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Treatment for CD depends on which part and how much of the gut is affected.
Active inflammation is usually treated with steroid drugs which reduce the swelling and the pain of inflammation. Very mild inflammation may sometimes be treated with 5-ASA such as mesalazine or sulphasalazine, but this is uncommon. Immunosuppressants such as azathioprine, 6-mercaptopurine, or methotrexate, may be used for more persistent CD. Biologic drugs are available for more severe CD which has not responded to the usual treatments.
Another way of treating CD is with ‘enteral nutrition’ – a specially formulated liquid diet that can be taken instead of food, usually for up to eight weeks. Exclusive enteral nutrition is commonly used in children. Partial enteral nutrition with the Crohn's disease exclusion diet (CDED) has also been shown to be effective in children. In adults this type of liquid food is more likely to be prescribed as a supplement.
CD can sometimes cause blockages in the intestines or fistulas, and if medical treatment is not effective, surgery may be suggested. In an operation called a resection, severely inflamed sections of intestine are removed, and the healthy bowel joined together. Some people may have a stricture or narrowing of the intestine. This can sometimes be treated with a stricturoplasty operation in which the intestine is surgically widened or stretched. Sometimes, a stoma (ileostomy or colostomy) will be required to 'rest the bowel' distal to the stoma. Occasionally, for severe CD in the colon (large intestine) which is not responding to drug treatment, surgery to remove the whole colon may be recommended. You might then have an ileostomy or stoma.
Treatment for UC depends on how severe the symptoms are and how far the inflammation reaches round the colon.
Initially, especially if your UC is mild, you will probably be treated with 5-ASA drugs such as mesalazine or sulphasalazine. You may also be given corticosteroids. These medications help reduce the gut inflammation typical of UC. Once the active inflammation has gone into remission, 5-ASAs are usually prescribed as maintenance therapy to reduce the chance of a flare-up.
Immunosuppressant drugs, such as azathioprine or mercaptopurine may be prescribed for people with UC who continue to have frequent flare ups or ongoing symptoms. For more severe UC, treatment with corticosteroids given intravenously (directly into a vein, through a drip) may be necessary. You may also be started on a biologic medication such as infliximab or a small molecule medication, such as tofacitinib for induction and maintenance.
If the disease is very severe and is not responding to medical therapy, your doctor may suggest surgery to remove part or all of the large bowel. This usually means having an ileostomy and a stoma bag, at least temporarily. The colorectal surgeon will discuss with you options of either a permanent stoma or an internal pouch (IPAA - ileal pouch anal anastomosis). Although the idea of bowel surgery can be daunting, many people find they can cope better with a stoma or a pouch than with the UC symptoms they were previously experiencing.
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