Crohn’s Disease Treatment Options in 2026: A Nurse’s Guide

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

Crohn’s disease treatment aims to calm inflammation, ease symptoms, prevent flares and keep you in remission. Most people are treated with medicines, and some also need nutrition support or surgery. There is no cure yet, but there are more medicine options in 2026 than ever before.

The right plan depends on where your Crohn’s is, how active it is and how you have responded to past treatment. Here is a plain-language look at the main options so you can have a better talk with your gastroenterologist.

The Goals of Crohn’s Disease Treatment

Your care team is usually working toward a few goals at once:

Get you into remission (called “induction”)
Keep you in remission (called “maintenance”)
Heal the inflamed lining of the bowel
Prevent complications, like strictures, fistulas and abscesses
Support good nutrition and growth in children

Many experts now favor starting stronger medicines earlier for moderate to severe Crohn’s. The American Gastroenterological Association’s 2025 guideline supports using effective advanced medicines early, rather than slowly stepping up from weaker ones.

Aminosalicylates (5-ASAs): A Limited Role

Aminosalicylates, such as mesalamine and sulfasalazine, are a mainstay for ulcerative colitis. For Crohn’s disease, their role is much smaller.

MedlinePlus notes that 5-ASAs may help control mild to moderate symptoms, and rectal forms are only used when Crohn’s affects the large intestine. However, research reviews have found that mesalamine offers little benefit for most people with active Crohn’s. The American College of Gastroenterology’s 2025 guideline also describes mesalamine as having limited benefit.

If you take a 5-ASA now and feel well, do not stop it on your own. Ask your doctor whether it is still the best choice for you.

Corticosteroids (Steroids)

Steroids, such as prednisone and budesonide, calm inflammation quickly. They are often used to get a flare under control.

Budesonide is a steroid that works mainly in the gut. It is often used for mild to moderate Crohn’s in the end of the small intestine and the start of the colon.
Prednisone is used for moderate to severe flares.

Steroids are meant for short-term use only. They do not keep Crohn’s in remission over the long run. Long-term use can cause serious side effects, including bone loss. Your doctor will usually start a longer-term medicine while you taper off steroids.

Never stop a steroid suddenly. Your doctor will give you a plan to lower the dose slowly.

Immunomodulators

These medicines calm the overactive immune system. They include:

Azathioprine
Mercaptopurine (6-MP)
Methotrexate

They can take a few months to work. Doctors may use them to help you stay off steroids, or together with a biologic. The 2025 AGA guideline suggests infliximab plus a thiopurine (azathioprine or mercaptopurine) over infliximab alone for some people.

You will need regular blood tests while taking these medicines. Methotrexate can cause serious harm to an unborn baby. If you or your partner could become pregnant, talk with your doctor about birth control, both during treatment and for a time after it ends.

Biologics

Biologics are medicines made from living cells. They target specific proteins that drive inflammation. MedlinePlus describes biologic and small molecule therapies as the most common long-term treatments for Crohn’s. They are given as an IV infusion, a shot under the skin, or both.

Biosimilars, which are close copies of some biologics, are also available.

Anti-TNF medicines

These block a protein called tumor necrosis factor (TNF):

Infliximab (Remicade and biosimilars)
Adalimumab (Humira and biosimilars)
Certolizumab pegol (Cimzia)

Anti-integrin medicine

Vedolizumab (Entyvio) is an integrin blocker. It works by blocking certain cells that cause inflammation.

IL-12/23 and IL-23 blockers

These block signals called interleukins that fuel inflammation:

Ustekinumab (Stelara and biosimilars) blocks IL-12 and IL-23.
Risankizumab (Skyrizi) blocks IL-23. It was approved for Crohn’s in June 2022. In October 2026, the FDA approved an option to give its starting doses as shots under the skin, which can be started at home, instead of by IV.
Mirikizumab (Omvoh) blocks IL-23. It was approved for Crohn’s in early 2025.
Guselkumab (Tremfya) blocks IL-23. It was approved for Crohn’s in March 2025, with both IV and under-the-skin starting doses.

Safety with biologics

Because biologics calm the immune system, they can raise the risk of infections. Mayo Clinic notes a small increased risk of certain cancers and infections with medicines that suppress the immune system. Before you start some biologics, such as infliximab, your doctor will check for tuberculosis (TB) and may test for hepatitis B. It is also a good time to review your vaccines.

Call your doctor if you get a fever, chills, a cough that will not go away or other signs of infection.

JAK Inhibitor: Upadacitinib

Upadacitinib (Rinvoq) is a pill. It is a small molecule medicine called a JAK inhibitor, which blocks signals inside immune cells. The FDA approved it for adults with moderate to severe Crohn’s in May 2023.

In October 2025, the FDA updated its label. It is now for adults who have already tried at least one approved systemic therapy, and it can be used when TNF blockers are not a good choice. Before that, people had to try a TNF blocker first.

Upadacitinib carries boxed warnings for serious infections, cancer, major heart problems, blood clots and death. These risks are higher in adults 50 and older with heart risk factors and in current or past smokers. Mayo Clinic notes JAK inhibitors should not be used during pregnancy. Your doctor will weigh the benefits and risks with you.

Other Medicines

Your doctor may also use:

Antibiotics, such as ciprofloxacin or metronidazole, to treat abscesses and fistulas
Acetaminophen for mild pain
Calcium and vitamin D to protect your bones
Anti-diarrhea medicine, such as loperamide, only if your doctor says it is safe

NIDDK advises avoiding NSAIDs like ibuprofen and naproxen, because they can make symptoms worse. NIDDK also warns that loperamide can raise the risk of a serious problem called megacolon when inflammation is high. Check with your doctor before taking any over-the-counter medicine.

Nutrition Therapy and Bowel Rest

Sometimes the gut needs a break. Your doctor may recommend special liquid nutrition by mouth or through a feeding tube (enteral nutrition), or nutrition through a vein (parenteral nutrition). This is often short term, such as during a hospital stay or before surgery. NIDDK notes that the intestines usually heal during bowel rest.

Surgery

Surgery does not cure Crohn’s, but it can treat complications and greatly improve symptoms. NIDDK reports that 30% to 55% of people need surgery within 10 years of diagnosis.

Types of surgery include:

Bowel resection: removing a damaged part of the small or large intestine and joining the healthy ends
Draining an abscess or repairing a fistula
Proctocolectomy with ileostomy: removing the colon and rectum and creating an opening (stoma) on the belly, with a pouch to collect waste

Mayo Clinic notes that Crohn’s often returns near the joined area after a resection. That is why most people keep taking medicine after surgery.

Get Help Right Away

Call 911 or go to the emergency room for severe or constant belly pain, signs of a bowel blockage (vomiting, a swollen belly, or not passing gas or stool), heavy rectal bleeding, or vomiting that keeps you from holding down liquids.

If you are on a medicine that weakens your immune system, get care quickly for a high fever or signs of a serious infection.

Frequently Asked Questions

What is the newest Crohn’s disease treatment?

The IL-23 blockers mirikizumab and guselkumab were both approved for Crohn’s in 2025. In October 2026, risankizumab gained an option to start treatment with shots under the skin instead of IV. Ask your doctor which option fits your needs.

Can I stop my Crohn’s medicine when I feel better?

Do not stop on your own. Many people stay well because of their maintenance medicine, and stopping can trigger a flare. Talk with your doctor before making any change.

Does surgery cure Crohn’s disease?

No. Surgery can remove damaged bowel and treat problems like blockages and fistulas, but Crohn’s can come back. Most people continue medicine afterward.

Are biologics safe?

Biologics have helped many people with Crohn’s, but they can raise the risk of infection. Your doctor will screen you before you start and check on you over time.

The Bottom Line

Crohn’s disease treatment in 2026 includes short courses of steroids, immunomodulators, many biologics, the JAK inhibitor upadacitinib, nutrition therapy and surgery. Aminosalicylates play only a small role in Crohn’s. Newer IL-23 blockers have added more choices, and many experts now favor using effective medicines early. Work closely with your gastroenterologist, and never start, stop or change a medicine on your own.