All you need to know about Crohn's disease

Symptoms of Crohn’s disease can include intestinal ulcers, discomfort, and pain.

Although it typically starts in childhood or early adulthood, Crohn’s disease can develop at any age.

Having a supportive network of people who understand life with Crohn’s disease is important. Bezzy IBD is a free online community and app by Healthline Media, which you can download from the App Store for iPhone and iPad.

This article explains what Crohn’s disease is and how it manifests. It also looks at its causes, diagnosis, complications, and treatments and offers some dietary tips.

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Crohn’s disease is one of a group of diseases known as inflammatory bowel disease (IBD). Ulcerative colitis is another type of IBD.

Crohn’s disease is an autoimmune-mediated inflammatory condition. This means the immune system mistakenly attacks the body’s own cells, thinking they are harmful when they are not.

Crohn’s can affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Symptoms mainly involve the intestinal system, but they can also affect the skin, joints, bones, eyes, kidneys, and liver.

Learn about the stages of Crohn’s disease here.

Types of Crohn’s disease

There are five types of Crohn’s disease, according to the Crohn’s and Colitis Foundation.

They are:

• Ileocolitis: The most common type, this affects the end of the small intestine and the large intestine, or colon.
• Ileitis: The only affects the ileum, or small intestine.
• Gastroduodenal Crohn’s disease: This affects the stomach and the duodenum, which is the beginning of the small intestine.
• Jejunoileitis: This causes patches of inflammation in the jejunum, the upper part of the small intestine.
• Crohn’s (granulomatous) colitis: This affects only the colon.

Symptoms range from vomiting to rectal bleeding and depend to some extent on the type.

Learn more about the five types of Crohn’s disease and their symptoms here.

Is Crohn’s an autoimmune disease?

There are many theories about why Crohn’s develops, including genetic factors, problems with the gut microbiome, and environmental exposure.

One prominent theory is that it is an autoimmune condition. This means that the immune system mistakenly attacks healthy cells in the body. As the immune system interacts with different organisms, this may trigger inflammation and intestinal damage.

In someone with Crohn’s disease, bacteria in the digestive tract may trigger an immune response that continues to occur, resulting in ongoing intestinal damage.

Learn more about immune system involvement in Crohn’s disease.

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 from person to person and depends on where the inflammation is in the gut. People tend to experience pain in the lower right side of the abdomen.
• Ulcers in the gut: These are raw areas that may bleed. If this happens, a person may find blood in their stools.
• Mouth ulcers: These are common symptoms of Crohn’s disease.
• Diarrhea: This can range from mild to severe, and there may be mucus, blood, or pus. A person may also feel the urge to have a bowel movement but find that nothing comes out.
• Fatigue: People with Crohn’s disease often feel very tired, and they may have a fever.
• Altered appetite: At times, a person may experience 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.

During a flare of Crohn’s disease symptoms, a person may also develop:

• arthritis
• uveitis
• skin rash and inflammation
• liver or bile duct inflammation
• delayed growth or sexual development in children

Learn more about the symptoms of Crohn’s disease here.

Symptoms in females

Around half of the females who develop Crohn’s disease do so before the age of 35. It can have some specific symptoms in females, such as:

• irregular menstruation due to effects on hormone function
• iron deficiency, as Crohn’s affects the absorption of nutrients and can lead to intestinal bleeding
• pain during sex, if symptoms affect areas near the anus or vagina
• discomfort about sex, as Crohn’s can affect a person’s libido and body image, as well as cause pain and other types of discomfort

Crohn’s disease does not appear to affect fertility, but research suggests that it is harder to conceive when the disease is active and after surgery.

Having an inflammatory bowel disease (IBD), such as Crohn’s, does not prevent a person from becoming pregnant. However, someone with this type of disease is more likely to:

• have a preterm delivery
• need a cesarean delivery
• give birth to an infant with a low birth weight

Learn more about how Crohn’s disease affects females here.

It is not clear what causes Crohn’s disease. Experts suggest that it may stem from an abnormal reaction of the immune system. However, they do not know whether this reaction causes the disease or results from it.

Factors that may increase the risk of inflammation include:

• genetic factors
• a person’s immune system
• environmental factors

A bacterium or virus may also play a role. For example, research suggests that there is a link between the bacterium Escherichia coli and Crohn’s disease.

Smoking is another risk factor.

Learn more about Crohn’s and genetics here.

A doctor will ask a person about their symptoms. A physical examination may reveal a lump in the abdomen resulting from when loops of inflamed bowels became stuck together.

How to test

The following tests may help in the diagnosis:

• stool and blood tests
• biopsy
• sigmoidoscopy, which involves using a sigmoidoscope, a short, flexible, tube-like tool to investigate the lower bowel
• colonoscopy, which involves using a flexible, tube-like tool, a colonoscope, to investigate the colon
• endoscopy, which involves inserting a long, thin, flexible tool called an endoscope down through the esophagus and into the stomach to investigate the upper part of the gut
• CT scan or barium enema X-ray, which help reveal changes in the bowel

Learn what to expect during a Crohn’s diagnosis here.

While treatment can help manage Crohn’s disease, there is no cure. Research continues, and once scientists can identify the causes, it may be possible to find a cure.

Meanwhile, the following information could one day help researchers develop a cure:

• Microbacterium avium tuberculosis, or MAP, bacteria appear to be more common in people with Crohn’s disease. Scientists are working to clarify the link.
• One theory is that Crohn’s disease results from changes in the gut microbiome. Learning more about this could reveal ways of rebalancing microbiota in the gut.
• The immune response plays a role in Crohn’s disease. As new methods of easing inflammation emerge, more effective ways of managing Crohn’s disease could result.
• Genetic factors may play a role. Identifying genes that affect the risk of Crohn’s disease and learning how to adjust them could lead to a cure.
• Implantable devices, regenerative medicine, and stem cell technology are also possible future options.

However, more investigations are needed before any of these can lead to a cure.

Learn more about research into possible cures and treatment options for Crohn’s disease.

Treatment for Crohn’s disease may involve medication, surgery, and nutritional supplements. The aim is to control inflammation, resolve nutritional problems, relieve symptoms, and reduce the occurrence of flares.

The course of treatment will depend on:

• where the inflammation occurs
• the severity of the issue
• any complications
• a person’s response to previous treatments

Some people go for long periods, even years, without experiencing any symptoms. These are periods of “remission.” However, symptoms usually flare up again.

As the duration of remission varies greatly, it can be hard to know how effective treatment is and how long remission will last.

Learn about remission from ulcerative colitis here.

Medication

There are many medications for Crohn’s disease, including:

• Aminosalicylates: These are anti-inflammatory drugs and include balsalazide (Colazal) and mesalamine (Lialda). A doctor may prescribe these for a person with a new diagnosis and mild symptoms.
• Steroids: These may include oral steroids, such as prednisone (Rayos) and budesonide (Entocort), or intravenous steroids, such as methylprednisolone (Solu-Medrol). They are for short-term use only, as they can have severe adverse effects.
• Antibiotics: These can be useful during Crohn’s flare-ups if a person has an abscess or fistula.
• Antidiarrheal drugs and fluid replacements: When the inflammation subsides, diarrhea usually becomes less severe. However, a person may still need something to address diarrhea and abdominal pain. It is important to have the choice of treatment guided by a doctor because some antidiarrheal drugs can mask an infection that needs treating.

Learn more about different treatments for Crohn’s here.

Biologics

Biologics are a type of drug that scientists have developed from living organisms. 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:

• 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)

Examples of biologics for Crohn’s disease include:

• infliximab (Remicade)
• adalimumab (Humira)
• certolizumab pegol (Cimzia)

Biologic treatments can have side effects, including vomiting, nausea, and weakened resistance to infection.

Some studies suggest that using biologics can reduce the likelihood of 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 of corticosteroids.

There are different types of biologic drugs, and each person reacts to these differently. A doctor will recommend a suitable option and suggest alternatives or combinations of drugs if the first choice proves ineffective.

Learn the difference between biologic and biosimilar drugs here.

Surgery

Most people with Crohn’s disease may eventually need surgery. This can relieve symptoms that have not responded to medication. It may also help address complications, such as an abscess, perforation, or blockage, as well as bleeding.

Removing part of the intestine can help, but it does not cure Crohn’s disease. Inflammation often returns to an area next to the area that was removed. Some people require more than one procedure in their lifetimes.

A person may need a colectomy, in which a surgeon removes the whole colon, or large intestine. This procedure may also involve making a small opening in the front of the abdominal wall and bringing the tip of the end of the small intestine into this opening, forming a stoma, through which feces exits the body. A pouch then collects the fecal matter. People with stomas can lead typical, active lives.

If the surgeon can remove the diseased section of the intestine and reconnect the healthy areas, no stoma is necessary.

Surgery is not an option for everyone, however. It is also important to know that the disease will recur after the operation.

Learn more about surgery for Crohn’s disease here.

Natural treatment

There is no cure for Crohn’s disease. People can help manage their symptoms using natural treatments that are complementary to prescription medications.

Some natural approaches to Crohn’s disease symptoms include:

• Dietary changes: During a flare-up, avoid high fiber foods, dairy, sugar, high fat foods, and spicy foods. Between flare-ups, drink more water, eat small meals, boil or steam food instead of frying it, and keep a food diary to track the effects of different foods.
• Behavioral changes: Consider quitting smoking, if this applies. And try relaxation practices and techniques, such as meditation, mindfulness, and 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 and peppermint may help reduce inflammation.

There is not enough scientific evidence to confirm that any of these approaches are safe and effective.

However, experts say that quitting smoking can help reduce the severity of symptoms and the frequency of flareups. People with Crohn’s who continue to smoke are more likely to have intestinal strictures and other complications.

Learn more about natural treatments for Crohn’s disease here.

Diet

Children with Crohn’s disease might need high calorie liquid formulas, especially if the condition affects their growth.

Many people with Crohn’s say that the following foods can increase diarrhea and cramping:

• bulky grains
• dairy products
• spicy foods
• alcohol

When a person’s appetite is very low, they may need to feed intravenously for a short period.

Learn about some foods that may help here.

Crohn’s disease and ulcerative colitis (UC) are both types of IBD. But they are different conditions.

Crohn’s disease can affect any part of the digestive tract, including the esophagus, stomach, small intestine, and large intestine, which is called the colon. Ulcerative colitis, on the other hand, only affects the colon.

Another major difference is the depth of inflammation in the intestinal wall. In Crohn’s disease, the inflammation affects all layers of the intestinal wall. In ulcerative colitis, the inflammation mainly affects the top layer, known as the mucosal layer.

Moreover, in Crohn’s disease, there can be healthy areas between diseased parts of the bowels. In ulcerative colitis, the damage appears in a continuous pattern.

In addition, the pain of Crohn’s disease pain may be different from the typical pain of other GI diseases, such as irritable bowel syndrome (IBS). In a person with IBS, there will also be no signs of colon inflammation.

Learn about the differences between Crohn’s and UC here.

There are five types of Crohn’s disease. Each affects a different part of the GI tract:

• Ileocolitis: This is the most common type, and it affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen.
• Ileitis: This only affects the small intestine. The symptoms are the same as those of 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 area of the small intestine, called the jejunum. Symptoms include abdominal cramping after meals, diarrhea, and in severe cases, fistulas.
• Crohn’s colitis: This only affects the large intestine, or colon. Symptoms may include diarrhea, rectal bleeding, and damage around the anus, such as ulcers, fistulas, and abscesses. It can also cause joint pain and skin lesions.

IBDs, such as Crohn’s disease, are common in children and adolescents. Crohn’s disease affects children and adults in similar ways. Typical symptoms include:

• unexplained weight loss
• bloody diarrhea
• abdominal pain

Children with Crohn’s disease may also experience poor growth and anemia. When a doctor is looking at the treatment options, they must consider the possible effects of the disease on a child’s growth, development, bone health, and psychosocial functioning.

A 2017 review of 49 pediatric studies in children with Crohn’s disease found that up to one-third of children with inflammation developed bowel complications more than 5 years after they received the diagnosis.

The same review notes that 48–88% of the children had received at least one corticosteroid course, and up to one-third had become dependent on steroids. The authors of the review also point to a trend toward lower rates of surgery as the use of immunomodulators and biologicals increases.

Learn more about Crohn’s disease in children here.

If symptoms are severe and frequent, the risk of complications is higher. A person with any of the following complications may need surgery:

• internal bleeding
• a stricture, which involves part of the gut narrowing, causing a buildup of scar tissue and a partial or complete blockage of the intestine
• a perforation, a small hole in the wall of the gut, which can lead to leakage, infections, and abscesses
• fistulas, which involves a channel forming between two parts of the gut

In addition, a person may have:

• a persistent iron deficiency
• food absorption problems
• a slightly higher risk of bowel cancer

Can Crohn’s disease be fatal?

Typically Crohn’s disease is not life threatening, but it can cause fatal complications, such as colorectal cancer or severe infections.

The life expectancy of someone with Crohn’s disease is usually the same as that of someone without it.

Learn more about whether Crohn’s disease can be fatal here.

Experts determine whether Crohn’s disease constitutes a disability on a case-by-case basis because each person with the condition has a different experience.

A person with Crohn’s disease could qualify for disability insurance if it prevents the person from working. Many people with IBD have to go through a series of appeals before the authorities approve their disability claims.

Learn whether Crohn’s is a disability here.

There is currently no cure for Crohn’s disease, but treatments and various care strategies can help manage it.

Still, the disease is likely to affect a person’s quality of life. Life expectancy may also be slightly lower for a person with Crohn’s disease because it increases the risk of developing other diseases, such as cancer, liver problems, biliary tract complications, and genitourinary tract infections.

Some people with Crohn’s need surgery and possibly more than one procedure over time.

Here are some questions people often ask about Crohn’s disease.

What are the symptoms of Crohn’s disease?

Depending on the type, a person may experience:

• diarrhea
• vomiting
• abdominal cramps
• loss of appetite
• weight loss
• abdominal pain
• rectal bleeding
• joint pain and skin lesions, in some cases
• with some types, abscesses, fistulas, and ulcers may develop

How does a person get Crohn’s disease?

Experts do not know precisely why Crohn’s disease occurs. However, research suggests an inappropriate immune response due to a combination of genetic and environmental factors.

A person with certain genetic features may develop Crohn’s as a result of exposure to drugs, toxins, infections, and intestinal microbes.

What are the early warning signs of Crohn’s disease?

The most common symptoms are:

• diarrhea
• weight loss
• abdominal cramping and pain

There may also be:

• anemia
• eye redness or pain
• fatigue
• fever
• joint pain
• nausea
• loss of appetite
• patches of painful swollen skin, especially on the legs

Learn more about the early warning signs of Crohn’s disease.

Which foods trigger Crohn’s disease symptoms?

Foods that may make symptoms worse are carbonated drinks and high fiber foods, such as popcorn, nuts, and vegetable skins. Eating a large meal can also worsen symptoms.

Crohn’s disease is a chronic, or long-term, condition that causes inflammation in the digestive tract. It can be painful, reduce the quality of life, and cause complications that can be fatal.

A person with Crohn’s disease can manage the symptoms with medication, stress reduction, and other approaches. Some people need surgery, as well.

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