Crohn's Disease

Last Updated: October 17, 2023

Crohn’s disease is an inflammatory bowel disease. It differs from ulcerative colitis in three major ways: it can occur anywhere from the mouth to the anus; it usually exhibits patches of inflammation; it can affect multiple layers of tissue.

Crohn's Disease falls under theAutoimmune DiseaseandGut Healthcategories.

What is Crohn’s Disease?

Crohn’s disease is an inflammatory bowel disease that causes inflammation and irritation in the lining of the gastrointestinal (GI) tract. It commonly affects the small and large intestine, but can occur at any point from the mouth to the anus. It tends to worsen over time, but periods of remission (where symptoms disappear) may last weeks or years. Though it can develop in anyone at any age, a person is more likely to develop it in their twenties. Additional risk factors include smoking and family history of inflammatory bowel disease.

Crohn’s disease can increase the risk of developing colon cancer, fistulas (abnormal tunnels in the GI tract), abscesses, anal fissures (small tears), intestinal obstructions, and inflammation in other areas of the body.[1]

What are the main signs and symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are diarrhea (occasionally bloody), abdominal pain and cramping, and unexplained weight loss. Other potential signs and symptoms include nausea, reduced appetite, joint or eye pain, fatigue, anemia, or fever.[2]

How is Crohn’s Disease diagnosed?

After gathering a medical history, a doctor (usually a gastroenterologist) will perform a number of exams and tests to diagnose Crohn’s Disease. They will likely start with a physical exam to check for bloating and abdominal tenderness and listen to the sounds of the GI tract. Other diagnostic tests may include blood tests to detect anemia and inflammation, stool tests to rule out other diseases, endoscopies (such as a colonoscopy) to view the GI tract lining and collect biopsies, or imaging tests such as a computed tomography (CT) scan.[3]

What are some of the main medical treatments for Crohn’s Disease?

There is no cure for Crohn’s Disease, but it can be managed with long-term care from a gastroenterologist, and medications that suppress the immune system or interrupt inflammatory processes to prevent damage to the intestinal lining and, in some cases, initiate remission. One noteworthy class of drugs is TNF-alpha inhibitors, such as infliximab.[4]

Anti-diarrheal medications and acetaminophen (also known as paracetamol or the brand name Tylenol) can be used to treat diarrhea and abdominal pain, and antibiotics are used to treat infections that might occur (such as abscesses). Fistulas, anal fissures, and ulcers can be treated with medication and dietary modifications, but in some cases, severely damaged sections of the intestine may need to be surgically removed and rerouted or attached to a reservoir to enable the passage of stool.

Severe symptoms may also require bowel rest, which can involve partial enteral nutrition — using specific liquid formulas to meet a patient’s dietary needs — or delivering nutrients intravenously to bypass the GI tract completely. Partial enteral nutrition may help to prevent flares when a patient is in remission, especially when fed through a nasogastric tube that delivers the formula directly into the stomach through the nose.[5][6]

Have any supplements been studied for Crohn’s Disease?

Probiotics, prebiotics, and synbiotics have all been studied for IBD, but they appear to be much more effective in ulcerative colitis than in Crohn’s disease.[7][8] Resveratrol could improve both GI symptoms and quality of life.[9][10] Finally, there's a trial that suggested that boswellia may reduce disease activity to a similar degree to mesazaline, but more evidence is required to confirm these findings.[11]

How could diet affect Crohn’s Disease?

No specific dietary interventions are recommended for people with Crohn’s disease. The specific carbohydrate diet and Mediterranean diet were equally effective when comparing six-week remission rates, while the autoimmune protocol diet improved quality of life. However, these studies lacked control groups, and because Crohn’s disease can enter remission spontaneously, it’s unclear whether the diets caused remission.[12][13]

A low-FODMAP diet may reduce some GI symptoms, but doesn’t reduce disease activity.[14] Other exclusion diets — like those that remove carrageenan or animal products or require the use of organic foods — have little to no effect on IBD disease activity or remission rates.[15]

People with Crohn’s disease may have lower circulating levels of fat-soluble vitamins A, D, E, and K, and low vitamin A status was associated with higher levels of C-reactive protein in one meta-analysis.[16] Additionally, they might not be eating adequate calories, so supplementation may be recommended.[17]

Are there any other treatments for Crohn’s Disease?

Fecal microbiota transplants appear effective for inducing remission in IBD, but most of the available trials for Crohn’s disease lack control groups, so more confirmatory trials are needed.[18]

Both mindfulness exercises and cognitive behavioral therapy can improve quality of life, and regular exercise is an effective way to manage disease-related fatigue.[10][19][20]

Although hyperbaric oxygen therapy is associated with remission and clinical improvements in Crohn’s disease, most studies have serious design flaws (like a lack of randomization or control groups), so it’s unclear whether those occurred as a result of the treatment or as a normal part of the disease process.[21]

What causes Crohn’s Disease?

The cause of Crohn’s Disease is unknown, but researchers believe it could be due to an autoimmune reaction potentially triggered by gut microbes, and that genes could also play a role.

In observational studies, a Western dietary pattern is associated with an increased risk of developing Crohn’s disease, while dietary fiber, fruit, vegetable, and fish intake are associated with a reduced risk.[22][23][24]

Smoking may double the chances of developing Crohn’s disease, while other lifestyle factors — such as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and certain types of birth control pills — may increase the risk, but only slightly.[2]

Examine Database: Crohn's Disease
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Update History
2023-10-17 00:30:02

One study added to FAQs

minor

The findings from one study have been added to the FAQs, regarding the effects of boswellia on Crohn's disease activity.

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2023-09-20 12:10:42

Small addition to medical treatments FAQ.

minor

We added a mention in TNF-alpha inhibitors such as infliximab to this FAQ, and additionally linked to a meta-analysis discussing it.

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Edited By

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References
  1. ^Definition & Facts for Crohn’s Disease: NIDDK; Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; cited Feb 2023
  2. ^Symptoms & Causes of Crohn’s Disease: NIDDK; Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; cited Feb 2023
  3. ^Diagnosis of Crohn’s Disease: NIDDK; Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; cited Feb 2023
  4. ^Barberio B, Gracie DJ, Black CJ, Ford ACEfficacy of biological therapies and small molecules in induction and maintenance of remission in luminal Crohn's disease: systematic review and network meta-analysis.Gut.(2023-Feb)
  5. ^Yang H, Feng R, Li T, Xu S, Hao X, Qiu Y, Chen MSystematic review with meta-analysis of partial enteral nutrition for the maintenance of remission in Crohn's disease.Nutr Res.(2020-09)
  6. ^Treatment for Crohn’s Disease: NIDDK; Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; cited Feb 2023
  7. ^Chen M, Feng Y, Liu WEfficacy and safety of probiotics in the induction and maintenance of inflammatory bowel disease remission: a systematic review and meta-analysis.Ann Palliat Med.(2021-Nov)
  8. ^Xiao-Feng Zhang, Xiao-Xian Guan, Yu-Jun Tang, Jin-Feng Sun, Xiao-Kai Wang, Wei-Dong Wang, Jian-Ming FanClinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysisEur J Nutr.(2021 Feb 8)
  9. ^Joanna Giang, Xiao Lan, Megan Crichton, Wolfgang Marx, Skye MarshallEfficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysisNutr Diet.(2021 May 7)
  10. ^Davis SP, Bolin LP, Crane PB, Wei H, Crandell JNon-pharmacological interventions to manage fatigue in adults with inflammatory bowel disease: A systematic review and meta-analysis.Complement Ther Clin Pract.(2020-Nov)
  11. ^Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges RTherapy of active Crohn disease with Boswellia serrata extract H 15.Z Gastroenterol.(2001-Jan)
  12. ^James D Lewis, Robert Sandler, Carol Brotherton, Colleen Brensinger, Hongzhe Li, Michael D Kappelman, Scott G Daniel, Kyle Bittinger, Lindsey Albenberg, John F Valentine, John Hanson, David Suskind, Andrea Meyer, Charlene W Compher, Meenakshi Bewtra, Akriti Saxena, Angela Dobes, Benjamin Cohen, Ann D Flynn, Monika Fischer, Sumona Saha, Arun Swaminath, Bruce Yacyshyn, Ellen Scherl, Sara Horst, Jeffrey R Curtis, Kimberly Braly, Lisa Nessel, Maureen McCauley, Liam McKeever, Hans Herfarth, DINE-CD Study GroupA Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn's DiseaseGastroenterology.(2021 May 27)
  13. ^Anita Chandrasekaran, Shauna Groven, James D Lewis, Susan S Levy, Caroline Diamant, Emily Singh, Gauree Gupta KonijetiAn Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel DiseaseCrohns Colitis 360.(2019 Oct)
  14. ^Peng Z, Yi J, Liu XA Low-FODMAP Diet Provides Benefits for Functional Gastrointestinal Symptoms but Not for Improving Stool Consistency and Mucosal Inflammation in IBD: A Systematic Review and Meta-Analysis.Nutrients.(2022-May-15)
  15. ^Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T, Parian A, Matarese LE, Bracewell K, MacDonald JK, Gordon M, Mullin GEDietary interventions for induction and maintenance of remission in inflammatory bowel disease.Cochrane Database Syst Rev.(2019-Feb-08)
  16. ^Fabisiak N, Fabisiak A, Watala C, Fichna JFat-soluble Vitamin Deficiencies and Inflammatory Bowel Disease: Systematic Review and Meta-Analysis.J Clin Gastroenterol.(2017)
  17. ^Kelly Lambert, Daniel Pappas, Chiara Miglioretto, Arefeh Javadpour, Hannah Reveley, Laura Frank, Michael C Grimm, Dorit Samocha-Bonet, Georgina L HoldSystematic review with meta-analysis: dietary intake in adults with inflammatory bowel diseaseAliment Pharmacol Ther.(2021 Sep)
  18. ^Cheng F, Huang Z, Wei W, Li ZFecal microbiota transplantation for Crohn's disease: a systematic review and meta-analysis.Tech Coloproctol.(2021-05)
  19. ^Ewais T, Begun J, Kenny M, Rickett K, Hay K, Ajilchi B, Kisely SA systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease.J Psychosom Res.(2019-01)
  20. ^Li C, Hou Z, Liu Y, Ji Y, Xie LCognitive-behavioural therapy in patients with inflammatory bowel diseases: A systematic review and meta-analysis.Int J Nurs Pract.(2019-Feb)
  21. ^McCurdy J, Siw KCK, Kandel R, Larrigan S, Rosenfeld G, Boet SThe Effectiveness and Safety of Hyperbaric Oxygen Therapy in Various Phenotypes of Inflammatory Bowel Disease: Systematic Review With Meta-analysis.Inflamm Bowel Dis.(2022-03-30)
  22. ^Li T, Qiu Y, Yang HS, Li MY, Zhuang XJ, Zhang SH, Feng R, Chen BL, He Y, Zeng ZR, Chen MHSystematic review and meta-analysis: Association of a pre-illness Western dietary pattern with the risk of developing inflammatory bowel disease.J Dig Dis.(2020-Jul)
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  24. ^Milajerdi A, Ebrahimi-Daryani N, Dieleman LA, Larijani B, Esmaillzadeh AAssociation of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.Adv Nutr.(2021-06-01)
Examine Database References
  1. Joint Pain (General) - James D Lewis, Robert Sandler, Carol Brotherton, Colleen Brensinger, Hongzhe Li, Michael D Kappelman, Scott G Daniel, Kyle Bittinger, Lindsey Albenberg, John F Valentine, John Hanson, David Suskind, Andrea Meyer, Charlene W Compher, Meenakshi Bewtra, Akriti Saxena, Angela Dobes, Benjamin Cohen, Ann D Flynn, Monika Fischer, Sumona Saha, Arun Swaminath, Bruce Yacyshyn, Ellen Scherl, Sara Horst, Jeffrey R Curtis, Kimberly Braly, Lisa Nessel, Maureen McCauley, Liam McKeever, Hans Herfarth, DINE-CD Study GroupA Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn's DiseaseGastroenterology.(2021 May 27)
  2. Crohn's Disease Symptoms - David L Suskind, Dale Lee, Young-Mo Kim, Ghassan Wahbeh, Namita Singh, Kimberly Braly, Mason Nuding, Carrie D Nicora, Samuel O Purvine, Mary S Lipton, Janet K Jansson, William C NelsonThe Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn's Disease: A Randomized Diet Controlled TrialNutrients.(2020 Dec 6)
  3. Crohn's Disease Symptoms - Timna Naftali, Lihi Bar-Lev Schleider, Iris Dotan, Ephraim Philip Lansky, Fabiana Sklerovsky Benjaminov, Fred Meir KonikoffCannabis induces a clinical response in patients with Crohn's disease: a prospective placebo-controlled studyClin Gastroenterol Hepatol.(2013 Oct)
  4. Crohn's Disease Symptoms - Jaya Benjamin, Govind Makharia, Vineet Ahuja, K D Anand Rajan, Mani Kalaivani, Siddhartha Datta Gupta, Yogendra Kumar JoshiGlutamine and whey protein improve intestinal permeability and morphology in patients with Crohn's disease: a randomized controlled trialDig Dis Sci.(2012 Apr)
  5. Crohn's Disease Symptoms - Akobeng AK, Miller V, Thomas AG, Richmond KGlutamine supplementation and intestinal permeability in Crohn's diseaseJPEN J Parenter Enteral Nutr.(2000 May-Jun)
  6. Crohn's Disease Symptoms - E Den Hond, M Hiele, M Peeters, Y Ghoos, P RutgeertsEffect of long-term oral glutamine supplements on small intestinal permeability in patients with Crohn's diseaseJPEN J Parenter Enteral Nutr.(Jan-Feb 1999)
  7. Crohn's Disease Symptoms - Peter R Holt, Seymour Katz, Robert KirshoffCurcumin therapy in inflammatory bowel disease: a pilot studyDig Dis Sci.(2005 Nov)
  8. Crohn's Disease Symptoms - Josep Bassaganya-Riera, Raquel Hontecillas, William T Horne, Mikki Sandridge, Hans H Herfarth, Richard Bloomfeld, Kim L IsaacsConjugated linoleic acid modulates immune responses in patients with mild to moderately active Crohn's diseaseClin Nutr.(2012 Oct)
  9. Crohn's Disease Symptoms - Naftali T, Mechulam R, Marii A, Gabay G, Stein A, Bronshtain M, Laish I, Benjaminov F, Konikoff FMLow-Dose Cannabidiol Is Safe but Not Effective in the Treatment for Crohn's Disease, a Randomized Controlled TrialDig Dis Sci.(2017 Jun)
  10. Crohn's Disease Symptoms - Limketkai BN, Godoy-Brewer G, Parian AM, Noorian S, Krishna M, Shah ND, White J, Mullin GEDietary Interventions for the Treatment of Inflammatory Bowel Diseases: An Updated Systematic Review and Meta-analysis.Clin Gastroenterol Hepatol.(2023-Sep)