Crohn’s disease (CD) is an autoimmune disorder that affects the gastrointestinal (GI) tract. In Crohn’s disease, parts of the GI tract 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.
People who suffer from Crohn’s disease often experience cramping or pain in the abdomen, diarrhea, bleeding, and weight loss. Crohn’s is a chronic disease. The symptoms can vary and people can have flare ups, or times when the symptoms are intense, and periods of remission, when the symptoms are less severe or absent.
There’s no cure for Crohn’s. However, there are medications available to help manage the symptoms and prevent relapse.
Doctors will normally prescribe aminosalicytes to reduce inflammation and ease the symptoms if you have a mild or moderate form of CD. 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 or as a suppository or as a combination of both, depending on where CD affects your body.
The side effects of these medications include:
Some people taking this medication have a lower white blood cell count or have had problems with their kidneys. If you take these medications, your doctor may want to monitor your kidney function or order regular blood tests to make sure your white blood cell count isn’t too low. You should tell your doctor if you’re allergic to sulfa drugs.
Doctors normally prescribe these types of medications for the long-term to keep CD in remission. You shouldn’t stop taking your medications without first consulting your doctor.
Corticosteroids help reduce inflammation in the body. Doctors prescribe corticosteroids for short-term relief of CD symptoms. Doctors usually prescribe budesonide (Pulmicort) for some mild and moderate cases of CD. If you have a more serious case of CD or if budesonide isn’t effective, your doctor may prescribe prednisone or methylprednisolone.
The side effects of corticosteroids are:
- intraocular pressure or glaucoma in the eyes
- high blood pressure
- weight gain
There can be some serious side effects if you take corticosteroids over a period of three months, including a loss of bone density (osteoporosis) and liver issues. If you have trouble withdrawing from prednisone, 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 are taking corticosteroids for a long time.
No one knows the cause of CD. But researchers believe that it’s caused by a problem with your immune system. Cells that normally protect your body “attack” the gastrointestinal (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 CD 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 are headache, nausea, vomiting, and diarrhea. Because these medications suppress the immune system, they 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 CD. 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:
- infliximab (Remicade)
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- natalizumab (Tysabri)
Because these are given by IV or injection, you may experience redness, swelling, or irritation where you received the injection. You may also get headaches, fever, chills, or develop low blood pressure. In rare cases, some people have gotten severe infections or tuberculosis (TB) after receiving this treatment. You should have a TB test before taking these medications. Let your doctor know if you have TB before taking this medication.
Doctors may prescribe additional medications to help with other symptoms of CD.
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 CD are at risk for developing blood clots or have 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 also prescribe iron supplements or vitamin B12 shots to treat the anemia.
As with any medication regime or medical management plan, work closely with your doctor and follow the instructions as prescribed.