What is Crohn’s disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, and weight loss. Other complications outside the gastrointestinal tract may include anemia, skin rashes, arthritis, inflammation of the eye, and tiredness. The skin rashes may be due to infections as well as pyoderma gangrenosum or erythema nodosum. Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of bowel cancer.

More research about Crohn’s disease is necessary. Researchers aren’t sure how it begins, who is most likely to develop it, or how to best manage it. Despite major treatment advances in the last three decades, no cure is available yet. Crohn’s disease most commonly occurs in the small intestine and the colon. It can affect any part of your gastrointestinal (GI) tract, from your mouth to your anus. It can involve some parts of the GI tract and skip other parts. The range of severity for Crohn’s is mild to debilitating. Symptoms vary and can change over time. In severe cases, the disease can lead to life-threatening flares and complications.

Crohn’s symptoms

The symptoms of Crohn’s disease often develop gradually. Certain symptoms may also become worse over time. Although it’s possible, it’s rare for symptoms to develop suddenly and dramatically. The earliest symptoms of Crohn’s disease can include:

• diarrhea
• abdominal cramps
• blood in your stool
• a fever
• fatigue
• loss of appetite
• weight loss
• feeling as if your bowels aren’t empty after a bowel movement
• feeling a frequent need for bowel movements

It’s sometimes possible to mistake these symptoms for the symptoms of another condition, such as food poisoning, an upset stomach, or an allergy. You should see your doctor if any of these symptoms persist.

The symptoms may become more severe as the disease progresses. More troublesome symptoms may include:

• a perianal fistula, which causes pain and drainage near your anus
• ulcers that may occur anywhere from the mouth to the anus
• inflammation of the joints and skin
• shortness of breath or decreased ability to exercise due to anemia

Early detection and diagnosis can help you avoid severe complications and allow you to begin treatment early.

What causes Crohn’s disease?

It isn’t clear what causes Crohn’s disease. However, the following factors may influence whether you get it:

• your immune system
• your genes
• your environment

Up to 20 percent of people with Crohn’s disease also have a parent, child, or sibling with the disease, according to the Crohn’s & Colitis Foundation.

According to a 2012 study, certain things can affect the severity of your symptoms. These include:

• whether you smoke
• your age
• whether or not the rectum is involved
• length of time you’ve had the disease

People with Crohn’s are also more likely to develop intestinal infections from bacteria, viruses, parasites, and fungi. This can affect the severity of symptoms and create complications.

Crohn’s disease and its treatments can also affect the immune system, making these types of infections worse.

Yeast infections are common in Crohn’s and can affect both the lungs and the intestinal tract. It’s important that these infections are diagnosed and properly treated with antifungal medications to prevent further complications.

Crohn’s diagnosis

No single test result is enough for your doctor to diagnose Crohn’s disease. They will begin by eliminating any other possible causes of your symptoms. Making a Crohn’s disease diagnosis is a process of elimination.

Your doctor may use several types of tests to make a diagnosis:

• Blood tests can help your doctor look for certain indicators of potential problems, such as anemia and inflammation.
• A stool test can help your doctor detect blood in your GI tract.
• Your doctor may request an endoscopy to get a better image of the inside of your upper gastrointestinal tract.
• Your doctor may request a colonoscopy to examine the large bowel.
• Imaging tests like CT scans and MRI scans give your doctor more detail than an average X-ray. Both tests allow your doctor to see specific areas of your tissues and organs.
• Your doctor will likely have a tissue sample, or biopsy, taken during an endoscopy or colonoscopy for a closer look at your intestinal tract tissue.

Once your doctor has completed reviewing all the necessary tests and ruled out other possible reasons for your symptoms, they may conclude that you have Crohn’s disease.

Your doctor may go on to request these tests several more times to look for diseased tissue and determine how the disease is progressing.

Complications

If symptoms are severe and frequent, the likelihood of complications is higher. The following complications may require surgery:

• internal bleeding
• stricture, where a part of the gut narrows, causing build up of scar tissue, and partial or complete blockage of the intestine
• perforation, when a small hole develops in the wall of the gut, from which contents can leak, cause infections or abscesses
• fistulas, when a channel forms between two parts of the gut

There may also be:

• a persistent iron deficiency.
• food absorption problems.
• slightly higher risk of developing bowel cancer.

Treatment for Crohn’s disease

A cure for Crohn’s disease isn’t currently available, but the disease can be well-managed. A variety of treatment options exist that can lessen the severity and frequency of your symptoms.

Medications

Several types of medications are available to treat Crohn’s. Anti-diarrheal and anti-inflammatory drugs are commonly used. More advanced options include biologics, which use the body’s immune system to treat the disease.

Which medications, or combination of medications, you need depends on your symptoms, your disease history, the severity of your condition, and how you respond to treatment.

Anti-inflammatory drugs

The two main types of anti-inflammatory drugs doctors use to treat Crohn’s are oral 5-aminosalicylates and corticosteroids. Anti-inflammatory drugs are often the first drugs you take for Crohn’s disease treatment.

You typically take these drugs when you have mild symptoms with infrequent disease flares. Corticosteroids are used for more severe symptoms but should only be taken for a short time.

Immunomodulators

An overactive immune system causes the inflammation that leads to the symptoms of Crohn’s disease. Drugs that affect the immune system, called immunomodulators, may reduce the inflammatory response and limit your immune system’s reaction.

Antibiotics

Some doctors believe antibiotics may help reduce some of the symptoms of Crohn’s and some of the possible triggers for it.

For example, antibiotics can reduce drainage and heal fistulas, which are abnormal connections between tissues that Crohn’s can cause. Antibiotics can also kill off any foreign or “bad” bacteria present in your gut that could be contributing to inflammation and infection.

Biologic therapies

If you have severe Crohn’s, your doctor may try one of a number of biologic therapies to treat the inflammation and complications that can occur from the disease. Biologic drugs can block specific proteins that may trigger inflammation.

Dietary changes

Food doesn’t cause Crohn’s disease, but it can trigger flares.

After a Crohn’s diagnosis, your doctor will likely suggest making an appointment with a registered dietitian (RD). An RD will help you understand how food may affect your symptoms and what diet changes may help you.

In the beginning, they may ask you to keep a food diary. This food diary will detail what you ate and how it made you feel.

Using this information, the RD will help you create eating guidelines. These dietary changes should help you absorb more nutrients from the food you eat while also limiting any negative side effects food may be causing. Read on for more info on diet in the next section.

Surgery

If less invasive treatments and lifestyle changes don’t improve your symptoms, surgery may be necessary. Ultimately, about 75 percent of people with Crohn’s disease will require surgery at some point in their lives, according to the Crohn’s & Colitis Foundation.

Some types of surgery for Crohn’s include removing damaged portions of your digestive tract and reconnecting the healthy sections. Other procedures repair damaged tissue, manage scar tissue, or treat deep infections.

Natural treatments for Crohn’s

Many people use complementary and alternative medicine (CAM) for various conditions and diseases, including Crohn’s disease. The U.S. Food and Drug Administration hasn’t approved these medicines for treatment, but many people use them in addition to mainstream medications.

Talk to your doctor if you’re interested in trying any of these treatments alongside your current regimen.

Popular alternative treatments for Crohn’s disease include the following:

• Probiotics. These are live bacteria that can help you replace and rebuild the good bacteria in your intestinal tract. Probiotics may also help prevent microorganisms from upsetting your gut’s natural balance and causing a Crohn’s flare.

Scientific data about effectiveness is limited. You can find a wide selection of probiotic supplements online.

• Prebiotics. These are potentially beneficial materials found in plants, such as asparagus, bananas, artichokes, and leeks, that help feed the good bacteria in your gut and increase their numbers. Prebiotics are also available to buy in supplement form.
• Fish oil. Fish oil is rich in omega-3s. According to a 2017 study, research is ongoing regarding its possible treatment of Crohn’s disease. Oily fish like salmon and mackerel are rich in omega-3s. You can also try fish oil supplements, which you can shop for online.
• Supplements. Many people believe certain herbs, vitamins, and minerals ease the symptoms of a variety of diseases, including the inflammation associated with Crohn’s disease. Research is ongoing as to which supplements may be beneficial.

Aloe vera. People believe that the aloe vera plant has anti-inflammatory properties. Because inflammation is one of the key components of Crohn’s disease, people often use it as a natural anti-inflammatory. However, there is no current research that suggests aloe vera helps with Crohn’s. If you are interested, you can find a selection of aloe vera gels, creams, juices, and more online.

• Acupuncture. This is the practice of strategically sticking needles in the skin to stimulate various points on the body. One theory is that acupuncture may cause the brain to release endorphins, chemicals that block pain and strengthen the immune system.
• A 2014 study found that acupuncture, combined with moxibustion — a type of traditional Chinese medicine that involves burning dried medicinal herbs on or near your skin —improves symptoms of Crohn’s disease. People with active Crohn’s disease reported less stomach pain, diarrhea, and inflammation after getting acupuncture.

Tell your doctor if you use any CAM treatments or over-the-counter medications. Some of these substances can affect the efficiency of medications or other treatments. In some cases, an interaction or side effect could be dangerous, even life-threatening.

Crohn’s surgery

Surgery for Crohn’s disease is considered a last-resort treatment, but three-quarters of people with this Crohn’s will ultimately need some type of surgery to relieve symptoms or complications.

Once medications are no longer working or side effects have become too severe to treat, your doctor may consider one of the following surgeries.

• Strictureplastywidens and shortens the intestines in an attempt to reduce the effects of scarring or damage to the tissue.
• During a bowel resection, portions of damaged intestine are removed. Healthy intestine is stitched together to reform the intestines.
• An ostomy creates a hole through which your body can eliminate waste. These are usually performed when a portion of the small or large bowel is removed. They can be permanent or temporary when your doctor wants to give your intestines time to heal.
• A colectomy removes sections of the colon that are diseased or damaged.
• A proctocolectomy is surgery to remove the colon and rectum. If you have this surgery, you will also need a colostomy (a hole in the large intestine for emptying waste).

Crohn’s disease surgery is helpful for relieving symptoms, but it’s not without its risks.

Is inflammatory bowel disease (IBD) the same as irritable bowel syndrome (IBS)?

How long will IBD last?

IBD is a lifelong (chronic) condition. A few patients find their disease becomes milder (“burned out”) after age 60, but many do not.

Do I have to take medicine forever?

Probably. IBD is a chronic disease, and most patients need a maintenance medicine to ease symptoms and reduce the number and severity of flares. Most maintenance medicines act fairly slowly, so if you have an active flare, you may need to take additional medicine temporarily.

Are there some medicines that can get me out of a flare quickly?

Yes. These are not necessarily used long term because of side effects. Patients will often change over from rescue medicines to long-term maintenance medicines. Rescue medicines include steroids such as prednisone and cyclosporine.

Why do I need to keep taking medicines when I feel well?

It’s important to keep taking maintenance medicines because they reduce the recurrence of flares. For biologic medicines (like infliximab, adalimumab, and certolizumab) it is important to keep taking them to prevent the formation of antibodies against the medicine. The formation of antibodies can lead to allergic reactions and loss of benefit from the medicine. Taking biologic medicines regularly can maintain their good effect.

Why might I need a colonoscopy?

A colonoscopy is used to make the initial diagnosis of Crohn’s disease or ulcerative colitis. A colonoscopy can also assess the symptoms of IBD flares and the response to treatment. A third important use of a colonoscopy is to screen for early colon cancer or to look for abnormal cells that may turn into cancer cells.

Will surgery cure my IBD?

No, but surgery can be very helpful. For patients with ulcerative colitis, removal of 97% of the colon dramatically reduces symptoms. Surgery is no picnic, but it can often dramatically improve the quality of life of someone with severe colitis. There are several ways to reconnect the intestine after the colon is removed, each of which has pros and cons.

The effect of surgery for Crohn’s disease can often be like pushing a giant reset button, as surgery can remove scarred tissue and strictures, fistulas and abscesses that cause a lot of symptoms for which medicines are not very effective. After surgery for Crohn’s disease, maintenance medicines are often more effective and help prevent further complications that lead to requiring further surgery in the future.

Is it dangerous to suppress (weaken) the immune system for the rest of my life?

There are some risks in suppressing or weakening your immune system. Viruses that stay in your body, like the chicken pox virus, are more likely to be activated (cause shingles) in people taking immunosuppressives such as azathioprine and methotrexate. Bacterial infections of the skin and soft tissues are more likely in people taking anti-TNF medicines. However, for many, all these risks are outweighed by the risks of complications of IBD, which accumulate over time.

You can reduce some of these risks. You can discuss early vaccination with your doctor. Also, after some years in remission some patients take a “drug holiday” and stop the immunosuppressive medicine with close monitoring by their doctor for any recurrence of inflammation. If you are on anti-TNF therapy and you are in the final trimester of pregnancy or going to have an operation, your doctor may adjust your dosing schedule to minimize complications.

Could any condition other than IBD be causing my symptoms?

Yes. Patients with IBD can get IBD-like symptoms for other reasons. Infections can cause diarrhea. Previous inflammation can cause increased sensitivity of the nerves in the intestine and make you very sensitive to intestinal cramping. Overgrowth of bacteria in the small intestine can cause cramping and gas. This is why you should visit a health care provider if there is a change in your symptoms because it might not be a flare of IBD.

Why shouldn’t my pain be treated with narcotics?

Narcotics treat the symptoms, not the cause (inflammation) of IBD. Narcotics can make the inflammation worse. Research has shown that patients with IBD who use narcotics are more likely to have severe abdominal infections (abscesses), strictures and intestinal obstruction. We try to avoid prescribing narcotics for IBD because they seem to be harmful.

Why not just take prednisone whenever I have a flare?

Prednisone has many side effects, including bone loss, diabetes, cataracts, emotional distress and severe acne, which make us want to minimize the use of prednisone as much as possible. In addition, the longer prednisone or other steroids are used, the less likely they are to work. That’s why we like to save prednisone for when (and if) you really need it to rescue you from a flare. Maintenance medicines are designed to reduce your flares in both number and severity. Therefore, you shouldn’t need to take prednisone as often. There is also evidence that taking maintenance medicine and reducing inflammation in the colon reduces colon cancer.