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Crohn's disease is a
inflammatory bowel disease (IBD). Parts of the
digestive system get swollen and have deep sores
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 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.
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.
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 exam. 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
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.
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 counseling if you
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.
Learning about Crohn's disease:
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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.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
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
kidney stones, and certain uncommon forms of
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.
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.
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
Call a doctor right away if you have been diagnosed with
Crohn's disease and you have one or more of the
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:
The following doctors can diagnose most cases of Crohn's disease:
To help you manage Crohn's disease, you will probably be
referred to a
To be evaluated for surgery, you may be referred to a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
is diagnosed through a
medical history and physical exam, 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 will probably have you take aminosalicylates, antibiotics, and other medicines to control inflammation.
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.
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.
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
nonsteroidal 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 counseling and social support from family, friends, or
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
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 it, 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
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
Many people with inflammatory bowel disease consider nontraditional 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:
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Sands 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.
Other Works Consulted
American Gastroenterological Association (2006). American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology, 130(3): 935–939. Also available online: http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508506000734.pdf.
American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738–745. Available online: http://www.gastro.org/practice/medical-position-statements.
Strong SA, et al. (2007). Practice parameters for the surgical management of Crohn's disease. Diseases of the Colon and Rectum, 50(11): 1735–1746.
May 16, 2013
E. Gregory Thompson, MD - Internal Medicine & Arvydas D. Vanagunas, MD - Gastroenterology
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