A type of inflammatory bowel disease that can affect any part along the digestive tract is known as Crohn’s disease.

What is Crohn’s disease?

Crohn’s disease is a long-term condition that causes inflammation in the digestive tract. It is one of the main types of inflammatory bowel disease. Crohn’s can affect people at any age, but is most commonly diagnosed in older children, teenagers and young adults — especially between the ages of 15 and 35.

The inflammation from Crohn’s disease can happen anywhere along the digestive tract, but it most often affects the small intestine and large intestine. Crohn’s disease may appear and disappear (often called a flare), though treatment is still needed when symptoms are not active.

Types of Crohn’s Disease

The types of Crohn’s disease are often identified by two factors.

• By location in the gastrointestinal tract:
  • Ileal Crohn’s disease: Inflammation mainly in the end of the small intestine (ileum).
  • Colonic Crohn’s disease: Involves the large intestine (colon).
  • Ileocolonic Crohn’s disease: Affects both the ileum and the colon.
  • Upper GI Crohn’s disease: Involves the stomach and beginning of the small intestine.
• By the behavior of the disease:
  • Inflammatory: It causes swelling and irritation without damaging the bowel wall.
  • Stricturing: It narrows the bowel due to long-term inflammation and scarring, which can lead to blockages.
  • Penetrating: The inflammation creates tunnels through the wall of the intestine, which can form abnormal connections called fistulas.

Crohn’s Disease Symptoms

Digestive Symptoms

• Diarrhea or frequent loose stools
• Abdominal pain or cramping
• Blood in the stool
• Constipation or a feeling of incomplete bowel movements
• Bloating or feeling full

Other Common Symptoms

• Fatigue
• Poor appetite
• Weight loss
• Fever
• Delayed growth or puberty in children
• Joint or muscle pain
• Mouth sores
• Skin rashes or bumps

Crohn’s Disease vs. Ulcerative Colitis

Though they share similar symptoms, it’s important to know that these forms of inflammatory bowel disease are not the same. Each condition affects a different part of the gastrointestinal (GI) tract.

• Crohn’s disease affects any part of the GI tract and the entire thickness of bowel wall.
• Ulcerative colitis affects only the large intestine (colon) and the innermost lining of the large intestine.

Crohn’s Disease Diagnosis

A diagnosis of Crohn’s disease begins with a full check-up and several tests to look at the digestive system. These tests help find out where the inflammation is and how severe it is.

Blood and stool tests

These tests check for inflammation, infection or low iron levels (anemia). The presence of fecal calprotectin or lactoferrin — each a type of protein — can help clinicians detect inflammation in the intestines.

Imaging scans

• MR enterography: A scan that takes pictures of the small intestine. The person will need to drink a flavored liquid before the test to help the doctor see the intestines clearly.
• CT scan: X-ray technology produces images of the digestive tract to help find inflammation or complications.

Endoscopy

• Colonoscopy: A thin, flexible tube with a camera is used to look inside the large intestine. Small tissue samples (biopsies) are taken to look for inflammation.
• Upper GI endoscopy: Checks the esophagus, stomach and upper part of the small intestine if symptoms are higher in the belly.

Crohn’s Disease Treatment

Treatment for Crohn’s disease will depend on how severe the disease is and where in the digestive tract it is located. The main goals of treatment are to reduce inflammation, improve symptoms and increase quality of life.

Medications

Crohn’s disease is best managed by medications prescribed by the patient’s care team. Medications used to treat Crohn’s disease include:

• Antibiotics: Sometimes used when there is an infection or small bowel bacterial overgrowth.
• Steroids: Used for short periods to bring down inflammation during flares.
• Oral 5-aminosalicylates: Sometimes used for mild or moderate Crohn’s disease to reduce inflammation in the colon.
• Immunomodulators: Medication that reduces inflammation and also alters the body’s immune response by preventing the activity of the white blood cells that mistakenly attack healthy cells in the gastrointestinal tract in cases of Crohn’s disease.
• Biologic therapies: Medicine that targets the substance in the body that causes inflammation.
• Vitamins and supplements: Supports growth and prevents problems like anemia or bone loss.

Nutrition Therapy

A liquid formula diet called exclusive enteral nutrition (EEN) may be suggested to bring inflammation down, particularly in children. Certain dietary changes as recommended by a doctor may provide temporary relief while medication therapy is beginning.

Surgery

Surgical treatments do not lead to permanent remission of Crohn’s disease, but they may relieve symptoms and improve quality of life. In the past, up to 80% of people with Crohn's disease needed surgery at some point in their lives. But, with newer biologic medication over the past decade, the rates of patients requiring surgery have declined.

When may surgery be considered?

• When medications and nutrition therapy do not relieve symptoms.
• To treat a stricture, which is a narrowing of the intestinal wall that may lead to blockage.
• To treat a perforation, which is a hole in the intestinal wall that may lead to infection in the intestine.
• To treat a fistula, which is an abnormal connection between the intestines and another area of the body.
• To treat abscesses, which are pus-filled pockets of infection.
• To treat precancerous or cancerous activity in the bowels.
• To aid growth and development issues in children whose condition has affected their ability to get proper nutrients.
• When there are other internal complications, such as bleeding from the gut or colon, inflammation or intestinal blockage.

In the event of any of these developments, a health care professional will best determine if or when a surgical procedure is needed.

Types of Surgery for Crohn’s Disease

Small bowel or ileocecal resection: This method involves removing the affected part of the short intestine. The two healthy ends of the intestine are sewn together.

• Small bowel resection: Performed when part of the small intestine has a stricture or a perforation.
• Ileocecal resection: Performed when tissue at the end of the small intestine (terminal ileum) has been severely affected by stricture, fistula or abscess and requires removal.

Strictureplasty: This method is used when a stricture occurs. During strictureplasty, the narrowed part of the intestine is cut and the remaining ends sewn back together, which shortens and widens the intestine so food can pass through. Unlike other methods, this does not involve removing part of the small intestine. It is typically used to treat the lower part of the small intestine. Multiple strictures can be repaired during a single procedure.

Colorectal Resection: This method involves removing the affected part of the large intestine.

• Proctocolectomy: Performed when both the colon and rectum are affected and require removal. Since this surgery removes most of the path that stool passes through, a new path must be created. For most patients with Crohn’s disease who require this surgery, the proctocolectomy is followed by an ileostomy. During an ileostomy, the end of the small intestine (ileum) is brought through a hole created in the abdomen (stroma) to connect to an ostomy pouch outside of the body that collects the waste.
• Colectomy: Performed when the colon is affected but not the rectum. During the procedure, the colon is removed, and the lower part of the small intestine is joined directly to the rectum. This scenario does not require an ostomy pouch.

Fistula treatment: When a fistula develops, medications will be used to help treat infection along the affected tract. Surgery is often still required to drain any abscesses that developed in the fistula and to eventually close it. While there are several types of fistulas that can develop from Crohn’s, anal (or perianal) fistulas and vaginal (rectovaginal) fistulas are two of the most common.

Abscess drainage: Small abscesses along the abdomen or anal area can sometimes be treated with antibiotics. However, larger abscesses may also need surgery to drain them. This can be performed in a minimally invasive procedure with a needle or catheter, or through an open surgery, during which a surgeon cuts into the abscess in the affected area and inserts a tube to drain the infection.

Ostomy: A procedure that creates a new pathway for stool to pass through in the absence of removed intestine.

• Ileostomy: The end of the small intestines (ileum) is brought through a hole created in the abdomen (stoma) to connect to an ostomy pouch outside of the body that collects the waste.
• Colostomy: Performed when part of the colon has been removed.

Complications from Crohn’s Disease

Crohn’s disease can lead to other health problems over time, including:

• Anemia (low red blood cell count)
• Kidney stones
• Liver problems, such as inflammation of the bile ducts
• Delayed growth and puberty in children
• Arthritis, or joint pain and swelling
• Colorectal cancer. People with Crohn’s disease have an increased risk of developing cancer in the colon and/or rectum. 

These complications may require special monitoring and treatment. Because everyone’s symptoms and affected areas are different, it’s important to keep regular check-ups with your care team and follow your personalized care plan. 

Crohn’s Disease and Pregnancy

While people with Crohn’s disease typically have healthy pregnancies, flares can increase risk for miscarriage, premature labor and low birth weight. Consult with a health care professional before considering pregnancy.

Outlook for People with Crohn’s Disease

People with Crohn’s disease typically live active lives, and have the same life expectancy as people without the condition. Ongoing treatment and maintaining suggested diet and lifestyle changes are key to keeping symptoms minimal or absent.

Preventive colonoscopies and other ongoing tests may be recommended by a health care professional to monitor the condition and prevent complications.