Crohn's Disease: Causes, Symptoms & Treatment

Crohn's disease is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal (GI) tract. Unlike ulcerative colitis (which affects only the colon), Crohn's can affect any part of the digestive tract from the mouth to the anus, though it most commonly involves the end of the small intestine (ileum) and the beginning of the colon. The inflammation in Crohn's extends through the full thickness of the intestinal wall.

Crohn's disease affects approximately 500,000 Americans, with peak onset between ages 15 and 35. It is a lifelong condition with periods of flares (active disease) and remission.

Symptoms vary depending on the location and severity of inflammation:

• Persistent diarrhea (sometimes bloody)
• Abdominal pain and cramping (often in the lower right area)
• Fatigue
• Unintentional weight loss
• Reduced appetite
• Fever
• Mouth sores
• Perianal disease (fistulas, abscesses, skin tags)
• Urgency to have bowel movements

Extraintestinal manifestations (occur in up to 25%):

• Joint pain and arthritis
• Skin conditions (erythema nodosum, pyoderma gangrenosum)
• Eye inflammation (uveitis, episcleritis)
• Liver and bile duct inflammation

Medications to induce and maintain remission:

• 5-aminosalicylates (mesalamine): For mild colonic disease
• Corticosteroids (prednisone, budesonide): For inducing remission in flares, not for long-term use
• Immunomodulators (azathioprine, 6-mercaptopurine, methotrexate): For maintaining remission
• Biologic therapies (have transformed Crohn's treatment):
  • Anti-TNF agents (infliximab, adalimumab, certolizumab)
  • Anti-integrin (vedolizumab)
  • Anti-IL-12/23 (ustekinumab)
  • Anti-IL-23 (risankizumab)
• Small molecule therapies: Upadacitinib (JAK inhibitor)
• Antibiotics: Metronidazole, ciprofloxacin for perianal disease

Surgery:

• Up to 70-80% of Crohn's patients eventually require surgery
• Resection of diseased bowel segments
• Strictureplasty for narrowed areas
• Drainage of abscesses
• Surgery is not curative -- disease can recur

Nutritional support:

• Address nutritional deficiencies (iron, B12, vitamin D, folate)
• Exclusive enteral nutrition can induce remission, especially in children
• No specific universal diet, but many patients benefit from avoiding trigger foods

See a gastroenterologist if you have persistent diarrhea, recurrent abdominal pain, unintentional weight loss, blood in your stool, or unexplained fatigue. Early diagnosis and treatment can help prevent complications.