk of Crohn’s disease. Talk with your providers about other options for birth control if this is a concern for you.

Look after your mental health

Crohn’s disease and its flare-ups often cause stress, anxiety, and depression, which can interfere with your quality of life. It’s not clear that stress causes flare-ups, though it seems to make things worse. Talk with your provider if you are experiencing these, especially if these conditions are making your treatment difficult.

Keep in mind

Crohn’s disease is a chronic condition that is never fully cured. Although you can get into remission, the inflammation can always come back. Over time, you’ll learn what the signs of an early flare-up are for your body. Remember, because Crohn’s can affect so many parts of the GI tract, your symptoms may change over time. Finding a provider who you trust and are comfortable working with can help you stay on top of your Crohn’s disease to prevent serious complications.

Why trust our experts?

Written by:

Michael Dreis, MD

Dr. Dreis is an emergency medicine physician currently practicing in Milwaukee, Wisconsin. He went to medical school at the University of Wisconsin – Madison and completed his residency at Henry Ford Hospital in Detroit, Michigan.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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