Crohn disease

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Causes

The exact cause of Crohn disease is unknown. It occurs when your body's immune system mistakenly attacks and destroys healthy body tissue (autoimmune disorder), mainly in the digestive tract.

When parts of the digestive tract remain swollen or inflamed, the walls of the intestines become thickened.

Factors that may play a role in Crohn disease include:

  • Your genes and family history. (People who are white or of Eastern European Jewish descent are at a higher risk. But the risk has been rising in many different groups.)
  • Environmental factors.
  • Tendency of your body to overreact to normal bacteria in the intestines.
  • Smoking.

Crohn disease may occur at any age. It mostly begins in people between ages 15 and 35. But recently Crohn disease has been increasing in the older population, too.

Definition

Crohn disease is a disease where parts of the digestive tract become inflamed.

  • It most often involves the lower end of the small intestine and the beginning of the large intestine.
  • It may also occur in any part of the digestive system from the mouth to the end of the rectum (anus).

Crohn disease is a form of inflammatory bowel disease (IBD).

Ulcerative colitis is another form of IBD.

Exams and Tests

A physical exam may show a mass or tenderness in the abdomen, skin rash, swollen joints, or mouth ulcers.

Tests to diagnose Crohn disease include:

A stool culture or other tests may be done to check for other possible causes of the symptoms, such as infection, and to look for inflammation.

This disease may also alter the results of the following tests:

Outlook (Prognosis)

There is no cure for Crohn disease. However, the goals of treatment are to quiet the disease and keep it quiet. Surgery is used in particular situations but does not cure Crohn disease. If you smoke, stopping will help improve the disease.

Possible Complications

You have more risk for small bowel and colon cancer if you have Crohn disease. Your provider may suggest tests to screen for colon cancer. A colonoscopy is often recommended if you have had Crohn disease involving the colon for 8 or more years.

Those with more severe Crohn disease may have these problems:

  • Abscess or infection in the intestines
  • Anemia, a lack of red blood cells
  • Bowel blockage
  • Fistulas in the bladder, skin, or vagina
  • Slow growth and sexual development in children
  • Swelling of the joints
  • Lack of important nutrients, such as vitamin B12 and iron
  • Problems with maintaining a healthy weight
  • Inflammation of the bile ducts (primary sclerosing cholangitis)
  • Skin lesions, such as pyoderma gangrenosum

References

Ananthakrishnan AN, Reguerio MD. Management of inflammatory bowel diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 116.

Feuerstein JD, Ho EY; American Gastroenterological Association Institute Clinical Guidelines Committee, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease. Gastroenterology. 2021;160(7):2496-2508. PMID: 34051983 pubmed.ncbi.nlm.nih.gov/34051983/.

Galandiuk S, Netz U, Morpurgo E, Tosato SM, Abu-Freha N, Ellis CT. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 52.

Kaplan GG, Ng SC. Epidemiology, pathogenesis, and diagnosis of inflammatory bowel diseases. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 115.

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 127.

Ricci JP, Talamini MA. Management of Crohn's disease of the small bowel. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:134-137.

Support Groups

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

More information and support for people with Crohn disease and their families can be found at:

www.crohnscolitisfoundation.org

Symptoms

Symptoms depend on the part of the digestive tract involved. Symptoms range from mild to severe, and can come and go, with periods of flare-ups.

The main symptoms of Crohn disease are:

  • Crampy pain in the abdomen (belly area).
  • Fever.
  • Fatigue.
  • Loss of appetite and weight loss.
  • Feeling that you need to pass stools, even though your bowels are already empty (tenesmus). It may involve straining, pain, and cramping.
  • Watery or loose diarrhea, which may be bloody.

Other symptoms may include:

  • Constipation
  • Sores or swelling in the eyes
  • Draining of pus, mucus, or stools from around the rectum or anus (caused by an abnormal opening in the skin called a fistula)
  • Joint pain and swelling
  • Mouth ulcers
  • Rectal bleeding and bloody stools
  • Swollen gums
  • Tender, red bumps (nodules) under the skin, which may turn into skin ulcers

Treatment

Tips for managing Crohn disease at home:

DIET AND NUTRITION

You should eat a well-balanced, healthy diet. Include enough calories, protein, and nutrients from a variety of food groups.

An elemental diet has been shown to improve Crohn disease and its symptoms. However, this diet is not used often because of the taste.

Depending on the location(s) of your Crohn disease, the type of your Crohn disease, and the other problems it may cause, certain foods may be more difficult to eat. Types of food problems may vary from person to person.

Some foods can make diarrhea and gas worse. To help ease symptoms, try:

  • Eating small amounts of food throughout the day.
  • Drinking lots of water (drink small amounts often throughout the day).
  • Avoiding high-fiber foods (bran, beans, nuts, seeds, and popcorn).
  • Avoiding large amounts of uncooked or fibrous vegetables and fruits. Sometimes peeling, softening, or pureeing helps.
  • Avoiding fatty, greasy, or fried foods and sauces (butter, margarine, and heavy cream).
  • Limiting dairy products if you have problems digesting dairy fats. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
  • Avoiding foods that you know cause gas, such as beans and vegetables in the cabbage family, such as broccoli.
  • Avoiding spicy foods.

Ask your health care provider about extra vitamins and minerals you may need, such as:

  • Iron supplements (if you are iron deficient).
  • Calcium and vitamin D supplements to help keep your bones strong.
  • Vitamin B12 to prevent anemia, especially if you have had the end of the small intestine (ileum) removed.

If you have an ileostomy, you will need to learn:

STRESS

You may feel worried, embarrassed, or even sad and depressed about having a bowel disease. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can worsen digestive problems.

Ask your provider for tips on how to manage your stress.

MEDICINES

Ask your provider about taking anti-diarrheal medicines. In general, these should be avoided in people with IBD, if possible. Treating the IBD is the key to making diarrhea and other symptoms better.

Other medicines to help with symptoms include:

  • Fiber supplements, such as psyllium powder (Metamucil) or methylcellulose (Citrucel). Ask your provider before taking these products or laxatives.
  • Acetaminophen (Tylenol) for mild pain. Avoid medicines such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) which can make your symptoms worse.

Your provider may also prescribe medicines to help control Crohn disease:

  • Aminosalicylates (5-ASAs) are medicines that help control mild to moderate symptoms. Some forms of the medicine are taken by mouth, and others must be given rectally. The latter are only used in Crohn disease of the large intestine.
  • Corticosteroids, such as prednisone or budesonide, treat moderate to severe Crohn disease. They may be taken by mouth or inserted into the rectum. They may help until a long-term medicine with fewer side effects is started and can take effect.
  • Antibiotics to treat abscesses or fistulas.
  • Immunosuppressive medicines that quiet the immune system's reaction such as azathioprine, 6-mercaptopurine, and others to avoid long-term use of corticosteroids.
  • Biologic therapy and small molecule therapy are the most common long-term treatments. They are given in different ways (oral, injection, infusion). Speak with your provider about your particular situation.

SURGERY

Some people with Crohn disease may need surgery to remove a damaged or diseased part of the intestine. In some cases, the entire large intestine is removed, with or without the rectum.

People who have Crohn disease that does not respond to medicines may need surgery to treat problems such as:

  • Bleeding
  • Failure to grow (in children)
  • Fistulas (abnormal connections between the intestines and another area of the body)
  • Infections
  • Narrowing of the intestine (strictures)

Surgeries that may be done include:

Crohn disease can involve the:The correct answer is all of the above. In people with Crohn disease, the immune system mistakenly attacks the digestive tract--the part of your body that food and waste pass through. This leads to swollen and inflamed tissue, most often in the small intestines. But these changes may occur anywhere from the mouth to the end of the rectum.Which is NOT a goal of Crohn disease treatment?The correct answer is weight loss. Many people with Crohn disease lose too much weight, either because of poor appetite or poor absorption of nutrients. The goals of treatment are to reduce inflammation, pain, and diarrhea, and to improve nutrition. Tell your doctor if you're losing weight.Diet changes are an important part of treating Crohn disease.The correct answer is true. No specific diet has been shown to improve Crohn disease in everyone. But you can learn to avoid foods that make your symptoms worse. You should eat a well-balanced diet with enough calories, protein, and essential nutrients. Ask your health care provider to help you plan balanced meals.Which is a good food choice for people with Crohn disease?The correct answer is none of the above. All of these foods can cause gas. Because people with Crohn disease are prone to gas, avoiding these foods is a good idea. Talk with your health care provider about which foods are better for people with Crohn disease.People with Crohn disease should eat plenty of fiber.The correct answer is false. Too much fiber may make your symptoms worse. Try baking or stewing fruits and vegetables if eating them raw bothers you. Eat low-fiber foods if that does not help enough. Ask your doctor about any extra vitamins or mineral supplements you may need.For mild pain, people with Crohn disease can take:The correct answer is acetaminophen (Tylenol). It's best to avoid aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). These medicines may make your symptoms worse. If you have Crohn disease, check with your doctor before taking any over-the-counter medicines.Prescription medicines for Crohn disease can:The correct answer is both. Some medicines reduce inflammation in the intestines, which can relieve pain and diarrhea. Others keep the immune system from attacking the digestive tract. These medicines can have serious side effects, so talk to your doctor about the pros and cons.Biologic therapy may help when other treatments don't provide enough relief.The correct answer is true. Biologic therapies are given by injection. Your doctor may recommend biologic therapy if other medicines don't reduce inflammation enough or if you develop certain complications.Surgery to remove part of the intestine will cure Crohn disease.The correct answer is false. Some people with Crohn disease may need surgery to remove a damaged part of the intestine or rectum. This can correct bleeding, blockages, and other serious intestinal problems. But it is not a cure. Discuss the risks and benefits of surgery with your doctor.Patients with Crohn disease who smoke are more likely to need surgery.The correct answer is true. Smoking can make Crohn symptoms worse and increase the chances of needing surgery. Quitting smoking can make Crohn disease less severe. Ask your doctor about strategies that can help you quit.What else can help manage Crohn disease?The correct answer is all of the above. Stress can make Crohn symptoms worse, so it's important to find ways to relax. You may find it helpful to join a support group. The Crohn and Colitis Foundation offers support groups throughout the United States.

When to Contact a Medical Professional

Contact your provider if you:

  • Have very bad abdominal pain
  • Cannot control your diarrhea with diet changes and medicines
  • Have lost weight, or your child with Crohn disease is not gaining weight
  • Have rectal bleeding, drainage, or sores
  • Have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without an illness
  • Have nausea and vomiting that lasts for more than a day
  • Have skin sores that do not heal
  • Have joint pain that prevents you from doing your everyday activities
  • Have side effects from medicines you are taking for your condition

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