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Crohn's disease is a lifelong inflammatory bowel disease (IBD). Parts of the digestive system get swollen and have deep sores called ulcers. Crohn's disease usually is found in the last part of the small intestine and the first part of the large intestine. But it can develop anywhere in the digestive tract, from the mouth to the anus.
Doctors don't know what causes Crohn's disease. You may get it when the body's immune system has an abnormal response to normal bacteria in your intestine. Other kinds of bacteria and viruses may also play a role in causing the disease.
Crohn's disease can run in families. Your chances of getting it are higher if a close family member has it. People of Eastern European (Ashkenazi) Jewish background may have a higher chance of getting Crohn's disease. Smoking also puts you at a higher risk for the disease.
The main symptoms of Crohn's disease are belly pain and diarrhea (sometimes with blood). Some people may have diarrhea 10 to 20 times a day. Losing weight without trying is another common sign. Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and openings (fistulas) between organs.
Infections, hormonal changes, and smoking can cause your symptoms to flare up. You may have only mild symptoms or go for long periods of time without any symptoms. A few people have ongoing, severe symptoms.
It's important to be aware of signs that Crohn's disease may be getting worse. Call your doctor right away if you have any of these signs:
Your doctor will ask you about your symptoms and do a physical examination. You may also have X-rays and lab tests to find out if you have Crohn's.
Tests that may be done to diagnose Crohn's disease include:
Your treatment will depend on the type of symptoms you have and how bad they are.
There are a few steps you can take to help yourself feel better. Take your medicine just as your doctor tells you to. Exercise, and eat healthy meals. Don't smoke. Smoking makes Crohn's disease worse.
The most common treatment for Crohn's disease is medicine. Mild symptoms of Crohn's disease may be treated with over-the-counter medicines to stop diarrhea. But talk with your doctor before you take them, because they may cause side effects.
You may also use prescription medicines. They help control inflammation in the intestines and keep the disease from causing symptoms. (When you don't have symptoms, you are in remission.) These medicines also help heal damaged tissue and can postpone the need for surgery.
Crohn's disease makes it hard for your body to absorb nutrients from food. A meal plan that focuses on high-calorie, high-protein foods can help you get the nutrients you need. Eating this way may be easier if you have regular meals plus two or three snacks each day.
Having Crohn's disease can be stressful. The disease affects every part of your life. Seek support from family and friends to help you cope. Get counselling if you need it.
Many people with inflammatory bowel diseases look to alternative treatments to improve their well-being. These treatments haven't been proved effective for Crohn's disease, but they may help you cope. They include massage, supplements such as vitamins D and B12, and herbs like ginseng.
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The cause of Crohn's disease is unknown. This disease may result from an abnormal response by the body's immune system to normal intestinal bacteria.footnote 1 Disease-causing bacteria and viruses also may play a role.
Crohn's disease can run in families, so some people may be more likely than others to develop the condition when exposed to something that triggers an immune reaction. Environmental factors may also play a role in causing this disease.
The main symptoms of Crohn's disease include:
Because Crohn's disease involves the immune system, you also may have symptoms outside the digestive tract. These may include joint pain, eye problems, a skin rash, or liver disease.
Other conditions with symptoms similar to Crohn's disease include diverticulitis and ulcerative colitis.
Crohn's disease is an ongoing (chronic) condition that may flare up throughout your life. It affects different people in different ways. Some people may have only mild symptoms. Others may have severe symptoms or complications that, in rare cases, may be life-threatening.
The disease may be:
Crohn's disease may be defined by the part of the digestive tract involved, such as the rectum and anus (perianal disease) or the area where the small intestine joins the large intestine (ileocecal disease). Some people may have features of both Crohn's disease and ulcerative colitis, the other major type of inflammatory bowel disease (IBD).
Because Crohn's disease can cause inflammation in parts of the intestines that absorb nutrients from food, it can cause deficiencies in vitamin B12, folic acid, or other nutrients. The disease can increase the risk of gallstones, kidney stones, and certain uncommon forms of anemia.
In long-term Crohn's disease, scar tissue may replace some of the inflamed or ulcerated intestines. This scar tissue can form blockages (bowel obstructions) or narrowed areas (strictures) that can prevent stool from passing through the intestines. Blockages in the intestines also can be caused by inflammation and swelling, which may improve with medicines. Sometimes blockages can only be treated with surgery.
If sores break through the wall of the intestines, abnormal connections or openings (fistulas) may form. Fistulas can form between two parts of the intestines, between the intestines and other organs (such as the bladder or vagina), or between the intestines and the skin. In rare cases, this can lead to infection of the abdominal wall.
Crohn's disease of the colon and rectum that has been present for 8 years or longer increases the risk of cancer. With regular screening, some cancers can be found early and treated successfully.
Inflammatory bowel disease also increases the risk of melanoma, a serious type of skin cancer. Your doctor may recommend regular screening by a dermatologist.footnote 2
Most women who have Crohn's disease can have a normal pregnancy and deliver a healthy baby. The best idea is to wait until the disease is in remission before becoming pregnant. Women who become pregnant when their disease is under control are more likely to avoid flare-ups during pregnancy.
Some medicines used to treat the disease can be used during pregnancy. It's a good idea to talk with your doctor about which medicines are okay. But sometimes severe Crohn's disease can harm your baby more than medicines to keep it under control.
Things that may increase your risk of getting Crohn's disease include:
Things that may cause Crohn's disease symptoms to flare up include:
Call a doctor right away if you have been diagnosed with Crohn's disease and you have one or more of the following:
If you have any of these symptoms and you have been diagnosed with Crohn's disease, your condition may have become much worse. Some of these symptoms also may be signs of toxic megacolon. This is a rare complication of Crohn's disease that requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.
People who have Crohn's disease usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:
Your family doctor or general practitioner can diagnose Crohn's disease.
For help managing Crohn's disease, you may be referred to a specialist, such as an internist or a gastroenterologist.
To be evaluated for surgery, you may be referred to a:
Crohn's disease is diagnosed through a medical history and physical examination, imaging tests to look at the intestines, and lab tests.
It may go undiagnosed for years, because symptoms usually develop gradually and it doesn't always affect the same part of the intestine.
Other diseases can have the same symptoms as Crohn's disease. But doctors can diagnose Crohn's by doing a test that looks at the inside of the intestine.
Other tests may be done to confirm or evaluate the disease.
The main treatment for Crohn's disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, long-lasting symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery. The type of treatment you need depends on the type of symptoms you have and how bad they are.
Mild symptoms may respond to an antidiarrheal medicine such as loperamide (Imodium, for example). This medicine slows or stops the painful spasms in your intestines that cause symptoms.
For mild to moderate symptoms, your doctor may have you take antibiotics. Sometimes aminosalicylates are used.
Severe symptoms may be treated with corticosteroids, immunomodulator medicines, or biologics. With severe symptoms, the first step is to control the disease. When your symptoms are gone, your doctor will plan your treatment to keep you symptom-free (in remission).
After symptoms are controlled, your treatment will focus on medicine or a combination of medicines that keeps Crohn's disease in remission.
Your doctor will want to see you about every 6 months if your condition is stable. You'll be seen more often if you have flare-ups. You may have lab tests every 2 to 3 months.
Some severe cases of Crohn's disease need to be treated in the hospital. In the hospital, you may get supplemental nutrition through a tube placed in your nose and down into the stomach (enteral nutrition). Or your bowel may need to rest, and you will be fed liquid nutrients in a vein (total parenteral nutrition, TPN). See Other Treatment.
Surgery may be needed if no medicine is effective or if you have complications. See Surgery.
Crohn's disease cannot be prevented, because the cause is unknown. But you can take steps to reduce the severity of the disease. For help, see Home Treatment.
If Crohn's disease doesn't cause symptoms, no treatment is needed. Mild symptoms may be treated with antidiarrheal medicines or changes in diet and nutrition.
In general, doctors recommend that you do not use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. These medicines may cause flare-ups of Crohn's disease. But some people may be more likely to have flare-ups from NSAIDs than others. Talk to your doctor about whether to avoid these medicines.
You can also help yourself by:
Crohn's disease can affect every aspect of your life. It may make you feel isolated or depressed. But you can take steps to improve your outlook and coping skills. You may want to seek professional counselling and social support from family, friends, or clergy.
Children who have Crohn's disease may feel self-conscious if they don't grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing the disease than adults, so your support is especially important.
Medicines usually are the treatment of choice for Crohn's disease. They can control or prevent inflammation in the intestines and help to:
The choice of medicine usually depends on how severe the disease is, what part of the intestine is affected, and whether complications are present. Medicines for Crohn's disease include:
Surgery for Crohn's disease may be done if:
Surgery is rarely done, and it's not a cure. When surgery for Crohn's is needed, as little of the intestine as possible is removed to keep the intestines working normally. The disease tends to return to other areas of the intestines after surgery.
Surgery may improve a child's well-being and quality of life and restore normal growth and sexual development.
It may take time to adjust to living with an ostomy. It may help to know that most people are able to adapt and resume all of their usual activities. Talk with your doctor about support groups in your area for people with ostomies.
Other treatments for Crohn's disease include balloon dilation, supplemental nutrition, and complementary therapies.
Balloon dilation isn't surgery. It may be done if you want to delay surgery, or if you have had surgery before and your doctor wants to save as much of the intestine as possible.
During the procedure, the doctor moves an endoscope through your intestine from your anus. The endoscope is a long, thin tube that has a video camera on the end. An uninflated balloon is placed across the narrowed part of the intestine. When the balloon is inflated, it makes that part of the intestine wider.
The balloon is deflated and then removed. Not as much is known about the long-term success of balloon dilation compared to surgery.
Some people who have Crohn's disease need additional nutrition because severe disease prevents their small intestine from absorbing nutrients.
Supplemental liquid feedings may be done through a tube placed in the nose and down into the stomach (enteral nutrition) or through a vein (total parenteral nutrition, or TPN). Enteral nutrition or TPN may be needed when:
Supplemental feeding can restore good nutrition to children who are growing more slowly than normal. It also can build strength if you need surgery or have been weakened because of severe diarrhea and poor nutrition.
Supplemental nutrition allows the intestines to rest and heal. But it's common for symptoms to return when TPN is stopped and you go back to a regular diet. TPN doesn't change the long-term outcome of Crohn's disease.
Many people with inflammatory bowel disease consider non-traditional or complementary medicine in addition to prescription medicines. They may turn to these alternatives because there is no cure for Crohn's disease. People may also use complementary medicine for help with:
These therapies have not been proved effective for Crohn's disease, but they may improve your well-being. Therapies include:
Current as of: November 7, 2018
Author: Healthwise StaffMedical ReviewE. Gregory Thompson MD - Internal MedicineAdam Husney MD - Family MedicineArvydas D. Vanagunas MD - Gastroenterology
CitationsSands BE, Siegel CA (2010). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1941–1973. Philadelphia: Saunders Elsevier.Singh S, et al. (2014). Inflammatory bowel disease is associated with an increased risk of melanoma: A systematic review and meta-analysis. Clinical Gastroenterology Hepatology, 12(2): 210–218. DOI: 10.1016/j.cgh.2013.04.033. Accessed March 25, 2015.Other Works ConsultedFeuerstein JD, et al. (2017). American Gastroenterological Association Institute guideline on therapeutic drug monitoring in inflammatory bowel disease. Gastroenterology, 153(3): 827–834. DOI: 10.1053/j.gastro.2017.07.032. Accessed June 25, 2018.Lichtenstein GR, et al. (2018). ACG clinical guideline: Management of Crohn's disease in adults. American Journal of Gastroenterology, 113(4): 481–517. DOI: 10.1038/ajg.2018.27. Accessed July 12, 2018.Terdiman JP, et al. (2013). American Gastroenterological Association Institute guideline on the use of thiopurines, methotrexate, and anti-TNF-a biologic drugs for the induction and maintenance of remission in inflammatory Crohn's disease. Gastroenterology, 145(6): 1459–1463. DOI: 10.1053/j.gastro.2013.10.047. Accessed June 25, 2018.
Current as of: November 7, 2018
Author: Healthwise Staff
Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Arvydas D. Vanagunas MD - Gastroenterology
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