Crohn’s disease is a lifelong inflammatory condition that affects the digestive tract, causing symptoms such as abdominal pain, diarrhea, and fatigue. While there is no cure, modern treatment approaches aim to control inflammation, manage symptoms, and help patients maintain long periods of remission. From traditional medications to promising therapies being tested in clinical trials, medical advances are offering hope for improved quality of life for those living with this challenging condition.

Understanding Treatment Goals for Crohn’s Disease

Managing Crohn’s disease means working toward several important goals at once. The primary aim is to reduce inflammation throughout the digestive tract, which helps relieve uncomfortable symptoms like diarrhea and abdominal pain. But treatment goes beyond just feeling better in the moment—it also focuses on preventing flares (periods when symptoms are active) and maintaining remission (times when symptoms disappear or are minimal).^[1][2]

Treatment approaches depend heavily on where the disease affects your digestive tract and how severe it is. Crohn’s can develop anywhere from the mouth to the anus, though it most commonly affects the small intestine and the beginning of the large intestine. The pattern of the disease also matters—some people develop narrowing of the intestines called strictures, while others may develop abnormal tunnel-like openings called fistulas.^[3]

Your treatment plan will be personalized based on your specific situation. Healthcare providers consider factors like your age, the location and severity of inflammation, whether you’ve had complications, and how you’ve responded to previous treatments. This individualized approach helps ensure you receive the most effective care with the fewest side effects.^[5]

Medical societies have established standard treatments that are proven to work, and these form the foundation of care for most people with Crohn’s disease. At the same time, researchers are continuously investigating new therapies through clinical trials, offering hope for even better treatment options in the future. These clinical trials test innovative approaches that may become tomorrow’s standard treatments.^[12]

Standard Treatment Approaches

The medications used to treat Crohn’s disease fall into several categories, each working in different ways to control inflammation and manage symptoms. Your doctor may start with one type of medication and adjust your treatment plan based on how well it works and whether you experience side effects.^[8]

Anti-inflammatory Medications

5-aminosalicylic acid derivatives (also called 5-ASA drugs or aminosalicylates) contain a substance that decreases inflammation in the digestive tract. These medications can help reduce inflammation in the lining of the intestines. However, they are generally more effective for mild disease and may not be strong enough for moderate to severe cases.^[11][12]

Corticosteroids (or steroids) are powerful anti-inflammatory drugs that can help reduce inflammation throughout your body. Doctors often prescribe them for short-term use to bring active symptoms under control during a flare. Common examples include prednisone and budesonide. While corticosteroids can be effective at relieving symptoms quickly, they are not intended for long-term use because of potential side effects. These side effects can include weight gain, mood changes, increased blood sugar, bone loss, and increased risk of infections. Because of these concerns, doctors typically use steroids only until other medications can take effect.^[11][12]

Immunosuppressant Medications

Immunomodulators or immune modifiers work by changing how your immune system functions, which helps stop it from causing ongoing inflammation. These medications include azathioprine and 6-mercaptopurine (6-MP), which belong to a class called thiopurines. Another option is methotrexate. These drugs can be effective for maintaining remission and allowing patients to reduce or stop taking steroids.^[11][12]

Before starting thiopurine medications like azathioprine or 6-MP, doctors often check your levels of an enzyme called thiopurine methyltransferase (TPMT). This test helps determine whether you can safely take these medications and what dose is appropriate. Immunomodulators generally take several weeks to months to reach their full effect, so they’re often used alongside other medications initially.^[12]

Biologic Therapies

Biologics are advanced medications made from living organisms or their products. They target specific proteins involved in the inflammatory process. The most commonly used biologics for Crohn’s disease are tumor necrosis factor (TNF) blockers, which work by blocking a protein called TNF-alpha that promotes inflammation.^[11][12]

Several TNF blockers are approved for treating Crohn’s disease, including infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia). Infliximab is given through an infusion (delivered directly into a vein), typically at weeks 0, 2, and 6, then every 8 weeks for maintenance. Adalimumab and certolizumab are given as injections (shots under the skin) that patients can learn to give themselves at home.^[11]

Other types of biologics target different proteins involved in inflammation. Interleukin blockers work by blocking inflammatory proteins called interleukins. Ustekinumab (Stelara) blocks interleukin-12 and interleukin-23, while newer medications like mirikizumab-mrkz (Omvoh) and risankizumab-rzaa (Skyrizi) specifically block interleukin-23. These medications start with infusions followed by maintenance injections.^[11][12]

Biologic therapies have significantly improved outcomes for people with moderate to severe Crohn’s disease. They are particularly helpful for patients who haven’t responded well to other medications or who are dependent on corticosteroids. Some studies suggest that combining a TNF blocker with an immunomodulator like azathioprine may be more effective than using either medication alone, especially in patients who haven’t taken these drugs before.^[12]

JAK Inhibitors

Janus kinase (JAK) inhibitors are a newer class of medications taken by mouth (oral medications) that work by blocking certain proteins called JAKs that are involved in inflammation. Upadacitinib (Rinvoq) is approved for adults with moderate to severe Crohn’s disease who have tried TNF blockers that didn’t work well or couldn’t be tolerated. This medication is taken as one pill every day.^[11][12]

Antibiotics and Other Medications

Antibiotics can play a role in treating certain complications of Crohn’s disease. They may help reduce drainage from anal fistulas and can sometimes help induce remission. Doctors may prescribe antibiotics when there’s evidence of infection or to manage specific complications.^[12]

Other medications help manage specific symptoms. Antidiarrheals can reduce diarrhea, antispasmodics can help with abdominal cramping, and pain relievers like acetaminophen (Tylenol) can help with discomfort. However, it’s important to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, as these can worsen inflammation in the digestive tract.^[12][17]

Surgery

Even with medications, many people with Crohn’s disease will eventually need surgery. Between 30% and 55% of people with Crohn’s disease require surgery within 10 years of diagnosis. Surgery doesn’t cure Crohn’s disease, but it can treat complications and improve symptoms when medications aren’t enough.^[9]

Common reasons for surgery include fistulas, abscesses (pockets of infection), intestinal obstructions caused by scarring, severe bleeding, or inflammation that doesn’t improve with medications. The most common surgical procedure is small bowel resection, where a surgeon removes the diseased portion of the intestine and connects the healthy ends back together.^[9]

Surgeons increasingly use minimally invasive techniques when possible, which can lead to faster recovery times and smaller scars. After surgery, most patients need to continue taking medications to help prevent the disease from returning in other areas of the digestive tract.^[13]

Treatment in Clinical Trials

Clinical trials are research studies that test new treatments before they become widely available. For Crohn’s disease, these trials are investigating innovative approaches that may offer better symptom control, fewer side effects, or more convenient administration compared to existing treatments.^[5]

Understanding Clinical Trial Phases

Clinical trials progress through different phases, each designed to answer specific questions about a new treatment. Phase I trials test safety and appropriate dosing in a small number of people. Phase II trials examine whether the treatment works effectively and continue to monitor safety in a larger group. Phase III trials compare the new treatment to standard treatments or placebo in an even larger population to confirm effectiveness and monitor side effects. Understanding these phases helps patients make informed decisions about participating in research.^[5]

Advanced Biologic Therapies

Researchers continue to develop new biologic medications that target different pathways involved in inflammation. Some trials are testing medications that block other interleukins or immune system molecules that haven’t been targeted before. These new biologics aim to provide options for patients who haven’t responded to currently available treatments or who experience side effects from them.^[12]

The interleukin-23 blockers mentioned earlier, such as mirikizumab and risankizumab, were relatively recently approved after showing effectiveness in clinical trials. These medications demonstrated the ability to induce and maintain remission in patients with moderate to severe Crohn’s disease. They offer an alternative mechanism of action compared to TNF blockers, which can be beneficial for patients who don’t respond to or lose response to anti-TNF medications.^[11]

Small Molecule Therapies

Beyond JAK inhibitors like upadacitinib that are already approved, researchers are developing other small molecule medications that can be taken by mouth. These drugs offer the convenience of pill form rather than injections or infusions. Some experimental small molecules work through different mechanisms than JAK inhibitors, potentially offering additional options for patients who need alternatives to current treatments.^[11]

Integrin Inhibitors

Some biologic therapies work by blocking integrins, which are proteins that help inflammatory cells travel to the intestines. By preventing these cells from reaching the gut, integrin inhibitors can reduce inflammation. Clinical trials have tested various integrin inhibitors, and some have shown promise for treating Crohn’s disease. These medications may offer a different safety profile compared to other biologics, which could be important for certain patients.^[11]

Microbiome Modification

The microbiome—the community of bacteria and other microorganisms living in the digestive tract—appears to play a role in Crohn’s disease. Some clinical trials are investigating whether modifying the microbiome through techniques like fecal microbiota transplantation or specially designed probiotic treatments can help manage the disease. While this approach is still experimental, early research suggests it might have potential as an adjunct to traditional treatments.^[5]

Participation and Eligibility

Clinical trials for Crohn’s disease are conducted at medical centers around the world, including locations in the United States, Europe, and other regions. Each trial has specific eligibility requirements based on factors like disease severity, location of inflammation, previous treatments tried, and overall health status. Some trials specifically recruit patients who haven’t responded to TNF blockers or other standard treatments.^[5]

Participating in a clinical trial can provide access to new treatments before they’re widely available, along with close monitoring by medical experts. However, it’s important to understand that not all experimental treatments prove to be effective or safe, and some participants may receive a placebo (inactive treatment) rather than the active drug being tested. Patients considering clinical trials should discuss the potential benefits and risks thoroughly with their healthcare provider.^[5]

Most Common Treatment Methods

• Anti-inflammatory Medications
  • 5-aminosalicylic acid derivatives that decrease inflammation in the intestinal lining
  • Corticosteroids for short-term symptom control during flares, including prednisone and budesonide
• Immunosuppressant Therapy
  • Thiopurines like azathioprine and 6-mercaptopurine for maintaining remission and steroid sparing
  • Methotrexate as an alternative immunomodulator
• Biologic Therapies
  • TNF blockers including infliximab, adalimumab, and certolizumab pegol delivered by infusion or injection
  • Interleukin-12/23 blocker ustekinumab given by infusion followed by injections
  • Interleukin-23 blockers like mirikizumab and risankizumab for moderate to severe disease
• JAK Inhibitors
  • Upadacitinib taken as one pill daily for patients who haven’t responded to TNF blockers
• Antibiotic Treatment
  • Used to manage complications like fistulas and abscesses
  • Can help induce remission in some patients
• Surgical Intervention
  • Small bowel resection to remove diseased portions of intestine
  • Procedures to treat fistulas, abscesses, and strictures
  • Used when medications aren’t effective or complications develop

Managing Daily Life with Crohn’s Disease

Treatment extends beyond medications and medical procedures. Managing Crohn’s disease effectively involves making adjustments to daily routines, eating habits, and lifestyle choices. These strategies can help minimize symptoms and improve overall quality of life.^[19]

Dietary Considerations

While no specific diet can cure Crohn’s disease, paying attention to what you eat can help manage symptoms. Many people find that certain foods trigger flares or worsen symptoms. Keeping a food diary can help identify problem foods for you personally. Common triggers include high-fiber foods like raw fruits and vegetables, dairy products if you’re lactose intolerant, high-fat foods, and spicy dishes.^[21]

During a flare-up, a low-residue diet that limits fiber may help reduce abdominal pain and diarrhea. This approach involves avoiding raw fruits and vegetables, whole grains, nuts, and seeds. Instead, focus on well-cooked vegetables without skins, refined grains, and lean proteins. Some people also benefit from eating smaller, more frequent meals rather than three large meals per day.^[21]

When you’re in remission, you can usually eat a more varied diet. Working with a registered dietitian who specializes in inflammatory bowel disease can help ensure you’re getting adequate nutrition while avoiding foods that trigger your symptoms. Good nutrition is especially important because Crohn’s disease can interfere with nutrient absorption, potentially leading to deficiencies in vitamins D and B12, iron, and other nutrients.^[21]

Lifestyle Modifications

Staying physically active can benefit both your physical and mental health. Exercise may help reduce inflammation, strengthen bones (which can be affected by long-term steroid use), decrease fatigue, and improve sleep quality. Low-impact activities like swimming, walking, and strength training are often well tolerated. However, during flares, it’s okay to take a break and resume activity when you feel better.^[16]

Smoking has a significant negative impact on Crohn’s disease. It can worsen symptoms, increase the risk of complications, and reduce the effectiveness of medications. If you smoke, quitting is one of the most important steps you can take to improve your disease outcome.^[17]

Planning ahead can help you manage unexpected symptoms when you’re away from home. Consider keeping an emergency kit with toilet paper, wet wipes, hand sanitizer, and a change of clothes in your car or workplace. Knowing where bathrooms are located can provide peace of mind and reduce anxiety about being in public.^[16]

Monitoring and Communication

Tracking your symptoms can help you and your doctor understand how well your treatment is working and identify early signs of a flare. Several smartphone apps can help you monitor bowel movements, symptoms, and medications. Keeping this information can help provide your gastroenterologist with a more complete picture of your disease activity between office visits.^[17]

Contact your doctor at the first sign of a flare—symptoms like increased diarrhea, abdominal pain, bleeding, or fatigue that doesn’t improve. Early intervention can often prevent flares from becoming severe. Your doctor can determine whether the flare is due to an infection, a reaction to new medications, or a change in your disease that requires treatment adjustment.^[17]

Emotional Support

Living with a chronic condition like Crohn’s disease can affect your mental health and wellbeing. Anxiety, depression, and stress are common among people with inflammatory bowel disease. Support groups can connect you with others who understand what you’re going through. Mental health professionals can help you develop coping strategies for managing the emotional aspects of living with Crohn’s disease.^[19]