Key takeaways

  • If your Crohn’s disease symptoms have come back, it’s possible that your medication has stopped working. Some tests will be necessary to confirm this.
  • When choosing a new medication to try, you and your doctor will consider factors such as symptom severity, possible side effects, and any other health conditions you have.
  • You’ll meet with your doctor often during the transition to a new medication. It may take anywhere from 2 weeks to a few months to find out whether a new treatment is working.

The first sign that your medication is not working is that your initial Crohn’s symptoms begin to recur.

Each person with Crohn’s has their own individual set of symptoms, so it’s important for you to recognize what your exact Crohn’s symptoms are. Typical symptoms include abdominal pain, anal pain or discharge, stool changes or diarrhea, weight loss, and rectal bleeding.

However, a return of symptoms alone is not always a sign of medication failure. Objective measures of Crohn’s disease, such as blood tests, stool tests, and/or endoscopy, must be assessed to confirm that a medication has stopped working.

If you start to notice your symptoms returning, it’s important to reach out to your managing gastroenterologist for further assessment.

There are several things to consider, but the most important factors are:

  • which medications you’ve previously tried that have not worked for you
  • how severe your symptoms are and where they’re located (if they’re more severe, a doctor would consider a stronger medication that works faster)
  • whether you have any other diseases
  • which route of administration you prefer (IV infusions, subcutaneous injections, or oral pills)
  • what side effects each medication may cause
  • whether you have plans for future pregnancy (since not all medications are safe in pregnancy)

We call it a “shared decision-making” process. Each person with Crohn’s has their own preferences, and we want to find the best medication tailored to each person’s situation that is most in line with their preferences.

During the transition process, it’s likely that you’ll need to meet with your gastroenterologist very regularly, ranging from weekly to every 4 weeks, to ensure that you’re responding to the medication and not developing any side effects.

During each follow-up visit, gastroenterologists often ask a very specific set of questions to try to objectively determine how your symptoms are progressing. You may need additional testing to ensure that no medication-specific side effects have occurred.

Each specific Crohn’s treatment has its own time frame for symptom and disease improvement, so it depends on which medication you decide to use. Some medications can cause improvement in as little as 1 to 2 weeks, but the typical time frame for clinical response ranges from 2 to 12 weeks after starting therapy.

After starting treatment, we often wait 3 to 6 months to repeat blood or stool tests to confirm that things are headed in the right direction, though this can change depending on how severe your symptoms are.

Finally, we often repeat endoscopic assessment within the first year of a new treatment to definitively determine improvement.

Dr. Michael Schopis is an ABIM board certified internal medicine physician specializing in gastroenterology and hepatology.