Crohn’s Disease

Although there is no cure for Crohn’s disease, treatment can significantly reduce symptoms, allowing for periods of remission, in which the disease is inactive. It may be treated in several different ways depending on the specific type of Crohn’s and the severity of the disease.

Both surgical and nonsurgical treatments for Crohn’s disease are available:

Nonsurgical treatment

If your Crohn’s disease symptoms are not severe, nonsurgical treatment can help reduce symptoms and improve quality of life. Options may include:

Medication

• Anti-inflammatory drugs may be prescribed to reduce inflammation and relieve pain. This is a common course of treatment for mild to moderate cases of Crohn’s disease. Aminosalicylates (like 5-ASA), are aspirin-like anti-inflammatory agents often used as the first drug therapy for people with early-stage, mild Crohn’s disease.
• Courses of corticosteroids. immunosuppressing drugs that can calm overactive immune responses and reduce inflammation — are sometimes used to induce remission. The steroid prednisone, for example, is often used to treat people with moderate to severe disease to reduce continued symptoms despite other treatments. However, we will discuss strategies to limit or avoid their use because steroids do not maintain remission and have side effects.
• Immunomodulators such as 6-mercaptopurine and azathioprine may also be used to help reduce inflammation and maintain remission by lowering the body’s immune response, which is heightened in people with Crohn’s disease.
• Biologics are a newer therapy used to neutralize the proteins in the body that are causing inflammation. Biologics may be administered through intravenous (IV) infusions or self-injections you can do at home. More recently, oral biologic medications have been discovered and are available as part of the treatment options at NewYork-Presbyterian.
• Antibiotics are prescribed in cases in which infection is a concern. Some cases of Crohn’s, for example, may begin after an infection. Some people may benefit from probiotics as well. Additionally, certain vitamins, supplements, pain relievers, and antidiarrheal medicines may be prescribed to relieve symptoms and help your body better absorb certain nutrients.
• Infusion therapies may be recommended in some cases. Infusions may include stem cell infusion therapy to alleviate inflammation, medications for controlling chronic pain, iron infusions for Crohn ’s-associated anemia, and intravenous hydration and nutrition therapy.

Dietary changes

People with Crohn’s may find that certain foods and beverages — such as wheat, sugar, dairy, and alcohol — make their symptoms worse. When you have Crohn’s, it’s important to make sure you get enough nutrients to support your health.

Working with your gastroenterologist, a registered dietitian can help you identify foods you should avoid and make sure you are eating and absorbing enough food to meet your nutritional needs.

Lifestyle changes

Some people with Crohn’s disease find that relieving stress or stopping cigarette smoking helps ease symptoms. Engaging in relaxing activities like yoga, meditation, reading, and walking can help reduce stress. Some people see a therapist to talk about the symptoms and learn how to manage the mental effects of Crohn’s better. Psychiatrists can also prescribe certain medications to reduce anxiety and stress.

Surgical treatment

Surgery may be necessary if dietary changes, lifestyle changes, and medications are not enough to control symptoms. Minimally invasive laparoscopy or robotic-assisted laparoscopy is often used for some types of Crohn’s surgery. This method uses small incisions to allow for less discomfort after surgery and a speedier recovery than open abdominal surgery.

At NewYork-Presbyterian, our colorectal surgeons have pioneered several IBD surgical approaches used today, offering resection to remove diseased intestinal tissue and strictureplasty to open up intestines narrowed by scar tissue. If needed in very severe cases, we also offer colectomy to remove some or all of the colon and proctocolectomy to remove the rectum.

Explore these surgeries and others often used for treating Crohn’s disease:

Small bowel resection

A small bowel resection involves the removal of parts of the small intestine damaged by Crohn’s disease. In most cases, there is enough healthy intestine remaining, which means the free ends of the small intestine can be connected.

If there is not enough healthy intestine remaining, an ileostomy will be performed, in which the small intestine is diverted through a small opening in the lower right abdomen, called a stoma. This allows stool to divert into an ostomy bag that is placed outside the abdomen. This bag lies fairly flat underneath clothing, and patients can continue their normal activities after recovery. Your medical team will help you adjust to this life change.

Intestinal strictureplasty

In some cases of Crohn’s, scar tissue can build up and block part of the intestinal tract, or severe inflammation in the digestive tract can narrow the small intestine, blocking digested food from passing through. An intestinal strictureplasty may be performed to widen the area and restore bowel function to address this.

No intestinal tissue is removed during a strictureplasty, and there are several different approaches to the surgery. Your doctor will recommend a specific approach based on the results of your diagnostic imaging tests.

Colectomy

During a colectomy, some or all of the colon (part of the large intestine) is removed. This may be done for severe cases of Crohn’s disease, based on the results of diagnostic imaging and tests, and whether medication has failed to relieve inflammation.

Proctocolectomy

If inflammation has spread to the rectum, a proctocolectomy may be performed to remove the colon and rectum. There are different variations of this surgery.

Proctocolectomy with end ileostomy

Crohn’s patients requiring a proctocolectomy usually have a proctocolectomy with end ileostomy, in which the end of the small intestine is inverted through a small hole created in the abdominal wall, called a stoma that allows stool to divert into an ostomy bag. This is placed externally on the lower right abdomen and lays fairly flat underneath clothing. Patients can continue their normal activities after recovery, and your medical team will help you adjust to this life change.

Some patients may be candidates for restorative procedures designed to avoid a permanent ileostomy. Select patients with Crohn’s disease may be candidates for an ileal pouch-anal anastomosis (IPAA), commonly called a J-pouch (named after the shape of the pouch) or a K-pouch (named for its inventor, Dr. Nils Kock).

A J-pouch allows patients to eliminate through their anus as their pouch functions as a rectum. A K-pouch is emptied by inserting a tube into the intestinal valve through a small opening in the abdominal wall.

Post-surgical treatment

It’s not unusual to need additional surgery to treat new areas of inflammation in the bowel. Our gastroenterologists use early intervention, including postoperative therapies, to reduce your risk of recurrence. You’ll also receive support and education from wound care nurses specially trained in caring for people with Crohn’s disease.

Clinical trials for Crohn’s disease

Clinical trials of cutting-edge Crohn’s treatments may also be available to some patients. At NewYork-Presbyterian, we regularly conduct clinical trials to assess innovative therapies for Crohn’s. If you are interested in learning more about current trials at NewYork-Presbyterian and other facilities across the nation, visit our Clinical Trials page.