“The vast majority of our patients do very well.”
Crohn’s disease, an autoimmune disease that causes inflammation in the digestive tract, has no cure, at least for now. That said, successful treatment for Crohn’s disease can help you reach remission—a state of no or mild disease activity and symptoms.
Before your doctor can recommend a treatment plan to help you alleviate Crohn’s disease symptoms, they have to assess the severity, extent, and type of Crohn’s disease that you’re experiencing, according to David P. Hudesman, MD, associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
The goal of treatment, according to Dr. Hudesman, is two-fold: “First, we want people to feel great; we want the patient to feel well. And second, we want the patient to be healed inside.” That essentially means addressing the inflammation in the lining of the digestive tract, which can not only relieve symptoms, but also help prevent other complications (such as colon cancer).
Medications to Treat Crohn’s Disease
“We have a variety of medications that decrease inflammation,” says Dr. Hudesman.
One major class of medications for moderate to severe Crohn’s disease is biologics, which work by preventing the immune system from attacking the intestine, thus preventing inflammation, damage, and symptoms. There are several different types of biologics, including anti-TNFs, anti-integrins, and anti-IL-12/23s. The names refer to their ability to target specific proteins that are involved in inflammation.
Another common medication for Crohn’s disease is immunosuppressants or immunomodulators. While biologics are more targeted at turning off the immune response against the digestive tract, immunosuppressives have a more general action at suppressing the immune system.
Both biologics and immunosuppressants are used for long-term maintenance of Crohn’s disease. For short-term treatment of flares, your doctor may prescribe corticosteroids. They work by suppressing the entire immune system and can be very effective at reducing symptoms during a flare, but they have significant side effects if taken for too long.
Surgery to Treat Crohn’s Disease
“In some people with Crohn’s, surgery might be the best option, and one of the first options chosen for therapy,” says Dr. Hudesman.
One reason to choose therapy is if Crohn’s symptoms are being driven by fibrosis, which is essentially scar tissue in the digestive tract. All the above medications are great for addressing inflammation, but not fibrosis. This is where surgery can play a big role.
“If somebody comes to the office that has a narrowing or stricture, that looks mainly scarred down, [we can help by] just doing surgery and taking out that small piece of intestine,” says Dr. Hudesman. “Their symptoms will go away and they’ll feel great for a very long time.”
That said, symptoms can return after surgery. That’s why it’s important to continue attending follow-up appointments with your doctor and taking any medications as prescribed. Following healthy lifestyle habits for Crohn’s disease may also help.
“Working with your provider, there’s no reason you can’t live a completely normal life—take whatever job you want, travel, have a relationship,” says Dr. Hudesman. “The vast majority of our patients do very well.”
Dr. Hudesman is an associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
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First we wanna define the extent and the severity of the disease.
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Once we know what type of Crohn's that patient has,
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then we discuss what are the possible treatment options.
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Our goal of treatment, two-fold:
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First, we want people to feel great, we want the patient to feel well.
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And second, we want the patient to be healed inside.
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So we have a variety of different medications that decrease inflammation.
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For moderate to severe Crohn's, we use our biologic and immunosuppressive agents.
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These are drugs that prevent our bodies from attacking our own intestine
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so patients would feel better and they would heal inside.
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For biologic agents, we have different classes.
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We have our anti-TNFs, we have our anti-integrins,
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we have our anti-IL-12/23s,
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and then we have oral immunosuppressives:
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thiopurines and methotrexate.
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So the anti-TNFs and the anti-IL-12/23s prevent inflammation.
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They're just blocking different pathways of inflammation,
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whereas our anti-integrins work a little bit differently.
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They're a little more gut-specific or targeted to the intestine.
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And the way those work is, if you imagine the cells
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that are causing damage in your body, that are causing inflammation in your body,
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are cars on a highway, and each exit off the highway
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is a different part of your body,
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your brain, your heart, your lung, your intestine,
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all these medications are doing is messing with the car's GPS,
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so it can't get off that exit to your intestine.
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In some people with Crohn's, surgery might be the best option,
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and one of the first options chosen for therapy.
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Symptoms are usually driven by two main things:
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either inflammation or swelling,
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and something called fibrosis, and you can think of fibrosis
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almost like scar tissue on the inside.
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All the medications we've been talking about, they all treat inflammation,
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so if somebody comes to the office that has a narrowing or a stricture,
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that looks mainly scarred down, so doing surgery,
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and just taking out that small piece of intestine,
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their symptoms will go away and they'll feel great for a very long time.
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Now, after surgery, Crohn's could still come back,
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so if you do have surgery for Crohn's disease, it's important to continue
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to follow with your physician, to decide if you need any medication
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immediately after surgery, or just following up with blood work
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and colonoscopies to make sure that disease isn't coming back.
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Working with your provider, there's no reason
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you can't live a completely normal life, take whatever job you want,
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travel, have a relationship.
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It's just the most important thing is following up with your physician,
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but the vast majority of our patients do very well,
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and there are periods where symptoms may worsen,
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but overall, they do very well long-term.
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Medication options for Crohn’s disease. New York, NY: Crohn’s & Colitis Foundation of America. (Accessed on December 6, 2019 at https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/medication.)
Patient education: Crohn’s disease (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on December 5, 2019 at https://www.uptodate.com/contents/crohn-disease-beyond-the-basics.)
The facts about inflammatory bowel diseases. New York, NY: Crohn’s & Colitis Foundation of America 2014. (Accessed on December 5, 2019 at https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf.)