General: There is no known cure for Crohn's disease. However, many medications, including anti-inflammatories and immunosuppressants, may help patients achieve and maintain remissions. Other medications, such as anti-diarrheals and laxatives, as well as lifestyle changes, may help reduce symptoms of Crohn's disease. People with mild symptoms or those who experience periods of remission may not require treatment.

Anti-inflammatories :

Sulfasalazine (Azulfidine®): Sulfasalazine (Azulfidine®) has been used to treat the symptoms of Crohn's disease. This medication helps reduce swelling in the gastrointestinal tract. Common side effects include nausea, vomiting, heartburn, and headache. People should avoid this medication if they are allergic to sulfa medications.

Mesalamine and olsalazine: Mesalamine (e.g., Asacol® or Rowasa®) and olsalazine (Dipentum®) have been used to decrease inflammation in the gastrointestinal tract caused by Crohn's disease. They are typically taken orally or rectally in the form of enemas or suppositories.

Olsalazine may cause or worsen diarrhea in some people. Serious side effects may include severe stomach pain or cramping, headache, and bloody diarrhea. Patients should seek immediate medical treatment if any of these side effects develop. Other, less serious side effects may include diarrhea, joint pain, mild nausea, gas, fever, sore throat, flu-like symptoms, constipation, dizziness, fatigue, and skin rash.

Balsalazide (Colazal®): Balsalazide (Colazal®) has also been used to decrease inflammation in the gastrointestinal tract caused by Crohn's disease.

Common side effects include diarrhea and stomach pain. Other, less common symptoms, may include, but are not limited to, constipation, coughing, blood in the urine, flu-like symptoms, dry mouth, cramps, gas, heartburn, upset stomach, decreased appetite, joint pain, lower back pain, muscle pain, stuffy nose, difficulty sleeping, fatigue or weakness, yellowish skin, and pain or burning during urination.

Corticosteroids: Corticosteroids have been shown to effectively reduce inflammation of the gastrointestinal tract in Crohn's disease patients. They may also be used in combination with other types of medications. For instance, corticosteroids may be more effective when taken with immunosuppressant drugs that decrease the body's inflammation response. In such cases, the corticosteroids are used to induce remission, while the immunosuppressants are used to help maintain remission.

In some cases, a doctor may prescribe steroid enemas that are inserted into the anus in order to treat symptoms in the lower colon or rectum. Unlike oral corticosteroids, which reduce inflammation throughout the entire body, steroid enemas only affect the lower gastrointestinal tract.

Corticosteroids are typically used for people who have moderate to severe Crohn's disease that does not respond to other treatments.

Corticosteroids should only be used as short-term medication. Treatment generally lasts about 3-4 months at a time. This is because long-term use may cause the drugs to become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a round face, and diabetes.

Immunosuppressants :

Azathioprine and mercaptopurine: Azathioprine (Imuran®) and mercaptopurine (Purinethol®) have been used to treat Crohn's disease. These drugs decrease the body's immune response that is responsible for inflammation. Since these medications are slow-acting, they are sometimes combined with corticosteroids.

Patients taking immunosuppressants may have an increased risk of developing certain types of cancers and infections. Patients should seek immediate medical attention if they develop serious side effects, such as pale skin, easy bruising or bleeding, unusual weakness, fever, sore throat, body aches, muscle pain, flu-like symptoms, severe nausea, vomiting, diarrhea, severe pain in the stomach that spreads to the back, increased heartbeat, burning or painful sensations during urination, dark urine, clay-colored stool, yellowing of the skin or eyes (called jaundice), or mouth sores. Less serious side effects may include, but are not limited to, upset stomach, nausea, diarrhea, decreased appetite, hair loss, and skin rash.

Cyclosporine: An immunosuppressant called cyclosporine (e.g. Neoral® or Sandimmune®) is usually only prescribed to individuals who are not responding to other medications. It may also be prescribed to help heal fistulas. Cyclosporine begins working within one to two weeks.

Patients taking immunosuppressants may have an increased risk of developing certain types of cancers (particularly lymphoma) and infections that may be fatal. Severe side effects may include kidney and liver damage because cyclosporine is broken down by the liver and kidneys.

Infliximab (Remicade®): Infliximab (Remicade®) was the first drug of a group of medications created to block inflammation in the body, and it has been used to treat some patients with Crohn's disease. This drug neutralizes a protein produced by the immune system, known as tumor necrosis factor (TNF). TNF helps stimulate inflammation. Infliximab removes TNF from the bloodstream before it can cause inflammation in the gastrointestinal tract.

Because TNF also stimulates the destruction of some types of cancer cells in the body, people who take infliximab may have an increased risk of developing certain types of cancer. Patients should seek immediate medical attention if they develop serious side effects, such as shortness of breath, swelling of the ankles or feet, red/purple or scaly skin rash, joint or muscle pain, mouth sores, numbness or tingling sensations, vision problems, feeling of weakness in the arms or legs, pain or burning sensation during urination, nausea, stomach pain, fever, decreased appetite, dark urine, clay-colored stools, or yellowing of the skin or eyes (called jaundice). Other, less serious side effects are more common and may include stomach pain, stuffy nose, sinus pain, headache, or mild skin rash.

Other treatment options :

Drink fluids: Individuals with diarrhea should drink plenty of water. Patients may also benefit from drinks that contain electrolytes, such as Gatorade®, Pediatric Electrolyte®, Pedialyte®, or Enfalyte®.

Avoid certain foods: Certain foods, including dairy products, fatty foods, high-fiber foods, or highly seasoned foods, may worsen symptoms of diarrhea. These foods are more difficult than most foods to digest, and they may aggravate the digestive tract. Therefore, these foods should be avoided or limited until the diarrhea has gone away.

Avoid smoking: People with Crohn's disease should avoid smoking because it may worsen symptoms.

Nutritional supplements: If a person develops malnutrition as a complication of Crohn's disease, nutritional supplements may be recommended. Patients should talk to their doctors before taking supplements.

Anti-diarrheals: A fiber supplement, such as psyllium powder (Metamucil®) or methylcellulose (Citrucel®) may help relieve symptoms of mild to moderate diarrhea. These are considered bulk laxatives because they absorb liquid in the intestines and make a bulkier, softer stool that is easier to pass. More severe cases of diarrhea may be treated with loperamide hydrochloride (Imodium®). Loperamide hydrochloride slows down the speed at which fluids move through the bowels.

Patients should seek immediate medical attention if they develop serious side effects, such as stomach pain or bloating, worsening of diarrhea or diarrhea that is watery or bloody, fever, sore throat, and headache with a blistering skin rash. Less serious side effects may include, but are not limited to, dizziness, fatigue, chest pain, constipation, mild stomach pain, or mild skin rash.

Antibiotics: Antibiotics, such as metronidazole (Flagyl®) or ciprofloxacin (Cipro®), may be prescribed. These medications have been shown to help heal fistulas and abscesses in people with Crohn's disease. These antibiotics may also help reduce harmful bacteria in the intestine and suppress the immune response in the intestines, thereby reducing inflammation. However, it remains unknown exactly how these medications work.

Patients should not consume alcohol while taking metronidazole and for three days after stopping the medication. Side effects of metronidazole may include, but are not limited to, nausea, stomach pain, diarrhea, dizziness, headache, vaginal itching or discharge, dry mouth, unpleasant or metallic taste, cough, sneezing, runny nose, or swollen or sore tongue. Side effects of ciprofloxacin may include, but are not limited to, nausea, vomiting, dizziness, drowsiness, blurred vision, difficulty sleeping, muscle pain, joint stiffness, and increased skin sensitivity to sunlight. Patients should talk to their doctors if they develop serious side effects, such as seizures, fever, body aches, flu-like symptoms, numbness or tingling sensations, chest pain, sudden pain or swelling in the joints, confusion, hallucinations, depression, sores inside the mouth, pain or burning sensations during urination, and diarrhea.

Laxatives: Inflammation may cause the intestines to narrow, resulting in constipation. Laxatives may be taken to relieve symptoms of constipation. Oral laxatives, such as bisacodyl tablets (Correctol® or Dulcolax®), have been used. Side effects may include, but are not limited to, cramps, faintness, and stomach discomfort.

Pain relievers: A qualified healthcare provider may recommend acetaminophen (Tylenol®) for mild abdominal pain cause by inflammation.

Researchers have found a strong correlation between non-steroidal anti-inflammatory drugs (NSAIDs) and Crohn's disease flare-ups (sudden onset of symptoms). Therefore, people with Crohn's disease should avoid NSAIDs, which includes medications, such as ibuprofen (Advil® or Motrin®) or naproxen (Aleve®).

Surgery: If all other treatments fail to relieve symptoms, a doctor may recommend surgery. In such cases, the damaged part of the intestinal tract may be surgically removed. The healthy sections are then re-connected. This procedure is called a colostomy.

Surgery may also be needed to close fistulas.

Some Crohn's patients may experience blockages in the intestine that require surgery to remove the blockage.

If the intestines have become too narrow, a strictureplasty may be performed to help widen the digestive tract.

Patients may receive antibiotics, such as ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole, before and/or after surgery in order to reduce the risk of infection. Other complications, including bleeding, are associated with surgery.

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Boswellia: Boswellia has been noted to possess anti-inflammatory properties. However, limited human data exist, and there is inadequate evidence for or against using boswellia in the treatment of Crohn's disease.

Avoid if allergic to boswellia. Use cautiously with a history of stomach ulcers or gastroesophageal reflux disease (GERD). Use cautiously if taking lipid-soluble medications. Avoid if pregnant or breastfeeding.

DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Initial research reports that DHEA supplements are safe for short-term use in patients with Crohn's disease. Preliminary research suggests that DHEA may reduce symptoms of the disorder and help patients achieve remission, although further research is necessary before a clear conclusion can be drawn.

Avoid if allergic to DHEA. Use cautiously with adrenal or thyroid disorders, depression, panic disorder, bipolar disorder, psychotic disorders, heart disorders, polycystic ovary syndrome, anovulatory infertility (failure to ovulate), steroid 21-hydroxylase deficiency, gynecomastia, overactive thyroid, bacterial infections, or diabetes. Use cautiously if at risk for prostate cancer, liver cancer, breast cancer, or ovarian cancer. Use cautiously in HIV patients with Kaposi's sarcoma or in patients who have received flu shots. Use cautiously if taking alprazolam, amlodipine, anastrozole, benfluorex, beta-adrenergic antagonists, calcium channel blockers, canrenoate, danazol, diltiazem, growth hormone, methylphenidates, metopirone, nitrendipine, or hormones or dietary supplements with hormone-like effects (e.g. chromium picolinate). Avoid if pregnant or breastfeeding.

Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid. Preliminary research reports improvements with N-acetyl glucosamine as an added therapy in inflammatory bowel disease (IBD), such as Crohn's disease. Further scientific evidence is necessary before a recommendation can be made.

Avoid if allergic or hypersensitive to shellfish or iodine. Glucosamine may cause drowsiness, somnolence, or insomnia. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with asthma, diabetes, bleeding disorders, kidney disorders, or active peptic ulcer disease. Avoid if pregnant, planning to become pregnant, or if breastfeeding.

Melatonin: Melatonin is a neurohormone produced in the brain. Levels of melatonin in the blood are highest before bedtime. Based on preliminary research, melatonin is a promising therapeutic agent for IBD, such as Crohn's disease. Further research is needed before a recommendation can be made.

There are rare reports of allergic skin reactions after taking melatonin by mouth. Avoid with bleeding disorders or if taking blood thinners. Use cautiously with seizure disorders, major depression, psychotic disorders, diabetes, low blood sugar levels, glaucoma, high cholesterol, atherosclerosis, or if at risk of heart disease. Use cautiously if driving or operating heavy machinery.

Omega-3 fatty acid: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). It has been suggested that the effects of omega-3 fatty acids on inflammation may be beneficial in patients with Crohn's disease when added to standard therapy and several studies have been conducted in this area. Although it is possible that omega-3 fatty acid may reduce inflammation associated with Crohn's disease, results of available studies are conflicting and no clear conclusion can be drawn at this time.

Omega-3 fatty acid is generally considered safe if taken in doses that do not exceed the recommended dietary allowance (RDA). Avoid if allergic to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery.

Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Evidence regarding benefit in Crohn's disease is mixed. There is preliminary evidence that Saccharomyces boulardii, a form of yeast with beneficial effects on the human intestine, might help reduce relapses. Another probiotic, E. coli Nissle, showed promise in another study. L. rhamnosus GG was ineffective in another trial. A small study with children suggested possible benefit from Lactobacillus GG, but it was not helpful in other studies. Two recent studies using Lactobacillus johnsonii LA1 or Lactobacillus rhamnosus strain GG found no effect for Crohn's disease. More studies are needed to determine the appropriate use of probiotics in Crohn's disease.

Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. Psychotherapy may not improve the course of Crohn's disease, although patients undergoing psychotherapy tended to have fewer operations and relapses. More research is needed in this area.

Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illnesses or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expressions.

Saccaromyces boulardii: Saccharomyces boulardii is a non-pathogenic yeast strain that has been used to treat and prevent diarrhea resulting from multiple etiologies. Evidence supports mild improvement of symptoms and quality of life in patients with Crohn's disease who use Saccharomyces boulardii. More clinical trials are required before a firm recommendation can be made in this area.

Avoid if allergic to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Use cautiously in immunocompromised or critically ill patients. Use cautiously with indwelling central venous catheters, colitis, cancer, or constipation. Use cautiously in the elderly, in individuals undergoing chemotherapy, and in infants. Use cautiously if taking antidiarrheal agents. Avoid with a yeast infection. Avoid if pregnant or breastfeeding.

Soy: Due to limited human study, there is not enough evidence to recommend for or against the use of soy as a therapy in preventing Crohn's disease. Further research is needed before a recommendation can be made.

Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore, are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs, such as warfarin, should check with their doctors and pharmacists before taking soy supplements.

Thiamin: Thiamin (also spelled "thiamine") is a water-soluble B-complex vitamin. It is also known as vitamin B1 or aneurine. Decreased serum thiamine levels have been reported in patients with Crohn's disease. It is not clear if routine thiamin supplementation is beneficial in such patients.

Thiamin is generally considered safe and relatively nontoxic, even at high doses. Avoid if allergic or hypersensitive to thiamin. Thiamin appears safe if pregnant or breastfeeding when taken in the recommended dosages.

Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Preliminary research of zinc supplements in patients with Crohn's disease has yielded positive results. Well-designed clinical trials are needed to confirm these results.

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because studies have not evaluated its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used because studies cannot rule out the possibility of harm to the fetus.

Fair negative scientific evidence :

Zinc: One small study found that zinc supplementation does not seem to improve inflammatory bowel disease (IBD).

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because studies have not evaluated its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used because studies cannot rule out the possibility of harm to the fetus.

Traditional or theoretical uses lacking sufficient evidence :

Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. It has been suggested, but not scientifically proven, that acupuncture may help treat inflammatory bowel diseases (IBD), such as Crohn's disease.

Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant.

Beta-glucan: Beta-glucan is a fiber that comes from the cell walls of algae, bacteria, fungi, yeast, and plants. It has been proposed that beta-glucan may help treat patients with Crohn's disease. However, research is currently lacking in this area.

Avoid if allergic to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate insoluble beta-glucan, as preliminary evidence suggests intravenous beta-glucan. in the microparticulate form may cause serious side effects, including hepatosplenomegaly (enlargement of both the liver and the spleen). Avoid if pregnant or breastfeeding due to a lack of safety evidence.

Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. Although cat's claw has been used to treat Crohn's disease, studies are currently lacking in this area. A firm conclusion cannot be reached until researchers evaluate the safety and efficacy of this therapy.

Because the cause of Crohn's disease is unknown, there is currently no known method of prevention.

Individuals who are diagnosed with Crohn's disease are encouraged to talk to their doctors before having children. Some Crohn's disease medications may potentially cause birth defects, and some may be passed to the infant during pregnancy or breastfeeding. Also, pregnant mothers who have active Crohn's disease have an increased risk of experiencing premature labor and having a miscarriage or stillbirth.

People who have symptoms of Crohn's disease should visit their doctors. People who are diagnosed with Crohn's disease should consult their gastroenterologists regularly to monitor the condition and help prevent complications.