Complete Guide to Crohn's Disease

by Dr. Matt Olesiak, M.D.

What is Crohn's disease?

Crohn's disease is a chronic (long-term) condition categorized as an inflammatory bowel disease (IBD) that results in inflammation of the digestive tract's tissues. This inflammation can trigger various symptoms, such as severe diarrhea, abdominal pain, fatigue, malnutrition, and weight loss.

Although the small intestine is the most commonly affected area, inflammation from Crohn's disease may affect other parts of the digestive tract in different individuals and often extends to the deeper layers of the bowel. It is a debilitating condition that can cause painful complications and even life-threatening consequences.

While Crohn's disease has no known cure, there are therapies that can reduce its symptoms and even lead to long-term remission.

Read on to learn more about Crohn's disease.

A graphical image of human intestines in blue on a black background.

How common is Crohn's disease?

The Crohn's and Colitis Foundation reports that Crohn's affects around 780,000 people in the United States (1).

What are the types of Crohn's disease?

There are several types of Crohn's disease, which are classified according to the affected area of the digestive tract.

Ileocolitis.

According to the Crohn's and Colitis Foundation, this, the most common type of Crohn's disease, "affects the end of the small intestine, known as the terminal ileum, and the large intestine, also called the colon." (2)
Ileitis.

This type affects only the ileum, which is the third and longest portion of the small intestine.
Gastroduodenal Crohn's Disease.

This type affects the stomach and the first part of the small intestine, which is called the duodenum.
Jejunoileitis.

In this type, inflammation occurs in patches along the small intestine's upper half, called the jejunum.
Crohn's (Granulomatous) Colitis.

Only the colon, also known as the large intestine, is affected by this type.

Each type of Crohn's disease can affect the symptoms and potential complications of this disease.

A graphical image of a side-by-side comparison of Crohn’s disease versus ulcerative colitis, with affected areas of the intestines highlighted in red.

What is the difference between Crohn's disease and ulcerative colitis?

Although Crohn's disease and ulcerative colitis share many symptoms and fall under the inflammatory bowel disease (IBD) category, they are distinct illnesses that impact different gastrointestinal (GI) tract regions.

Crohn's disease can affect any part of the GI tract from the mouth to the anus and can impact the entire bowel wall thickness. Conversely, ulcerative colitis solely affects the colon and rectum (also called the large intestine) and targets the innermost lining of the large intestine.

Crohn's disease can cause inflammation, ulcers, and scarring in the GI tract, while ulcerative colitis only causes inflammation and ulcers. Both conditions can lead to severe abdominal pain, fatigue, and weight loss.

Over one million people in the United States have inflammatory bowel disease (3), either Crohn's or ulcerative colitis.

An image of a mature woman sitting on a bed and holding her stomach in pain.

What are Crohn's disease symptoms?

Symptoms of Crohn's vary depending on the area of the digestive tract affected. According to the National Institute of Diabetes and Digestive and Kidney Diseases (4), symptoms can include:

Fatigue
Bloody stool
Rectal bleeding
Diarrhea
Constipation
Fever
Sores in the mouth
A feeling of fullness in the abdomen
Abdominal pain or cramping
Nausea
Loss of appetite
Unexplained weight loss
An inflammation of the anus resulting in pain and drainage around the anus (fistula).

A graphical image of the human digestive system in a transparent body, with the small intestine, stomach, and esophagus highlighted in red.

Crohn's disease may also present with symptoms outside of the digestive tract, including the following:

Anemia (iron deficiency)
Inflamed liver or bile ducts
Inflammation of the joints, eyes, skin

The above symptoms can range from mild to severe. They can also go away, called remission, and then flare up again.

What are the complications of Crohn's disease?

Chronic inflammation and obstruction of the large intestine can cause severe complications if left untreated for an extended time. Complications can include:

Kidney diseases, including kidney stones
Liver disease
Bowel perforation (hole in the bowel)
Bowel obstruction, which can narrow the bowel and hinder the passage of digestive contents.
Malnutrition due to diarrhea or the inability to eat enough of the right kinds of food due to stomach pains or cramps.
Tears in the anal lining during bowel movements (anal)
Passages or fistulas that form between the intestine and nearby organs
Abdominal swelling or distension
Gallstones
Colon cancer

A cropped image of a doctor with a stethoscope around his neck and holding a tablet computer.

What causes Crohn's disease?

The exact cause of Crohn's disease remains unknown, though researchers suspect an autoimmune reaction may be involved. This occurs when the immune system mistakenly attacks healthy cells in the body.

Genetics may also contribute to the development of the disease, as research suggests that it can be hereditary.

What about lifestyle factors? Well, while stress and certain foods have not been demonstrated to cause Crohn's disease, they can make symptoms worse.

A cropped image of a young woman using her hands to form a heart shape on her stomach.

What are the risk factors for Crohn's disease?

Though the exact cause of this condition is unknown, a few factors appear to increase the risk of developing Crohn's disease.

Family history.

If you have a first-degree relative with the disease, such as a parent, sibling, or child, you are at an increased risk. One out of five individuals with Crohn's disease is estimated to have a family member who has the disorder.
Age.

Although Crohn's disease can occur at any age, it is most likely to occur in young adults. Most people who develop Crohn's disease are diagnosed before their 30s.
Ethnicity.

Even though Crohn's disease can affect any ethnic group, whites are at the most significant risk, especially those of Eastern European (Ashkenazi) Jewish descent. Nonetheless, Crohn's disease is becoming more prevalent among Black people in North America and the United Kingdom.
Environment.

The prevalence of Crohn's disease is higher in developed countries than in developing ones. There is also a higher prevalence of this disease in urban areas as compared to rural areas.
Cigarette smoking.

In terms of controllable risk factors, cigarette smoking is the most significant. Smoking also increases the risk of suffering from more severe Crohn's disease and requiring surgery. Therefore,m the importance of quitting smoking cannot be overstated.
A high-fat diet.

Research indicates that regularly eating a high-fat diet increases your risk of this disease.
Frequent use of nonsteroidal anti-inflammatory medications (NSAIDS).

Though NSAIDS do not directly cause Crohn's disease, they can cause bowel inflammation, aggravating the condition. Popular brand names for NSAIDS include Advil, Aleve, and Motrin IB.

An image of a doctor in a white lab coat preparing to perform a colonoscopy.

How is Crohn's disease diagnosed?

In most cases, people with Crohn's disease first seek medical attention due to persistent diarrhea or constipation, abdominal cramping, or unexplained weight loss.

To diagnose Crohn's, your doctor will take a medical history, where they ask about your symptoms. They will also ask about your family history of health conditions, especially for autoimmune disease and inflammatory bowel diseases.

Your doctor will also perform a physical exam, which may include pressing on your stomach to determine if it's bloated and listening to your stomach with a stethoscope.

A cropped image of a doctor sitting at a desk and writing notes on a patient chart.

Your healthcare provider may also order one or more of the following tests to help determine the cause of your symptoms:

Blood test.

This blood test determines whether you have anemia or a low red blood cell count. One in three individuals with Crohn's disease is estimated to have anemia.
Stool test.

This test examines a stool sample to determine whether it contains bacteria or parasites. Infections that cause chronic diarrhea may be ruled out by this test.
Computed tomography (CT) scan.

CT scans produce images of the digestive system. As a result, your healthcare provider can determine the severity of the intestinal inflammation.
Colonoscopy.

A colonoscopy is a procedure during which your doctor examines the contents of your colon with an endoscope (a thin tube fitted with a light and camera). Your physician may take a tissue sample (biopsy) from your colon to test for inflammation.
Upper gastrointestinal (GI) endoscopy.

During an endoscopy, a long, thin tube is threaded through your mouth and down into your throat. Your doctor can view the interior of your body with the assistance of an attached camera. Tissue samples may also be taken during an upper endoscopy.
Upper gastrointestinal (GI) exam.

The X-ray images used during an upper GI examination enable your doctor to observe the passage of a swallowed barium liquid through your digestive tract.

How is Crohn's disease treated or managed?

As mentioned previously, there is no known cure for Crohn's. However, the condition can be successfully managed, putting the symptoms in remission and reducing the frequency of flare-ups.

As with any medical condition, Crohn's disease treatment varies depending on the underlying cause and severity of the symptoms.

Your healthcare provider may recommend one or more of these treatments for Crohn's disease:

Antidiarrheal medication.

Over-the-counter or prescription medications can help stop diarrhea.
Antibiotic.

Antibiotics effectively prevent or treat infections, which in severe cases can cause abscesses (pockets of pus). They can also sometimes cause fistulas (tunnels or openings connecting two organs that normally would not be connected).
Corticosteroids.

Anti-inflammatory drugs such as corticosteroids reduce inflammation caused by autoimmune diseases. Cortisone and Prednisone are popular corticosteroids.
Biologics.

Biologics, or biologic drugs, are medications derived from biological sources. These drugs are specifically made from natural sources such as microorganisms, living cells, or bacteria and contain various proteins, DNA, or sugars. A monoclonal antibody component to these medications suppresses the regular immune system response, helping reduce the painful intestinal inflammation of Crohn's disease.
Immunomodulators.

The drugs work by suppressing an overactive immune system to calm inflammation, which is helpful for Crohn disease.
Adjust your diet.

Dietary changes may be beneficial in reducing symptoms. For example, if you have diarrhea, your healthcare provider may suggest that you eat a high-fiber diet to firm up your stool. Other dietary changes include drinking more liquid, eating smaller meals several times daily, keeping a diary to identify foods that trigger your symptoms, and avoiding carbonated drinks.
Get regular exercise.

Exercise is beneficial to everyone, including people with Crohn's disease. Regular physical activity has been found to help manage anxiety and depressive symptoms associated with Crohn's and Colitis. Even ten to twenty minutes of walking per day can significantly reduce stress and symptoms associated with Crohn's disease.
Bowel rest.

Your provider may advise that you refrain from eating or drinking for several days or longer to allow your intestines to heal. Nutrition may be administered intravenously (parenterally) to meet your nutritional needs. During this period, you should only drink liquids your physician prescribes or have a feeding tube placed.
Surgery.

Surgical treatment will not cure Crohn's disease but can effectively treat its complications. Perforations, blockages, or bleeding in the intestinal tract may require surgery.

How long do Crohn's disease flares last?

Crohn's flares are highly individual and can last a few weeks to several months. It is possible to experience flare-ups after being in remission for months or years.

Due to this, discussing the best treatment option with your doctor and adhering to the treatment schedule is essential.

In addition, you should discuss it with your doctor before you stop any treatment. It is common for Crohn’s patients to cease all treatments. However, it may be detrimental to your health to stop your therapy on your own since it may result in another flare-up or interfere with the effectiveness of your medication.

Is inflammatory bowel disease (IBD) related to irritable bowel syndrome (IBS)?

People often interchange the terms "inflammatory bowel disease" and "irritable bowel syndrome," but they are very different.

While they are both chronic, bowel-related conditions, IBD involves intestinal inflammation, and IBS does not. Instead, IBS is a functional gastrointestinal disorder. Its symptoms are caused by a gut-brain interaction disorder leading to abnormal bowel function without an identifiable defect in the intestines or bowel.

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