Crohn’s disease is an autoimmune disorder that affects the gastrointestinal (GI) tract. Crohn’s disease causes parts of the GI tract to become inflamed. Sores (ulcers or lesions), openings (fistulas), or cracks in the intestines can develop that block the passage of food and waste. Crohn’s can affect any part of the GI tract, but it’s usually found in the colon.
The symptoms of Crohn’s disease can vary. People often experience:
- cramping or pain in the abdomen
- weight loss
Also, people can have flare-ups, or periods of intense symptoms, followed by remission, or periods when the symptoms are less severe or absent.
Crohn’s is a chronic disease so there’s no cure. However, there are medications available to help manage the symptoms and prevent relapse.
If you have mild or moderate Crohn’s, your doctor will likely prescribe aminosalicylates to reduce inflammation and ease symptoms. Sulfasalazine (Azulfidine) and mesalamine (Asacol) are the most commonly prescribed medications.
Olsalazine (Dipentum) and balsalazide (Colazal) are two other medications that have been developed. These medications can be taken by mouth, as a suppository, or as a combination of both, depending on where the disease affects your body. Doctors normally prescribe these types of medications as long-term therapy to keep Crohn’s in remission.
The side effects of these medications include:
If you take these medications, your doctor may want to monitor your kidney function. They may also order regular blood tests to make sure your white blood cell count isn’t too low. Also, let your doctor know if you’re allergic to sulfa drugs.
Corticosteroids help reduce inflammation in the body. Doctors prescribe corticosteroids for short-term relief of symptoms. Doctors usually prescribe budesonide (Pulmicort) for mild and moderate cases of Crohn’s disease. If you have a more serious case of Crohn’s or if budesonide isn’t effective, your doctor may prescribe prednisone or methylprednisolone.
The side effects of corticosteroids are:
- increased intraocular pressure in the eyes or glaucoma
- high blood pressure
- weight gain
There can be serious side effects if you take corticosteroids for more than three months, including a loss of bone density (osteoporosis) and liver issues.
Because of this your doctor may only keep you on corticosteroids for a certain period of time. After that, your doctor may prescribe methotrexate to help you stay in remission and to help with the withdrawal from prednisone.
Your doctor may also prescribe calcium and vitamin D supplements to prevent bone loss if you’re taking corticosteroids for a long time.
No one knows the exact cause of Crohn’s, but researchers believe it’s caused by a problem with your immune system. Cells that normally protect your body “attack” the GI tract. Because of this, medications that suppress or regulate your immune system can help.
Sometimes doctors will prescribe these medications if aminosalicylates and corticosteroids aren’t effective or if you develop fistulas. These medications can help your disease stay in remission and may even heal fistulas.
Some common immunosuppressive medications are:
- azathioprine (Imuran)
- mercaptopurine (Purinethol)
- cyclosporine (Gengraf, Neoral, Sandimmune)
- methotrexate (Rheumatrex)
The side effects of these medications include:
Because they suppress the immune system, these drugs could affect how well your body is able to fight infections. Some rare side effects are an inflammation of the pancreas (pancreatitis), liver problems, and a decrease in the amount of bone marrow made by the body (myelosuppression).
Biologics are a new type of drug used for people with moderate to severe or active Crohn’s. Your doctor may prescribe biologics if other medications aren’t working, or if you have openings, or fistulas, in your GI tract. They can also be given to help ease you off of steroid medications.
These medications are given intravenously (IV) or by a shot on a regular basis. They work to reduce inflammation in specific areas, such as the lining of your intestines, rather than suppressing your whole immune system.
The most common medications are:
Because these are given by IV or injection, you may experience redness, swelling, or irritation where you received the injection. You may also experience:
- low blood pressure
In rare cases, some people have gotten severe infections or tuberculosis (TB) after receiving this treatment. Before taking these medications, you be tested for TB.
Doctors may prescribe additional medications to help with other symptoms of Crohn’s. Antibiotics are sometimes prescribed to prevent an overgrowth of bacteria in the intestines or to prevent abscesses. Your doctor may also prescribe an anti-diarrheal if you have severe bouts of diarrhea.
Some people with Crohn’s are at risk for developing blood clots or other blood conditions, such as anemia. In the case of blood clots, your doctor may prescribe heparin, a blood thinner that prevents clots. If you show signs of anemia, your doctor may prescribe iron supplements or vitamin B-12 shots.
As with any medication regime or medical management plan, work closely with your doctor and follow the medication instructions.