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

Aminosalicylates

Corticosteroids

Immunomodulators

Antibiotics

Anti-diarrheals

Biologics

JAK inhibitors

Typical treatments for a Crohn’s flare-up

When you’re having worsening symptoms, you’re 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’ll probably start with a corticosteroid. Usually, people start with prednisone. Although, 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 isn’t 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 IV therapy.

Typical treatments to maintain remission

Once you’re in remission, you’ll 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 healthcare team will look for other options.

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

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. In some cases, you might need to get a prior authorization.

Types of bowel surgery

The type of bowel surgery that’s best for you will depend on what needs to be treated. A healthcare professional 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: The diseased section of the small intestine is removed and the healthy ends are reconnected. This is the most common surgical procedure for Crohn's disease. It's typically recommended when a section of the intestine is severely damaged or blocked.

• Ileostomy: The end of the small intestine is brought through an opening in the abdomen, allowing waste to exit into an external pouch. This may be temporary while the bowel heals. Or it may be permanent, depending on the severity of your Crohn’s disease.

• Colectomy: Part, or sometimes all, of the large intestine is removed. This is typically done when Crohn's has caused severe, widespread damage to the colon that hasn't responded to medication.

• Colostomy: This is similar to an ileostomy, but it involves the colon rather than the small intestine. Waste exits through an opening in the abdomen into an external pouch.

• Strictureplasty: This procedure widens narrowed sections of the intestine caused by scar tissue, relieving any potential blockages. It's a good option for people who have already had multiple resections and need to preserve as much bowel as possible.

• Total proctocolectomy with end ileostomy: Both the colon and rectum are removed entirely. This is usually reserved for the most severe cases of Crohn's colitis.

• Fistulotomy: This surgery repairs an abnormal tunnel (fistula) that has formed between two body parts, such as the intestine and your bladder or the intestine and your skin. It's used when fistulas can't be managed with medication alone.

Stop smoking

Smoking tobacco can cause Crohn’s flare-ups, so it’s important that you avoid smoking. Talk to a healthcare professional if you’re 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, like:

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

Supplements

Because Crohn's disease affects how your body absorbs nutrients, many people with Crohn's develop deficiencies over time. Certain supplements may help fill those gaps and support overall health, but they won't treat the underlying inflammation. Commonly recommended ones include:

• Vitamin D: Vitamin D deficiency is common in Crohn's and may be linked to more active disease. Your healthcare team can check your levels with a blood test.

• Vitamin B12: This is especially important if Crohn's affects your small intestine, where B12 is absorbed.

• Iron: You can use this to help manage anemia, which can result from chronic intestinal bleeding or poor absorption.

• Calcium: This is particularly helpful if you're taking long-term corticosteroids, which can weaken your bones over time.

Always talk to a healthcare professional before starting any supplement, as some can interact with Crohn's medications or worsen symptoms during a flare.

Avoid NSAIDs

Nonsteroidal 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, but the evidence is mixed. Talk with your healthcare team 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 healthcare team if you’re experiencing these issues, especially if they’re making your treatment difficult.

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