Crohn’s disease medications to avoid

5 Common Crohn’s Triggers

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People with Crohn’s disease usually alternate between periods when the disease is quiet and periods that involve flare-ups. But by identifying the trigger of these flares, you can minimize your symptoms in the future.

Crohn’s Symptoms: Common Triggers

Crohn’s symptoms can reawaken for unknown reasons, but by being alert and aware, you may be able to identify the specific triggers that have an effect on you:

Stress: The connection is poorly understood, but stress is thought to lead to flares in some people living with Crohn’s, says R. Balfour Sartor, MD, who directs the Broad Medical Research Program of the Crohn’s & Colitis Foundation of America (CCFA) and is a professor of medicine, microbiology, and immunology at the University of North Carolina-Chapel Hill.

In people who don’t have Crohn’s, “stress increases blood flow to the gut, which increases motility and stimulates contractions in the intestines, leading to diarrhea and nausea,” Dr. Sartor says. For people living with Crohn’s disease, who are already susceptible to cramping and diarrhea, it can be even worse, since stress can exacerbate these symptoms. “Beyond that, there is some evidence that stress can stimulate inflammation and activate disease activity,” he adds.

Smoking: Cigarettes can not only trigger flares, they can also raise the risk for more frequent surgery to treat Crohn’s, according to a review of data from 33 studies. The risk for more severe Crohn’s disease appears to go down after a smoker quits, according to researchers writing in the March 2016 issue of AlimentaryPharmacology & Therapeutics.

“One theory is that smoking causes constriction of blood vessels and leads to inadequate oxygen flow and nutrition in the intestines and increases biochemical mediators of inflammation, which causes injury to the area,” Sartor says.

Medications: Aspirin, ibuprofen, and certain antibiotics are some of the medications that can trigger flares in people with Crohn’s disease. Antibiotics change the balance of bacteria in the intestine, which can activate diarrhea even in people who do not have Crohn’s, Sartor notes.

Diet: Certain foods can change the bacterial profiles in people’s guts, triggering symptoms in some people with Crohn’s. No one type of food will cause flare-ups in everyone, so people should track their diets to determine the culprits. In general, foods that can increase gas and diarrhea — such as greasy and fried foods, beans, cabbage, and carbonated drinks — should be avoided. It’s also a good idea to stay away from raw vegetables, watermelon seeds, peanuts, or popcorn, especially if you are among those with Crohn’s disease who have a narrowing of the intestines, which increases the risk for intestinal obstruction, Sartor says.

Infections: Infections can also precipitate flare-ups, according to Sartor. “We know that gut infections can kick off symptoms in patients whose symptoms had been quiescent,” he says. There’s also some evidence that bacterial and viral infections can set off Crohn’s in people who have never had any symptoms. For example, he says, people may go on vacation and contract an infection — think “Montezuma’s revenge” — after exposure to E. coli. Though other travelers may get better without any residual problem, someone who’s genetically susceptible to Crohn’s may lack a mechanism to turn off the inflammation, Sartor explains.

Seasonal changes: Some people have flare-ups at different times of the year. “One theory is that it might have something to do with allergy to pollen or exposure to respiratory infections,” Sartor says.

Crohn’s Symptoms: Identifying Your Triggers

Before you can avoid triggers, you must identify them. Because triggers can vary from person to person, the best strategy is to keep track of the circumstances surrounding your flare-ups. Ask yourself the questions a doctor would ask to try to pinpoint triggers, such as:

  • Are you taking ibuprofen, aspirin, or a similar medication?
  • Did you have recent antibiotic exposure?
  • Did you recently have an infection?
  • Have you traveled recently?
  • Do you smoke?
  • In the week before your flare-up, did you experience stress or anything that was unusual?

Another useful way to identify triggers is to keep a journal of what you eat. That way, you will know everything you had within 24 hours of experiencing symptoms. It’s probably not necessary to write down every bite, Sartor says, but getting into the habit of listing the foods and beverages you consume each day, particularly ones commonly associated with triggering Crohn’s symptoms, makes sense. By keeping track of your daily routine as well, you can be your own detective and uncover any common threads between your flare-ups.

Crohn’s Symptoms: Avoiding Triggers and Calming Their Effects

Once you’ve identified your Crohn’s triggers, the next step is to avoid them:

  • If you suspect stress is one of your triggers, do what you can to eliminate or at least reduce your stress levels. “If you’re in an occupation that’s continuously stressful, look for another job,” Sartor says. “If you’re experiencing marital stress, go for counseling.” Try yoga, meditation, breathing exercises, listening to music — whatever works to help you relax. You may need to talk with your doctor about medications that can help lower your stress levels.
  • If you smoke, find a way to stop.
  • Stay away from aspirin and ibuprofen and switch to acetaminophen, which does not trigger flare-ups in people living with Crohn’s.
  • Avoid foods that are more likely to cause gas or increase the risk for intestinal obstruction.

By identifying and then avoiding all possible triggers, you can reduce the number of Crohn’s flare-ups you experience.

Antibiotic use tied to Crohn’s, ulcerative colitis

NEW YORK (Reuters Health) – People who are prescribed a large number of antibiotics tend to have a higher risk of inflammatory bowel disease (IBD), a new study finds, providing more evidence that antibiotics may be disturbing bacteria in our intestine.

“It’s not that antibiotics cause inflammatory bowel disease, but that it further supports the hypothesis that changing the gut flora may be disadvantageous,” co-author Dr. Charles N. Bernstein, who studies bowel disorders at the University of Manitoba, told Reuters Health.

Previous studies have linked antibiotic use and IBD, which includes Crohn’s disease and ulcerative colitis. In the current study, Canadian researchers found 12 percent of people diagnosed with the two conditions had been prescribed three or more antibiotics two years before compared to seven percent without the disease. This difference was consistent over a five-year period.

In other words, if antibiotics were solely responsible for the difference, for every 20 people prescribed three or more antibiotics, there would be one extra case of IBD.

Once the researchers took other factors into account, they found that people prescribed lots of antibiotics were as much as 50 percent more likely to get Crohn’s disease within two to five years.

Published in the American Journal of Gastroenterology, the study looked at 24,000 people from the one of the largest IBD databases in North America.

“It’s a well-done study that has a strong well-maintained database that allows the authors to get quality data,” said Dr. Jean-Paul Achkar, who studies the genetics of IBD at the Cleveland Clinic and was not part of the study.

“They even tried to adjust for non-antibiotic prescription history, and still antibiotics came out as being associated with increased risk of IBD,” he told Reuters Health.

An estimated 1.4 million Americans suffer from IBD, with approximately 30,000 new cases diagnosed each year, according to the Crohn’s and Colitis Foundation.

Both Crohn’s disease and ulcerative colitis – the two main forms of IBD — cause chronic inflammation in the intestines, triggering symptoms like abdominal pain, diarrhea and weight loss.

The cause of IBD is unclear, but some scientists think IBD may result from the immune system overreacting to viruses or bacteria in the intestine.

“There is growing evidence that alterations in the balance of normal intestinal bacteria could lead to the development of IBD,” said Achkar.

Most people who’ve taken antibiotics will not develop IBD. But Bernstein still thinks a portion of the population is at risk.

“It’s not that we should stop using antibiotics,” he said. “We get through a lot of important infections by using them. But we have to make sure that when we use them, it’s for the right reasons.”

SOURCE: bit.ly/r2Ye3Y American Journal of Gastroenterology, September 13, 2011.

Our Standards:The Thomson Reuters Trust Principles.

Medication Options for Crohn’s Disease

Successful medical treatment allows your intestinal tissue to heal and it helps relieve symptoms such as fever, diarrhea, and abdominal pain.

There are several groups of drugs used to treat Crohn’s disease. Some of these options are used to get your symptoms under control, which is known as inducing remission. Medical therapy, also called maintaining remission or maintenance, is used to decrease the frequency of Crohn’s flares.

You and your health care provider are partners in your health. This list of common Crohn’s medications can help you begin an informed discussion with your doctor.

Aminosalicylates (5-ASA)

These include medications that contain 5-aminosalicylic acid (5-ASA). These drugs are not specifically approved by the Food and Drug Administration (FDA) for use in Crohn’s, yet they can work to decrease inflammation in the lining of the GI tract.

Aminosalicylates are thought to be effective in treating mild-to-moderate episodes of Crohn’s disease and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.

Examples

  • Sulfasalazine

  • Mesalamine

  • Olsalazine

  • Balsalazide

Aminosalicylates

Video Length 00:01:04

Aminosalicylates Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA) and reduce inflammation in the lining of the intestine. Watch this video to learn more.

Corticosteroids

Corticosteroids suppress the immune system and are used to treat moderate to severely active Crohn’s disease. These drugs work non-specifically, meaning that they suppress the entire immune response, rather than targeting specific parts of the immune system that cause inflammation.

Corticosteroids have significant short- and long-term side effects and should not be used as a maintenance medication. If you cannot come off steroids without suffering a relapse of your symptoms, your doctor may need to prescribe other medications to help manage your disease.

Examples

These medications are available orally and rectally.

  • Prednisone

  • Methylprednisolone

Corticosteroids for IBD

Video Length 00:01:13

Corticosteroids for IBD Corticosteroids are powerful and fast-acting anti-inflammatory drugs that have been frequently used in the treatment of acute flare-ups of IBD. Watch this video to learn more.

Immunomodulators

This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators, which may take several months to begin working, are generally are used when aminosalicylates and corticosteroids haven’t been effective, or have been only partially effective.

These medications may be useful in reducing or eliminating the need for corticosteroids, and in maintaining remission in people who haven’t responded to other medications given for this purpose.

Examples

  • Azathioprine

  • 6-mercaptopurine

  • Cyclosporine

  • Tacrolimus

Immunomodulators for IBD

Video Length 00:01:10

Immunomodulators for IBD Immunomodulators weaken or modulate the activity of the immune system. And are medications often used to treat people with IBD. Watch this video to learn more.

Antibiotics

Antibiotics may be to treat bacterial infections in the GI tract. Infections in Crohn’s disease can include abscesses and fistulas around the anal canal and vagina.

Examples

  • Metronidazole

  • Ampicillin

  • Ciprofloxacin

Antibiotics for IBD

Video Length 00:01:21

Antibiotics for IBD Antibiotics are frequently used as a primary treatment approach primarily in Crohn’s disease and with particular complications in IBD. Watch this video to learn more.

Biologic/Biosimilar Therapies

These medications are the latest class of therapy for people with Crohn’s disease who have not responded well to conventional therapy. Biologics are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation.

Examples

  • Adalimumab

  • Certolizumab pegol

  • Infliximab

  • Natalizumab

  • Ustekinumab

  • Vedolizumab

Biologics for IBD

Video Length 00:01:21

Biologics for IBD Biologics are antibodies grown in the laboratory that stop specific proteins in the body from causing inflammation. Their mechanisms of action are more precisely targeted to the factors responsible for IBD.

Biosimilars are nearly identical copies of other already approved biologic therapies. They have the same effectiveness and safety as the originally approved biological therapy, in the target patient population. Learn about recently approved biosimilars.

Examples

  • Infliximab-abda

  • Infliximab-dyyb

  • Infliximab-qbtx

Have you been affected by step therapy? Step therapy is a health insurance practice that may require you to try and fail on a medication before providing coverage for your originally prescribed treatment. Learn more about step therapy and what you can do to advocate for your health.

Treatment for Crohn’s Disease

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Many people with Crohn’s disease need medicines. Which
medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

  • balsalazide
  • mesalamine
  • olsalazine
  • sulfasalazine

Some of the common side effects of aminosalicylates include

  • diarrhea
  • headaches
  • heartburn
  • nausea and vomiting
  • pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

  • budesonide
  • hydrocortisone
  • methylprednisolone
  • prednisone

Side effects of corticosteroids include

  • acne
  • bone mass loss
  • high blood glucose
  • high blood pressure
  • a higher chance of developing infections
  • mood swings
  • weight gain

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

  • 6-mercaptopurine, or 6-MP
  • azathioprine
  • cyclosporine
  • methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

  • a low white blood cell count, which can lead to a higher chance of infection
  • feeling tired
  • nausea and vomiting
  • pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

  • anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab, and infliximab
  • anti-integrin therapies, such as natalizumab and vedolizumab
  • anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

  • acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
  • antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
  • loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

  • ask you to drink a liquid that contains nutrients
  • give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
  • give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.8 Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

  • fistulas
  • bleeding that is life threatening
  • intestinal obstructions
  • side effects from medicines when they threaten your health
  • symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

  • laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
  • open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

  • laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
  • open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

  • Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
  • Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
  • Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
  • Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
  • Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
  • Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
  • Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.

Treatments

Treatment for Crohn’s Disease and Ulcerative Colitis depends on how severe the symptoms are, and how much of the gut is affected.

There is a range of drugs used to treat Inflammatory Bowel Disease (IBD). Initially, the aim of drug treatment is to reduce inflammation in the gut to bring relief from symptoms are induce (bring about) remission). Once the condition is under control, your doctor will usually continue to prescribe drugs to maintain remission and prevent relapse – this is called maintenance treatment.

In some cases, if medical treatment is not effective, then surgery may be required. .

We have a number of free to download information sheets and booklets that outline the different treatments available.

Following my surgery, there’s nothing stopping me, and since I came back from surgery I’ve missed just one day’s training. I’m living a normal life again, balancing football with a busy family life.

Drugs to treat IBD

Many of the drugs used to help control IBD are anti-inflammatory drugs. These include steroids, 5ASAs, immunosuppressants such as azathioprine, methotrexate and ciclosporin, and biological drugs like infliximab and adalimumab.

Other drugs used for IBD include antiobiotics such as metronidazole and ciprofloxacin, and symptomatic drugs such as antidiarrheals and bulking agents.

We have some detailed information sheets about some of the drugs most commonly used in IBD:

  • Adalimumab
  • Aminosalicylates (5-ASAs)
  • Azathioprine and Mercaptopurine
  • Azathioprine – for Young People
  • Biologic Drugs
  • Golimumab
  • Infliximab
  • Methotrexate
  • Methotrexate – for Young People
  • Steroids
  • Tofacitinib
  • Ustekinumab
  • Vedolizumab
  • Other Treatments for IBD

Surgery

Sometimes people with Inflammatory Bowel Disease require surgery. A range of surgeries can be recommended and these guides looks at what they are and when they are necessary, weighing up the pros and cons in the process:

  • Surgery for Crohn’s Disease
  • Surgery for Ulcerative Colitis

Other forms of treatment

Browse our list of free booklets, information sheets and guides for detailed information about other forms of treatment for Crohn’s and Colitis, including dietary therapy, counselling and fatigue.

As with Crohn’s, a variety of surgeries can be recommended for Ulcerative Colitis. This guide looks at what they are and when they are necessary, weighing up the pros and cons in the process.

Ulcerative Colitis, Edition 9 – last review June 2017. Next planned review 2020.
Crohn’s Disease, Edition 7a – last review October 2017. Amended July 2017. Next planned review 2019.

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