Crohn’s disease (CD) is a lifelong condition. Once it appears, patients may experience symptoms of varying intensity for the rest of their lives, usually in alternating periods of activity and remission.

Treatment of CD attempts to reduce or eliminate the inflammation caused by the disease, as well as its symptoms (e.g., diarrhea, abdominal pain). Long-term treatment with medication is often recommended. Medical and surgical treatment may be necessary to correct any medical complications of CD, such as malnutrition, fistulae and intestinal obstruction.

Medications used to reduce inflammation include:

• Aminosalicylates. Reduces inflammation in the lining of the digestive tract. The active component of these drugs is the compound 5-aminosalicylic acid (5-ASA) – the most common treatment choice for inflammatory bowel disease. Aminosalicylates can be taken orally or rectally (in enema or suppository form).
  
  
• Corticosteroids. Used to control inflammation when 5-ASA drugs are not effective. This medication can be taken orally, rectally (e.g., suppository, enema) or intravenously. Long-term use of corticosteroids can increase a patient’s risk of serious side effects, including high blood pressure, osteoporosis and diabetes. Fluid retention and a rounded/swollen appearance of the face may also occur. The risk of side effects varies depending on the type of corticosteroid used and the length of treatment. A newer formulation of steroids (budesonide) has fewer side effects because of less blood absorption and may be useful with mild to moderate ileal inflammation.
  
  
• Immunosuppressants. Suppress the body’s ability to create the disease-fighting substances (antibodies) that are attacking the intestinal tissue lining in patients with CD, causing inflammation. This decreases immune system activity in patients with CD. Usually taken orally, these drugs may not have an impact for weeks or months. Possible side-effects include nausea, vomiting, diarrhea and an increased risk of infections. Immunosuppressants may be prescribed for long-term treatment of symptoms.
  
  In 1998, the Food and Drug Administration (FDA) licensed an immunosuppressant as the first treatment specifically for Crohn’s disease. It is only available as an intravenous preparation. Infliximab is used for patients with moderate to severe Crohn’s disease (CD) whose symptoms have not adequately responded to conventional therapies. In 2002, infliximab was approved by the FDA for maintaining remission of symptoms in patients with CD. In May of 2006 it was approved for use in children with CD who do not respond to conventional therapies.
  
  Infliximab is known as an anti-TNF medication that works by blocking the immune system’s production of a specific chemical (called tumor necrosis factor, or TNF) that intensifies inflammation.

Various medications can be used to treat the symptoms or complications of CD. These medications include:

• Antidiarrheals. Used to relieve the chronic diarrhea that is one of the most common symptoms of CD.
  
  
• Laxatives. Used in cases where a partial intestinal obstruction leads to constipation. Laxatives are not used to treat complete intestinal obstruction.
  
  
• Acetaminophen. Used to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen should not be used by patients with CD because they may intensify symptoms.
  
  
• Iron supplements. Used to restore iron loss and treat anemia, which can result from chronic intestinal bleeding.
  
  
• Vitamin B-12 injections. Used to help prevent anemia from malabsorption.
  
  
• Antibiotics. Sometimes used to treat infections in the small intestine caused by fistulas or as the result of surgery. 

Surgery may be required in cases of intestinal obstruction or perforation, or when medications fail to control the symptoms of CD. Up to 70 percent of patients with CD will require surgery at some point during the course of the disease, according to the American College of Gastroenterology (ACG). Many patients experience inflammation and ulcers that go deep into the intestinal tissue – increasing their risk of fistulas, abscesses and intestinal obstructions that can require surgery.

Surgery for patients with CD can include:

• Strictureplasty. Used to widen narrowed areas of the digestive tract.
  
  
• Bowel resection. Removal of the diseased portion of the intestine. This may involve a partial colectomy (part of the colon is removed). In some cases an ostomy may be necessary to allow stool to pass from the body. An ostomy may be required temporarily or permanently depending on how much bowel is removed.
  
  
• Correction of fistulae. Closes tunnels to keep food products from being improperly diverted from the normal digestive pathway.
  
  
• Draining of abscesses. Removes infectious material.

Surgery may be necessary to relieve symptoms that do not respond to medications or to correct complications of CD (e.g., obstruction, fistulae, abscesses). However, it is not a cure. The goals of surgery are to conserve as much of the intestines as possible and to relieve a patient’s symptoms. According to the ACG, the disease returns in 70 to 85 percent of patients with CD, even after surgery. The inflammation tends to recur close to the area removed by surgery.

After surgery, the symptoms of CD may remain in remission for years. However, when symptoms recur, many patients may require second or third operations. Recurrence is more likely for patients with severe CD and for patients in whom it occurs outside the colon. Following surgery with medications used to treat CD may help reduce the risk of recurrence.  

Hospitalization may be necessary to treat patients with CD when they are malnourished or have experienced severe diarrhea and blood loss. A special diet may be recommended, supplements may be added to the regular diet or intravenous feeding may be required (enteral and parenteral nutrition). Nutrition supplements may be necessary before a surgical procedure to help boost the immune system. They may also be used to add extra calories to the diet for patients who are losing a lot of weight or children who are not growing at a normal rate.

Nutrition and emotional support are important aspects of coping with CD and helping to reduce the severity of its symptoms. A healthy diet for patients with CD includes foods that will not aggravate the digestive tract, such as soft, bland foods that are low in fiber. Adequate amounts of proteins, calories and vitamins should be consumed. Products that stimulate the digestive system and aggravate the symptoms of CD should be avoided. These include: high-fiber foods (e.g., bran, beans, fresh fruits, vegetables), dairy products, caffeine and alcohol.

Research also indicates that relapse rates of CD may diminish following a pregnancy.