Crohn’s disease is a chronic, or long-term, condition that causes inflammation of the digestive tract. Crohn’s disease can be painful, debilitating, and sometimes life threatening.
Crohn’s disease is an auto-immune mediated inflammatory condition that can affect any portion of the gastrointestinal (GI) tract, from the mouth to the anus.
The disease primarily involves the intestinal system, but it also has a variety of extraintestinal manifestations and can affect the skin, joints, bones, eyes, kidney, and liver.
Although Crohn’s disease typically starts in childhood or early adulthood, it can start at any age.
Having a support system that understands the experience of having Crohn’s disease is important. IBD Healthline is a free app for people with this condition. The app is available to download from the App Store and Google Play.
In this article, we explain what Crohn’s disease is and how it manifests. We also discuss its causes, diagnosis, complications, and treatment and provide some dietary tips.
Symptoms of Crohn’s disease vary depending on which part of the gut the condition affects. They often include:
- Pain: The level of pain varies between individuals and depends on where the inflammation is in the gut. Most commonly, a person will experience pain in the lower right side of the abdomen.
- Ulcers in the gut: These are raw areas in the gut that may bleed. If this happens, a person may notice blood in their stools.
- Mouth ulcers: These are a common symptom.
- Diarrhea: This can range from mild to severe. Sometimes, there may be mucus, blood, or pus. A person may feel the urge to have a bowel movement but find that nothing comes out.
- Fatigue: Individuals with Crohn’s disease often feel very tired. Fever is also possible during fatigue.
- Altered appetite: At times, a person may notice appetite loss.
- Weight loss: This can result from a loss of appetite.
- Anemia: A loss of blood can lead to anemia.
- Rectal bleeding and anal fissures: The skin of the anus becomes cracked, leading to pain and bleeding.
Other possible symptoms of a Crohn’s disease flare include:
While Crohn’s disease and ulcerative colitis are both inflammatory bowel diseases (IBDs), they are two different conditions.
Crohn’s disease can affect any part of the digestive tract, including the esophagus, stomach, small intestine, and large intestine, also known as colon. Ulcerative colitis, on the other hand, develops solely in the colon.
Another major differentiating factor is the depth of inflammation that affects the intestinal walls. In Crohn’s disease, it is transmural, meaning it’s a full thickness inflammation that involves all layers of the intestinal wall. By contrast, ulcerative colitis involves primarily the top layer, known as the mucosal layer.
Moreover, in Crohn’s disease, a person’s bowels can have healthy sections in between the diseased parts. In ulcerative colitis, however, the damage appears in a continuous pattern.
Crohn’s disease pain may differ from that typical of other gastric diseases, such as irritable bowel syndrome (IBS). Although similar, Crohn’s disease and IBS differ in some ways. A person with IBS may have diarrhea, abdominal pain, and constipation. In contrast, a person with IBS will not show any signs of colon inflammation.
There are five types of Crohn’s disease, and each affects a different part of the GI tract:
- Ileocolitis: This is the most common type of Crohn’s disease. It affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen.
- Ileitis: This form of the condition only affects the small intestine. The symptoms are the same as in ileocolitis, but a person with a severe case could develop fistulas or an inflammatory abscess.
- Gastroduodenal Crohn’s disease: This affects the stomach and the beginning of the small intestine. Symptoms may include nausea, vomiting, loss of appetite, and unexplained weight loss.
- Jejunoileitis: This causes spots of inflammation in the upper portion of the small intestine, called jejunum. Symptoms include abdominal cramping after meals, diarrhea, and, in severe cases, fistulas.
- Crohn’s colitis: This only affects the colon. Symptoms may include diarrhea, rectal bleeding, disease around the anus, such as ulcers, fistulas, and abscesses, joint pain, and skin lesions.
IBDs, such as Crohn’s disease, are
- unexplained weight loss
- bloody diarrhea
- abdominal pain
Children with Crohn’s disease may also experience less common symptoms, such as poor growth and anemia.
When a doctor treats a child with Crohn’s disease, they must consider the effects of the disease on a child’s growth, development, bone health, and psychosocial functioning.
The same report notes that 48–88% of the children had received at least one corticosteroid course, and up to one-third became dependent on steroids. Authors of the report point out there seems to be a trend toward lower surgery rates as the use of immunomodulators and biologicals increases.
Children with Crohn’s disease might need high calorie liquid formulas, especially if the condition affects their growth.
Many people with Crohn’s disease say that the following foods can increase diarrhea and cramping:
- bulky grains
- dairy products
- spicy foods
Some people do not feel like eating. In severe cases, they may need to feed intravenously for a short period. A specific Crohn’s disease diet may help.
Treatment for Crohn’s disease may involve medication, surgery, and nutritional supplements. The aim is to control inflammation, resolve nutritional problems, and relieve symptoms.
There is no known cure for Crohn’s disease, but some treatments can help by reducing the number of times a person experiences recurrences.
Crohn’s disease treatment will depend on:
- where the inflammation occurs
- the severity of the condition
- a person’s response to previous treatment for recurring symptoms
Some people can have long periods, even years, without any symptoms. Experts refer to this as remission. However, there will usually be recurrences.
As periods of remission vary greatly, it can be hard to know how effective treatment has been. It is impossible to predict how long a period of remission is going to be.
There are a variety of medications for Crohn’s disease, including:
- Anti-inflammatory drugs: A doctor will most likely start with mesalamine, which helps control inflammation.
- Steroids: These may include oral steroids, such as prednisone and Entocort, or intravenous steroids, such as SoluMedrol.
- Antibiotics: This type of medication can be useful in Crohn’s disease flare-ups if a person has an abscess or fistula.
- Anti-diarrheal drugs and fluid replacements: When the inflammation subsides, diarrhea usually becomes less severe. However, sometimes a person may still need something to address diarrhea and abdominal pain.
Biologics are a type of drug that scientists have developed from a living organism. Biologics reduce the body’s immune response by targeting proteins that lead to inflammation. They appear to help people with Crohn’s disease.
Below are some examples of this type of medication:
- anti-tumor necrosis factor agents, such as infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia)
- integrin receptor antagonists, such as vedolizumab (Entyvio)
- anti-interleukin-12 and interleukin-23 therapy, which may include ustekinumab (Stelara)
- anti-Janus kinase 1, such as tofacitinib (Xeljanz)
Examples of biologics for Crohn’s disease include:
- infliximab (Remicade)
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
Biologic treatments can produce side effects, including vomiting, nausea, and a weaker resistance to infection.
Some studies suggest the use of biologics can reduce the likelihood of a person needing abdominal surgery within 10 years to 30%. Before the introduction of biologics, researchers put this figure at 40–55%.
Biologics also appear to reduce the risk of adverse effects that can arise when a person uses corticosteroids.
There are different types of biologic drugs, and each person will react to them differently. A doctor will recommend a suitable option. They may also suggest trying an alternative or a combination of drugs if the first one proves ineffective.
Most people with a Crohn’s disease diagnosis may need surgery at some point. A surgical procedure can relieve symptoms that have not responded to medication. It may also help address complications, such as an abscess, perforation, bleeding, or blockage.
Removing part of the intestine can help, but it does not cure Crohn’s disease. Inflammation often returns to the area next to where the removed part of the gut was. In some cases, a person may need more than one surgery in their lifetime.
Sometimes, a person will need a colectomy, in which a surgeon removes the whole colon. They will make a small opening in the front of the abdominal wall and bring the tip of the ileum to the skin’s surface to form an opening called a stoma, through which feces exit the body. A pouch then collects the fecal matter. Doctors say a person who has a stoma can carry on leading a normal and active life.
If the surgeon can remove the diseased section of the intestine and then connect the intestine again, no stoma is necessary.
It is of note that surgery is not an option for everyone and that the disease will recur after the operation.
Most people with Crohn’s disease can live normal and active lives, hold jobs, raise families, and function successfully.
There is no known cure for Crohn’s disease. People can manage their symptoms using natural treatments that are complementary to prescription medications.
Some natural treatment options that may help with Crohn’s disease symptoms include:
- Diet: During a flare-up, a person should avoid high fiber foods, dairy, sugar, high fat foods, and spicy foods. Between flare-ups, it is advisable to drink more water, eat small meals, boil or steam food instead of frying it, and keep a food diary to track how different foods make a person feel.
- Behavioral changes: If a person smokes, they may consider quitting. They can also try relaxation practices and techniques, such as meditation, mindfulness, or yoga. Exercise and mental health counseling could be helpful as well.
- Supplements: Certain supplements, including curcumin, probiotics, bromelain, and
wormwood, may prove effective.
- Essential oils: Some essential oils, such as
patchouli, peppermint, and fish oil, may help reduce inflammation.
It is not clear what causes Crohn’s disease. Experts suggest it
Factors that may increase the risk of inflammation include:
- genetic factors
- a person’s immune system
- environmental factors
Smoking is another risk factor.
A doctor will ask a person about any signs and symptoms. A physical examination may reveal a lump in the abdomen resulting from when loops of inflamed bowels become stuck together.
The following tests may help in the diagnosis:
- stool and blood tests
- sigmoidoscopy, where a doctor uses a short, flexible tube, or sigmoidoscope, to investigate the lower bowel
- colonoscopy, during which a doctor uses a flexible tube, or colonoscope, to investigate the colon
- endoscopy, which doctors carry out if symptoms occur in the upper part of the gut. A long, thin, flexible telescope, or endoscope, goes down through the esophagus, or food pipe, into the stomach.
- CT scan or barium enema X-ray, which help reveal changes inside the bowel
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 a buildup of scar tissue and partial or complete blockage of the intestine
- perforation, which is when a small hole develops in the wall of the gut, from which contents can leak or cause infections or abscesses
- fistulas, when a channel forms between two parts of the gut
Additionally, a person may experience:
- a persistent iron deficiency
- food absorption problems
- a slightly higher risk of developing bowel cancer
Can Crohn’s disease be fatal?
Typically, Crohn’s disease is not life threatening but can cause complications that may be fatal. Some of these complications include colorectal cancer and severe infections.
A person’s life expectancy for Crohn’s disease is usually the same as that of a person without the condition.
Experts determine whether Crohn’s disease is a disability on a case-by-case basis, because each person with the condition will have a different experience.
A person with Crohn’s disease could qualify for disability insurance if the condition causes an inability to work. Many people with IBD may need to go through a series of appeals before the authorities approve their disability claim.
Crohn’s disease is a chronic, or long-term, condition that causes inflammation of the digestive tract.
Crohn’s disease can be painful and reduce a person’s quality of life. There are complications of Crohn’s disease that can be fatal.
A person with Crohn’s disease can manage symptoms with medication, stress reduction, and therapy. Surgery may be required to manage Crohn’s disease in some cases.