Crohn's disease

Crohn’s disease is a chronic (long-term) condition that causes irritation and inflammation in the gastrointestinal (GI) tract, which includes the large and small intestines. These organs digest the foods you eat and help maintain your body’s water balance. Crohn’s most often affects the lower end of the small intestine and the upper portion of the large intestine. Less commonly, Crohn’s disease occurs in other parts of the digestive tract, such as the mouth, esophagus (the tube that connects the mouth and stomach), stomach, and anus.  

First described by Burrill B. Crohn, MD, in 1932, Crohn’s disease tends to develop gradually and worsen with time, although treatment can help. Phases of remission (or periods when symptoms ease or go away completely) may occur for weeks or years.

How common is Crohn's disease?

Though it’s hard to pin down precise numbers, Crohn’s disease is believed to affect more than half a million people in the U.S. Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, impacts around 3.1 million people in the U.S. Research from the Centers for Disease Control and Prevention  (CDC) also shows the incidence of Crohn’s disease and other types of inflammatory bowel diseases appears to be on the rise among older Americans of all racial and ethnic backgrounds.

Is Crohn's disease an autoimmune condition?

Many healthcare experts view Crohn’s disease as an autoimmune condition, which means it results from the immune system mistakenly attacking healthy cells. In some cases, the immune response is triggered by a foreign microorganism or environmental factor. This aggressive immune response targets cells in the GI tract and can lead to intestinal damage over time.

What is the difference between Crohn’s disease and ulcerative colitis?

Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases that can cause similar symptoms. Ulcerative colitis differs from Crohn’s disease in that it is confined to the colon (the longest section of the large intestine). On the other hand, Crohn’s disease most often develops in the lowest part of the small intestine (ileum) and the beginning of the large intestine (cecum). Still, patches of Crohn’s disease can occur in any part of the gastrointestinal tract, from the mouth to the anus.  

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There are five main types of Crohn’s disease, including: 

• Ileocolitis: This is marked by inflammation in the small intestine and a portion of the large intestine. It’s the most common type of Crohn’s disease.   
• Ileitis: This involves inflammation in the ileum, or the lowest part of the small intestine next to the colon. 
• Gastroduodenal: This is characterized by inflammation that impacts the stomach and the start of the small intestine, called the duodenum.
• Jejunoileitis: This involves spotty areas of inflammation in the middle part of the small intestine, called the jejunum.  
• Crohn’s colitis: This only affects the large intestine. It is more commonly associated with skin lesions and joint pain than other types of Crohn’s disease.

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The symptoms of Crohn’s disease depend on what parts of the GI tract are affected. In general, the most common Crohn’s disease symptoms include:

• Stomach cramps
• Reduced appetite and weight loss 
• Watery diarrhea that may contain blood
• Fever
• Fatigue
• A frequent urge to go to the bathroom, even if your bowels are empty

Crohn’s disease symptoms may also involve:

• Mouth ulcers
• Constipation
• Bloody stools or rectal bleeding
• Eye swelling or sores
• Joint swelling and pain
• Swollen gums
• Tender, red bumps underneath the skin that may form ulcers
• Drainage of stool, pus, or mucus from the anus   
• Kidney stones
• Inflammation in the liver or bile ducts
• Delayed growth or sexual development (in children)

The symptoms of Crohn’s disease may be mild or severe, and they tend to come and go with periods of flare-ups (when symptoms worsen) and remission.

How are Crohn’s symptoms different in women and men?

While Crohn’s disease symptoms are generally the same in people assigned female at birth (AFAB) and people assigned male at birth (AMAB), there are some differences. For example, people AFAB with IBD are more likely to experience menstrual pain and irregular periods than those without IBD. Crohn’s disease symptoms like abdominal pain and diarrhea may worsen before and during a menstrual period.

Furthermore, experiencing bloody stools as well as having a period can put people at an increased risk of anemia.

People AFAB with IBD have an increased risk of developing osteoporosis before menopause due to malnutrition or taking steroids to help control flares. (Crohn’s disease can make it difficult to eat a range of foods and to absorb nutrients from food.) Experiencing Crohn’s disease flare-ups during pregnancy may also increase the risk of miscarriage, premature labor, or low birth weight, although this is uncommon.

People AMAB who have IBD are usually diagnosed later in life than people AFAB with IBD. They also have a higher risk of developing colorectal cancer and a rare liver disease called primary sclerosing cholangitis (PSC), as well as a decrease in sexual desire. Further research into how biological sex influences the symptoms of Crohn’s is ongoing.

When should I see a healthcare provider?

It’s always a good idea to speak with a healthcare provider (HCP) about Crohn’s disease if you notice unusual changes in your bowel habits that persist for more than a few days. This may include frequent diarrhea, constipation, abdominal pain, or persistent nausea. If you’ve already received a Crohn’s disease diagnosis and are experiencing uncomfortable flare-ups, an HCP can help you identify ways to better manage your symptoms and find meaningful relief.

Crohn’s disease flare-ups may sometimes involve symptoms that require immediate medical attention. Seek prompt care if you experience:

• Intense, persistent pain
• Frequent vomiting
• Trouble keeping down liquids 
• Rectal bleeding or bloody stool
• A lingering fever higher than 100.3 degrees Fahrenheit

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The precise cause of Crohn’s disease isn’t fully understood. Many experts believe that the body’s immune system and inherited factors play a role in the onset of the condition. Diet and lifestyle factors—such as frequent stress or eating a diet high in fat, sugar, and processed foods—can also influence the severity of symptoms but are not believed to be direct causes of Crohn’s disease.

Who is at risk for Crohn's disease?

Crohn’s disease can affect anyone at any age, although it’s most likely to be diagnosed in people between the ages of 20 and 30. Other risk factors that increase a person’s likelihood of developing Crohn’s disease include:

• Having a family member—usually a parent or sibling—with Crohn’s disease or another type of inflammatory bowel disease
• Being white or having Eastern European Jewish decent
• Smoking tobacco

It’s important to note that having one or more risk factors does not mean a Crohn’s disease diagnosis is inevitable. On the other hand, it’s also possible to develop Crohn’s disease without any known risk factors.

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Visiting an HCP, such as a primary care physician, is the first step in diagnosing Crohn’s disease. This professional will listen to your concerns and ask you questions about your symptoms. They may also want to discuss your personal and family medical histories, diet habits, and what medicines you’re currently taking, if any.

Next, your HCP will typically perform a physical exam to check for areas of swelling and tenderness around the abdomen. Depending on your symptoms and medical history, an HCP may refer you to a gastroenterologist, or a physician who specializes in evaluating and treating GI disorders. Your provider may then order a series of tests to pinpoint the cause of your symptoms and to make a diagnosis.  

Lab Tests

There are several lab tests that may be used to help confirm or rule out a diagnosis of Crohn’s disease. Blood tests can help uncover evidence of inflammation and complications related to Crohn’s disease. You may also be asked to provide a stool sample, which can be used to test for viral, bacterial, and parasitic infections in the GI tract.

Upper GI series

Also referred to as barium swallow, this is a special type of imaging test that uses fluoroscopy (an X-ray for moving organs) and barium liquid to produce detailed pictures of the upper gastrointestinal tract.

Immediately before the test, you’ll be asked to drink a chalky liquid containing a metallic compound called barium sulfate. The liquid coats the GI tract and helps organs appear more clearly on X-ray images. You’ll then lie on a table as a fluoroscopy imaging device captures in-motion pictures of the liquid passing through your GI tract.  

Lower GI series 

A lower GI series, also called a barium enema, examines the large intestine. During the test, a flexible tube with barium liquid is inserted into the rectum to coat the inside of the intestine and help it appear more clearly on an X-ray. A lower GI series exposes abnormalities that can point to Crohn’s disease, such as intestinal blockages and narrowed areas (also known as strictures).

Upper endoscopy (EGD)

An upper endoscopy allows your HCP to view your esophagus, stomach, and upper portion of the small intestine (duodenum) to check for signs of Crohn’s disease. During the procedure, an endoscope—a flexible, lighted tube with a small camera on the end—is inserted into your mouth and fed down to the small intestine. The procedure is performed using sedation, so you shouldn’t feel any discomfort.  

An enteroscopy is another diagnostic method similar to an endoscopy. During an enteroscopy, a special, long endoscope is used to access parts of the GI tract that a regular endoscope may not be able to reach.

In some cases, an HCP may want to perform a biopsy during an upper endoscopy procedure. A special tool at the end of the endoscope can be used to take a small sample of tissue from the GI tract for further examination.

Capsule endoscopy 

A capsule endoscopy involves swallowing a small capsule that contains a tiny camera. As the capsule travels down the GI tract, it captures images of the small intestine and sends them to a computer for review by an HCP. The capsule will then pass comfortably out of your body via stool.

Computed tomography (CT) scan

A CT scan is an imaging test that uses computer and X-ray technologies to produce pictures of the gastrointestinal tract. Before the test, you may receive an injection of a contrast dye and be asked to drink a solution that will help outline GI organs and expose abnormalities on the scanner.  

A CT scan involves different equipment than a standard X-ray. During the procedure, you’ll lie on a table that moves into a tunnel-shaped device that takes X-ray images.

Magnetic resonance imaging (MRI)

Another type of imaging test, an MRI scan uses a magnetic field and radio waves to produce images of the intestines. It may be performed with the assistance of intravenous (IV) or rectal contrast dye to help outline organs. MRI is often used to assess disease progression or evaluate fistulas (ulcers that penetrate the intestinal wall) in the intestines or anal area.

Enteroclysis

Enteroclysis is an X-ray imaging test that focuses on the small intestine. Before the procedure, a barium sulfate liquid is fed to the small bowel through a thin, lubricated tube that’s inserted into your nose or mouth. This liquid helps highlight the small intestine. As you lie on a table, fluoroscopic imaging takes in-motion X-ray images of the small intestine. You may be asked to move slightly during the test so the X-ray can capture pictures from different angles.

Colonoscopy

A colonoscopy is a procedure in which a thin, flexible tube called a colonoscope is inserted into the rectum and directed to the colon (large intestine) and the end of the small intestine. This tube has a small camera and a light on the end to capture detailed images of the colon and to screen for abnormalities. You’ll be sedated or given anesthesia to keep you comfortable during the procedure.

A similar procedure, called a flexible sigmoidoscopy, uses a colonoscope to examine just the lower portion of the large intestine (the sigmoid colon) and the rectum.

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There are several approaches to Crohn’s disease treatment, including medications, surgery, and lifestyle modifications. The best course of treatment for your case will depend on factors such as your symptoms, overall health, and care preferences. While there’s currently no cure for Crohn’s disease, proper management of the condition can help prevent flare-ups and improve quality of life.

Medication

Medications for Crohn’s disease generally focus on controlling the body’s immune response and reducing inflammation. Depending on your symptoms and type of Crohn’s disease, your HCP may prescribe one or more of the following medications:

• Anti-inflammatory drugs: Drugs like aminoacylates that help reduce inflammation can be effective for some people with mild to moderate Crohn’s disease symptoms. 
• Corticosteroids: Also referred to as steroids, corticosteroid drugs help quiet the body’s immune response and reduce inflammation. When combined with anti-inflammatory drugs, corticosteroids have the potential to provide significant relief for people with moderate to severe symptoms.   
• Immunomodulators: Often recommended for people who don’t respond well to other Crohn’s disease medications, immunomodulators work by suppressing or slowing immune system activity and reducing inflammation in the gastrointestinal tract. This may help counter the body’s abnormal response to food and bacteria in the digestive tract.  
• Antibiotics: Antibiotics can be prescribed to help prevent or treat infections and reduce drainage from abscesses and fistulas. Some experts also believe antibiotics can lower the quantity of inflammation-causing bacteria in the GI tract. Commonly used antibiotics for Crohn’s disease include metronidazole and ciprofloxacin.

Certain over-the-counter medications, such as acetaminophen and loperamide (an anti-diarrheal drug) can help provide occasional, short-term relief from Crohn’s disease symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen should be avoided, as they raise the risk of stomach ulcers and bleeding in the GI tract. Be sure to speak with your HCP before taking these medications if you have Crohn’s disease.

Biologics

Biologic therapy is a promising type of Crohn’s disease medication that may lead to remission of symptoms. It does so by targeting inflammation-triggering proteins in the immune system. Biologics are sometimes administered in a hospital or outpatient clinical setting. They are divided into three main classes:

• Anti-TNF (tumor necrosis factor) agents: These biologics work by blocking proteins that cause inflammation in the digestive tract. Examples of anti-TNF agents include golimumab, infliximab, adalimumab, and certolizumab pegol. 
• Anti-integrin therapy: This type of biologic stops white blood cells from attaching to the lining of the GI tract and causing inflammation. Examples of anti-integrin therapies include vedolizumab and natalizumab.
• Anti-interleukin-12 and interleukin-23 therapy: These biologics (ustekinumab and risankizumab) interfere with the actions of proteins or other molecules related to inflammation.

Surgery

Surgery isn’t a viable option for everyone with Crohn’s disease. Still, many people with the condition eventually require some type of surgical treatment to remove a diseased section of the gastrointestinal tract or to address complications, such as fistulas and intestinal obstructions.

While Crohn’s disease surgery doesn’t cure the condition, it can significantly improve quality of life for people with severe symptoms that don’t improve with non-surgical treatments. Examples of surgical procedures for Crohn’s disease include:

• Subtotal colectomy: A portion of the large intestine is removed through one large incision or via several small incisions (also known as laparoscopy). This surgery is also referred to as a large bowel resection.
• Small bowel resection: A portion of the small intestine is removed through one large incision or via laparoscopy.
• Proctocolectomy: The colon and rectum are removed. The end of the small intestine (ileum) is then attached to a surgically created opening in the abdomen (ileostomy) to provide a way to pass stool.H3: Bowel Rest

Resting your bowels for a few days or weeks may be helpful if you’re experiencing severe Crohn’s disease symptoms. Bowel rest involves consuming only certain types of liquids to allow your intestines to rest and heal. Your HCP can offer guidance about what type and duration of bowel rest is best for your needs.

Lifestyle modifications

Everyone is different, but some people find it helpful to supplement clinical treatment with alternative approaches to treat Crohn’s disease. For example, stress can aggravate Crohn’s disease symptoms and trigger flare-ups, so trying techniques to reduce stress may help you manage your condition.

To keep stress in check, consider trying: 

• Slow, deep breathing exercises
• Yoga
• Regular low-impact exercise, such as walking, stationary cycling, or swimming
• Journaling
• Prayer or meditation 
• Enjoying relaxing activities, such as reading a book, listening to music, or talking to a friend

Your HCP can help you identify what types of exercise and stress-relieving techniques are ideal for your needs.

If you smoke, it’s also important to quit as soon as possible. Quitting smoking will improve your digestive and overall health. 

Additionally, certain nutritional supplements may help ease the symptoms of vitamin deficiencies related to Crohn’s disease and prevent the malnutrition that results from a damaged digestive tract. Ask your HCP if supplements containing the following nutrients could benefit you:

• Magnesium
• Iron
• Folate  
• Vitamin B12
• Vitamin D
• Calcium

What are the potential complications of Crohn's disease?

Crohn’s disease can trigger a wide range of complications, especially if it’s poorly managed. Potential complications of Crohn’s disease include:

• Ulcers: Open sores can develop anywhere in the gastrointestinal tract, including the mouth. Treating Crohn’s disease usually resolves stomach ulcers.
• Bowel obstructions: A buildup of scar tissue in the intestines may block the flow of digested food and waste material. Surgical removal of blockages is often necessary.
• Anal fissures: Tiny tears in anal tissue can make bowel movements uncomfortable. Anal fissures can often be treated with simple measures like diet changes, ointments, and warm baths.   
• Fistulas: Fistulas occur when ulcers penetrate the intestinal wall and create an abnormal connection between two body parts, such as the intestines and skin. Some fistulas can resolve with medicine or diet changes, although surgery may be necessary for others.
• Malnutrition: This may result from a lack of ingested nutrients caused by Crohn’s symptoms like diarrhea, vomiting, and loss of appetite. Conditions like anemia and osteoporosis can result from malnutrition. IV fluids or feeding tubes may be used to help replace lost fluids and nutrients.
• Hidradenitis suppurativa: This skin condition causes abscesses and deep nodules and tunnels to form around the genital area, armpits, or underneath breasts. A combination of medications and skin care are often used to manage hidradenitis suppurativa. Procedures to remove or drain abscesses may also be necessary.
• Colon cancer: Cancer that forms in the colon or the large intestine. People with Crohn’s disease should receive colon cancer screening more frequently than those without Crohn’s disease. Surgery is the primary form of treatment for colon cancer.

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Diet plays a key role in Crohn’s disease management. Your ideal Crohn’s disease diet will depend on your symptoms, individual triggers, and what treatments you’re receiving. But most HCPs recommend taking the following steps:

• Avoiding carbonated waters and sodas
• Limiting or avoiding alcohol, spicy foods, and beverages that are caffeinated or sweetened with sugar
• Cooking vegetables (rather than eating them raw) and cutting them into small pieces
• Eating small amounts of food throughout the day instead of large meals
• Keeping a food diary to keep track of your diet and any resulting symptoms

Many HCPs also recommend that people with Crohn’s disease make several broader diet modifications. These include the following:

Adjust insoluble fiber intake

Fiber is an important nutrient for one’s overall health. But consuming too much insoluble fiber (the kind that doesn’t dissolve in water) can be hard on your intestines and can aggravate Crohn’s disease symptoms. Examples of foods rich in insoluble fiber include raw kale, apples (with skin), seeds, nuts, beans, and lentils.

Limit fat intake

While healthy fats are beneficial for most people with Crohn’s disease, saturated and trans fats should be limited or avoided altogether. Foods and beverages that are often high in saturated or trans fats include:

• Lard and shortening
• Whole milk
• Full-fat cheeses, yogurt, and sour cream
• Butter and stick-form margarine
• Red meats, especially meats with visible sections of fat
• Dark-meat chicken and chicken skin
• Most processed, pre-packaged snacks
• Candy
• Deep-fried foods like French fries, potato chips, and donuts

Limit dairy intake

There are several reasons why dairy and Crohn’s disease aren’t usually a good match. In addition to fat, most dairy products contain lactose, a naturally occurring sugar that can trigger digestive distress in people with Crohn’s disease of the small intestine. 

If you have Crohn’s disease, some forms of dairy may be easier to enjoy than others. For example, dairy products that are lactose-free or contain a lower amount of this sugar include:   

• Greek yogurt
• Low-fat cheeses, such as feta and goat cheese
• Lactose-free cow’s milk and yogurts
• Plant-based milks, such as almond, flaxseed, or pea milk (people with Crohn’s disease should avoid soy milk)

Drink enough water

Crohn’s disease symptoms like vomiting and diarrhea increase the risk of dehydration, so keeping hydrated is a critical part of managing your condition and staying healthy. The best way to stay hydrated is to drink plenty of water.

The CDC offers a few easy tips to increase water consumption and avoid dehydration:

• Order water when you eat at restaurants. This will save you money, too.
• Carry a reusable water bottle throughout the day and refill it when empty.
• Keep a few freezer-safe water bottles in the freezer to enjoy icy cold water on hot days.
• Add a lemon or lime wedge to water to add some flavor. 
• Drink water during meals.  

If you need an extra boost of hydration after a Crohn’s disease flare-up, consider giving coconut water a try. It can help replenish some of the electrolytes (essential minerals) that you may lose through vomiting or diarrhea. Just stay clear of electrolyte beverages that are high in sugar, such as sports drinks. Sugar often appears on nutrition labels as high-fructose corn syrup, sucrose, or glucose.

Consider alternative sources of vitamins and minerals

If tests show you’re deficient in certain vitamins and minerals, taking supplements may help you receive the nutrition you need to avoid complications and stay healthy. Supplements that are commonly recommended for people with Crohn’s disease include iron, calcium, folic acid, and vitamin B12.

With these general guidelines in mind, be sure to check in with your HCP before making any changes to your diet or supplement regimen.

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Crohn’s disease isn’t curable, but treatment can help. Finding the right combination of diet and treatment can help you lead an active, healthy life with Crohn’s disease.

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Crohn’s disease itself is not a deadly condition. People with Crohn’s disease generally have the same life expectancy as those without it. Still, certain Crohn’s disease complications (namely colon cancer) are life-threatening. If you have Crohn’s disease, it’s important to receive colon cancer screening early and often and to promptly discuss unusual symptoms with an HCP.

Crohn’s disease flare-ups can be frustrating and may require you to make adjustments to your daily life. The stress of living with Crohn’s disease can also take a toll on your mental health.

You may benefit from speaking to a therapist about your experience or joining a Crohn’s disease support group. Talk to your HCP about the kind of mental health support that may be best for you. If you’re struggling to cope with Crohn’s disease symptoms, your HCP is your best resource and ally. 

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