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Overview

If you have persistent symptoms such as diarrhea and abdominal pain or cramps, it could be Crohn’s disease. A chronic disorder, Crohn’s disease may cause you to have a wide-range of digestive symptoms that may be mild or severe and may flare up over time.

  • What is Crohn’s disease?

    Crohn’s disease is when there is irritation in the intestines. This is a type of inflammatory bowel disease (IBD). It can affect anywhere from the mouth to the anus (end of the bowel).

    Crohn’s disease usually occurs in the last part of the small intestine and the beginning of the colon. Sometimes it can show up in patches anywhere in the intestines though. If the irritation goes on for too long it can cause damage. This damage can be scar which narrows the bowel. Also, the body can form a tunnel going from inside the bowel out to the surface. This is called a fistula and can attach the bowels to other body parts like the skin or bladder. When this happens other problems can occur.

  • What is the outlook for people with Crohn’s disease?

    Since Crohn’s disease has no cure, medicines are need to keep it under control. Usually this works and people can go a long time without issues. But sometimes Crohn’s can still flare up even when on medicine. If that happens, different medicines can be tried. It is important to always take your medicine even when you feel good. If the irritation in gut comes back, you may not feel it. If irritation goes on for a long time, damage can happen that may need surgery to fix. The best way stop that is to look for signs of irritation and damage. Seeing your doctor for check-ups can do this and help you feel as good as possible.

    Women who have Crohn’s disease can get pregnant and everything be normal. If you have Crohn’s disease and want to get pregnant, you should talk with your Crohn’s doctor first. The best time to get pregnant is when you are feeling good. This will lower the chances of any problems with the pregnancy. If you do get pregnant when the irritation is bad, that can higher the chances of problems like losing the baby. This is why it’s important to keep the irritation under control after you get pregnant.

  • What are the signs and symptoms of Crohn’s disease?

    Signs and symptoms can be mild or severe and can be different. It depends on the part of the digestive tract involved. Symptoms usually build over time but also can happen suddenly.

    The most common symptoms of Crohn’s disease are:

    • Diarrhea
    • Pain and cramping in the abdomen (belly)
    • Feeling tired
    • Feeling the need to have a bowel movement
    • Fever
    • Weight loss

    Other symptoms may include:

    • Blood in the stool
    • Drainage around the anus
    • Joint pain
    • Lack of hunger
    • Nausea and vomiting
    • Pain, redness, or swelling in the eyes
    • Rashes
  • When should I see a doctor about Crohn’s disease?

    The signs and symptoms of Crohn’s disease can be like other conditions. If you have any symptoms, or changes in your bowel habits that don’t go away, see your doctor and get checked out.

  • What causes Crohn’s disease?

    Doctors don’t know the exact causes of Crohn’s disease. They think certain factors could be involved, such as:

    • Genes: People who have a family member with Crohn’s disease are more likely to get it.
    •  Infection can start Crohn’s disease: This is by turning the immune system on to attack the bowels but it never turns back off.
  • What are the risk factors for Crohn’s disease?

    Risk factors for Crohn’s disease can include:

    • Age: Most people get it are in their twenties, but it can happen at any age.
    • Family history:If you have one parent with Crohn’s disease, odds of getting it are 7 to 10 percent. If both parents have it, the odds go up to 35 percent.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs):While medicines such as aspirin, ibuprofen and naproxen do not cause Crohn’s disease, they can worsen inflammation and make the disease worse.
    • Race and ethnicity: White people and people of Eastern European Jewish (Ashkenazi Jewish) descent are at the highest risk.
    • Smoking:  Tobacco use doubles the risk of Crohn’s disease. It also increases the chances of having a more severe form that needs surgery.
    • Location: People who live in more developed countries and cities are also at higher risk.
    • Antibiotics:These can change the healthy bacteria living in the colon. These play a part in how the immune system is working in the intestines.
  • Who should be evaluated for Crohn’s disease?

    See your doctor if you have any of the signs, symptoms, or risk factors for Crohn’s disease. Your doctor will perform an exam and testing. This will see if you do have it or another condition instead.

  • How is Crohn’s disease diagnosed?

    Your doctor will discuss your symptoms, medical history and risk factors for Crohn’s disease and conduct a physical exam to check for signs of the condition. Although no single test for Crohn’s disease exists, a combination of tests can rule out other conditions and confirm a diagnosis. Your doctor will hear your symptoms, medical history and risk factors. They will also do an exam looking for any signs. No one test for Crohn’s disease exists, but a mixture of tests can rule out other problems and make the diagnosis.

    Tests that you may need:

    • Blood tests: Look for signs of infection, anemia (low blood count), low vitamin levels and abnormal liver tests.
    • Stool samples: Check for blood, inflammation or infections in the stool.
    • CT scans or MRI imaging:X-rays that see parts of the digestive tract in more detail. Can also see other parts of the body too.
    • Barium x-rays:  Also an x-ray that shows how the bowel is shaped and looks. Can be done by drinking a liquid or having it put inside your bowel with an enema.

    Doctors may also use diagnostic procedures such as:

    • Colonoscopy or flexible sigmoidoscopy: Using a thin, flexible tube with a lighted camera, your doctor looks at the inside lining of the colon. They can possibly see the lower end of the small intestine as well.
    • Biopsy: Your doctor may perform this during a colonoscopy. A small tissue sample is taken and looked at under a microscope.
    • Upper endoscopy: Also called an esophagogastroduodenoscopy (EGD), this procedure examines the upper part of the digestive tract.
    • Capsule endoscopy:You swallow a pill containing a tiny camera. This takes pictures of the digestive tract. It then sends the pictures to a computer for your doctor to look at.
  • What are the treatments for Crohn’s disease?

    Currently, there is no cure for Crohn’s disease. But treatments work differently in different people. There are many goals of treatment. They are to relieve symptoms and improve your quality of life. Also to heal the inflammation and prevent damage.

    Doctors usually start medicines to make symptoms go away. Then you can get medicines to keep it under control and prevent it from coming back.

    Medications

    Your doctor may use one or more medications such as:

    • Steroids: Some decrease inflammation throughout the body by suppressing the entire immune system. Others work just in the bowel and do not affect the immune system.
    • Immunosuppressant medications:  These medications reduce the body’s immune response. This reduces inflammation and allows the intestine to heal.
    • Biologic therapies:These medications block the body’s immune response. Doctors typically use biologic therapies to treat moderate to severe Crohn’s disease.
    • Antibiotics:These medications are used if a pocket of pus (called an abscess) or a fistula are present. They may also be used to get rid of harmful bacteria in the intestines that could be making things worse.

    Nutrition therapy

    • In children, special liquid diets can help some in treating Crohn’s disease. But these can be hard to drink and so are usually given through a tube. This is hard to do for a long time for most people.
    • Some people may need fluid nutrition injected through an IV and to not eat or drink anything. This is used in more severe cases.

    Surgery

    If other treatments do not work or if a complication happens, then surgery can be done. This is just a short-term fix though. Surgery will not cure the Crohn’s disease. The surgeon just removes the damaged or abnormal part of the digestive tract and reconnects the healthy areas. About half of the people with Crohn’s disease need surgery over the course of their lifetime.

    Alternative medicine

    Complementary and alternative medicine (CAM) therapies, such as acupuncture, fish oil, or nutritional supplements, have not shown much benefit for treating Crohn’s disease.

  • Am I at risk of developing other conditions?

    People with Crohn’s disease can develop problems due to the condition. Others may have side effects from medications. Some common issues include:

    • Anal fissures: A tear in the lining of the anus or in the skin around the anus. This can cause painful bowel movements, blood in the stool, or itching of the anus.
    • Ulcers:These open sores in the digestive tract, can also happen in the mouth, genital area or anus.
    • Fistulae: If ulcers go through the intestinal wall, an abnormal tunnel between different areas can form. Fistulas can lead to drainage, infections, and diversion of food. This can prevent you from getting enough nutrients.
    • Bowel obstruction: Long-term inflammation can cause scar tissue to form. This can thicken and narrow areas of the bowel, blocking the flow of digestive contents. Medications can reduce inflammation and open the narrowed areas. Others require surgery to remove the diseased portion of the bowel instead.
    • Malnutrition: Symptoms of Crohn’s disease may make eating difficult. Intestinal inflammation can prevent proper absorption of vital nutrients that are needed to stay healthy.
    • Colon cancer: Crohn’s disease that affects the colon increases the risk of developing colon cancer. People with Crohn’s disease should have colonoscopies more often than people without this risk factors. In certain situations, your doctor may want to spray a dye in the bowel (this is called “chromoendoscopy”) during your colonoscopy to see better.
  • What are some recommendations for living with Crohn’s disease?

    If you have Crohn’s disease, healthy lifestyle habits can help you maintain a good quality of life. Talk to your doctor about:

    • Healthy eating plan: Making some changes can help reduce symptoms. But diet alone cannot be used to treat your Crohn’s disease. Working with a dietician can be helpful to create a healthy eating plan and help you follow it. Dietary changes that help:
      • Eat nutritious foods (fruits, vegetables, whole grains)
      • Drink plenty of liquids
      • Avoid carbonated (fizzy) drinks
      • Avoid excessive high-fiber foods such as popcorn, vegetable skins, or nuts
      • Avoid fatty, fried foods, or fast foods.
      • Avoid processed, sugary foods (junk food).
      • Take vitamins (such as vitamin D or vitamin B12) or other nutritional supplements, if recommended by your doctor
    • Exercise: Make time for regular physical activity each day. Exercise can be as simple as walking for 10 to 20 minutes per day. It can help relieve stress and decrease symptoms.
    • Smoking cessation:Quitting smoking reduces your risk of health complications due to Crohn’s disease.

Author(s) and Publication Date(s)

Reviewed by Gary R. Lichtenstein, MD, FACG, University of Pennsylvania and David T. Rubin, MD, FACG, University of Chicago – June 2019

Joseph Feuerstein, MD, Beth Israel Deaconess, Boston, MA – Updated April 2021.

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