Crohn’s Disease

What Is Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract. The condition most commonly impacts the small and large intestines. Crohn’s disease inflames the intestine walls, which can cause damage that reaches the outer lining.

Crohn’s disease can occur at any age and is often diagnosed between the ages of 20 and 30 according to the Crohn’s & Colitis Foundation (Opens in a new window).

Crohn’s disease is chronic. That means it is a long-lasting health condition. Chronic conditions require ongoing management. Treatments can reduce swelling, improve symptoms, and lower the rate of recurrence, according to the National Institutes of Health (Opens in a new window).

Types of Crohn’s Disease

There are five different types of Crohn’s disease. The type depends on which part of the digestive tract is affected.

• Crohn’s Colitis: In this type of disease, only the colon (also known as the large intestine) is affected.
• Gastroduodenal Crohn’s Disease: This type affects the stomach and the beginning of the small intestine (also known as the duodenum).
• Ileitis: Only the small bowel (ileum) is affected in this type of disease.
• Ileocolitis: This is the most common type of Crohn’s disease. It affects the end of the small intestine (terminal ileum) and the large intestine (colon).
• Jejunoileitis: This type of the condition has areas of inflammation in the upper half of the small intestine (jejunum).

Causes of Crohn’s Disease

Crohn’s disease is an autoimmune condition. In a normal immune response in the digestive system, cells travel from the blood to the intestines and produce inflammation to fight off foreign invaders. In Crohn’s disease, the immune system mistakes harmless bacteria, food and healthy tissues for foreign bodies. The abnormal inflammation produced by the immune system leads to symptoms of Crohn’s disease.

Crohn’s Disease Risk Factors

• Certain medications: Some medicines may slightly increase the risk of Crohn’s disease. These can include antibiotics, birth control pills, and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Environmental factors: People in developed countries have a higher risk of Crohn’s disease.
• Genetic factors: Crohn’s disease runs in families. Your risk is higher if you have a parent or sibling with the condition. The risk is much higher if both parents have IBD.
• Smoking: This can double the risk of developing Crohn’s disease.

Prevention

There is no guaranteed way to prevent Crohn’s disease, but you may be able to reduce risk. Crohn’s and Colitis Foundation (Opens in a new window) reports that risk can be significantly lowered by:

• Avoiding smoking and unnecessary NSAID use
• Eating a nutritious diet
• Keeping a healthy weight
• Staying active.

Taking small steps to improve gut health may not guarantee prevention, but they can lower risk.

Crohn’s Disease vs. Ulcerative Colitis

Crohn’s disease and ulcerative colitis are both forms of inflammatory bowel disease.

Ulcerative colitis: Affects only the colon. It involves continuous inflammation limited to the inner lining.

Crohn’s disease: Can affect any part of the digestive tract. Crohn’s often involves deeper layers of the bowel wall.

Signs and Symptoms

Crohn’s disease is a chronic condition, but its symptoms may not be constant. Most patients experience periods of active symptoms, known as Crohn’s flares. They also have periods of remission when there may be no symptoms at all. Though genetics plays a large role in this disease, stress, infections, smoking, certain medications, and dietary triggers may contribute to a Crohn’s disease flare up.

Symptoms vary in severity, but may include:

• Cramping or pain in the abdomen
• Diarrhea
• Fatigue
• Fever
• Loss of appetite
• Mouth ulcers
• Nausea and vomiting
• Weight loss

Complications of Crohn’s Disease

• Abscesses (pockets of infection within the body)
• Anal fissures (small tears in the anus)
• Blockage in the intestine
• Cancer of the colon, rectum and small bowel
• Fistulas (abnormal tunnels connecting two parts inside of the body)
• Inflammation of eyes, joints, or skin
• Malnutrition
• Narrowing of the intestines
• Ulcers (open sores in the anus, intestines, or mouth)

The unpredictable symptoms of Crohn’s disease can significantly impact quality of life. If you or a loved one experience symptoms, see a gastroenterologist for diagnosis and treatment.

Diagnosis

Crohn’s disease can quickly worsen and cause more serious complications. Early diagnosis is important to manage symptoms. The doctor will take your medical history and your family health history. You will also have a physical exam. Different tests can be used to diagnose Crohn’s disease.

Imaging Tests

Computerized tomography (CT) scan: This test creates detailed images of the bowel. These images can help find problems like hidden infections, blockages and other abnormalities.

Lab Tests

Blood and stool tests: A sample of blood or stool is analyzed to look for inflammation. Some blood tests can help your doctor differentiate between Crohn’s disease and ulcerative colitis.

Procedures

Capsule endoscopy: During this procedure, you swallow a vitamin-sized pill that contains tiny cameras, a light and a transmitter. As it travels through your digestive tract, it captures thousands of high-definition images. These images are sent to  a recording device. The doctor uploads and reviews the images.

Colonoscopy: In this test, a flexible tube with a camera called a colonoscope is inserted into the anus. This allows your doctor to view the bowel lining for areas of redness, swelling, and ulcers. Small tissue samples may be taken during the procedure for further analysis.

Endoscopy: Like a colonoscopy, this test uses a flexible tube with a camera called an endoscope. It is inserted through the mouth. Endoscopy lets the doctor see the esophagus, stomach and upper small intestine. Small tissue samples may be taken during the procedure for further analysis.

Treatment

There is no cure for Crohn’s disease, but most people with the condition can live active lives. Evidence-based treatments help reduce inflammation and lower the risk of complications. Many people also have long periods of remission between flare-ups. The best treatment depends on where the inflammation occurs and how severe it is. Crohn’s disease is a chronic condition and requires ongoing monitoring by blood tests, stool tests and endoscopy. This helps your doctor evaluate disease activity and manage treatment. Colonoscopy or capsule endoscopy may be performed every 6-12 months for patients in remission or every 2-4 months for active Crohn’s disease.

Medications

Reducing inflammation can allow the intestinal tissue to heal. Less inflammation also provides relief from the most common symptoms. Medications can also extend periods of remission. Some of the medications used to treat Crohn’s disease include:

• Aminosalicylates: These anti-inflammatory drugs that may be used for a person with a recent diagnosis and mild symptoms.
• Antibiotics: These medications may be used during a Crohn’s disease flare if the person has an abscess or fistula.
• Antidiarrheal drugs: People with Crohn’s disease may need a treatment for diarrhea and abdominal pain.
• Biologics: These drugs reduce the body’s immune response by targeting proteins that cause inflammation.
• Immunomodulators: These medications lower inflammation by suppressing the immune system.
• JAK modulators: This class of drug blocks JAK enzymes to reduce inflammation and provide quick symptom relief. JAK modulators can help patients reach remission.
• Steroids: These medications may be used as a short-term treatment to quickly reduce inflammation and suppress immune system activity.

Biologics and immunomodulators are used to induce remission and are often continued as maintenance medications.

Surgery

If Crohn’s disease doesn’t respond to medical treatment, surgery may be needed. Surgical procedures involve removing a damaged part of the digestive tract.

Surgery may be used to treat serious complications, including:

• Fistulas
• Intestinal obstructions
• Life-threatening bleeding

Lifestyle Management

Diet is critical to manage Crohn’s disease symptoms. The Mediterranean diet (Opens in a new window) is best for improving Crohn’s disease. Inflammatory foods that should be avoided or limited include:

• Alcohol
• Caffeinated beverages
• Carbonated drinks
• Dairy-heavy food
• Greasy or spicy foods

Other habits that may help manage symptoms include:

• Drinking more water
• Eating soft, bland foods
• Eating smaller meals more frequently
• Getting quality sleep
• Keeping a food diary to help you identify foods that trigger Crohn’s symptoms
• Physical activity
• Quitting smoking

Other Treatment for Crohn’s Disease

Bowel rest is another treatment that may be used for Crohn’s disease if symptoms are severe. This treatment involves drinking certain liquids and not eating or drinking anything else, which allows the intestines to rest. The person receives nutrients from drinking a liquid, a feeding tube or an IV tube. This treatment may need to be done in a hospital, and it lasts for a few days to several weeks.

Clinical Trials

Clinical trials help determine new treatment options for Crohn’s disease. Patients with Crohn’s disease have access to clinical trials at National Jewish Health. Speak with your doctor to find out if a clinical trial may be a good fit for you.

Remission and Outlook

Many people with Crohn’s disease experience periods of remission when symptoms improve or disappear. Long-term management focuses on preventing flares, maintaining mucosal healing, and improving quality of life. With modern biologic therapies and careful monitoring, many patients lead full and active lives.

When to See a Specialist

If you or a loved one has symptoms of Crohn’s disease, it’s important to be evaluated by a gastroenterologist.

National Jewish Health in Denver, Colorado provides expert care for Crohn’s disease. Learn more about our gastroenterology program or use the button below to make an appointment.