Crohn's disease is a long-lasting (chronic) disease that affects the gastrointestinal (GI) tract. Crohn's disease often causes irritation and inflammation in the small intestine and the beginning of the large intestine, but it can affect any part of the GI tract. Crohn's disease is part of a group of illnesses that are known as inflammatory bowel disease (IBD).
Crohn's disease may start slowly and get worse over time. Symptoms may come and go. They may also go away for months or even years at a time (remission).
What are the causes?
The exact cause of this condition is not known. It may involve a response that causes your body's disease-fighting (immune) system to attack healthy cells and tissues (autoimmune response). Bacteria, genes, and your environment may also play a role.
What increases the risk?
The following factors may make you more likely to develop this condition:
- Having a family member who has Crohn's disease, another IBD, or an autoimmune condition.
- Using products that contain nicotine or tobacco, such as cigarettes and e-cigarettes.
- Being in your 20s.
- Having Eastern European ancestry.
What are the signs or symptoms?
The main symptoms of this condition involve your GI tract. These include:
- Pain or cramping in the abdomen. This is commonly felt in the lower right side of the abdomen.
- Frequent watery or bloody stools.
- This may mean having:
- fewer bowel movements in a week than normal.
- difficulty having a bowel movement.
- stools that are dry, hard, or larger than normal.
- Rectal bleeding.
- Rectal pain.
- An urgent need to have a bowel movement.
- The feeling that you are not finished having a bowel movement.
Other symptoms may include:
- Unexplained weight loss.
- Loss of appetite.
- Joint pain.
- Vision changes.
- Red bumps or sores on the skin.
- Sores inside the mouth.
How is this diagnosed?
This condition may be diagnosed based on:
- Your symptoms and your medical history.
- A physical exam.
- Tests, which may include:
- blood tests.
- stool sample tests.
- imaging tests, such as X-rays and CT scans.
- tests to examine the inside of your intestines using a long, flexible tube that has a light and a camera on the end (endoscopy or colonoscopy).
- A procedure to remove tissue samples from inside your bowel for testing (biopsy).
You may need to work with a healthcare provider who specialises in diseases of the digestive tract (gastroenterologist).
How is this treated?
There is no cure for this condition, but treatment can help you manage your symptoms. Crohn's disease affects each person differently. Your treatment may include:
- Resting your bowels. This involves having a period of healing time when your bowels are not passing stools. This may be done by:
- Drinking only clear liquids. These are liquids that you can see through, such as water, black coffee, fruit juice without pulp, broth, gelatine, and ice pops.
- Getting nutrition through an IV for a period of time.
- These may be used by themselves or with other treatments (combination therapy). These may include antibiotic medicines. You may be given medicines that help to:
- reduce inflammation.
- control your immune system activity.
- fight infections.
- relieve cramps and prevent diarrhoea.
- control your pain.
- You may need surgery if:
- medicines and other treatments are not working anymore.
- you develop complications from severe Crohn's disease.
- a section of your intestine becomes so damaged that it needs to be removed.
Follow these instructions at home:
- Take over-the-counter and prescription medicines only as told by your healthcare provider.
- If you were prescribed an antibiotic, take it as told by your healthcare provider. Do not stop taking the antibiotic even if you start to feel better.
- Avoid taking ibuprofen or other NSAID medicines if possible, these can make Crohn's disease worse.
Eating and drinking
- Talk with your healthcare provider or a diet and nutrition specialist (registered dietitian) about what diet is best for you.
- Drink enough fluid to keep your urine pale yellow.
- If you are taking steroids to reduce inflammation, get plenty of calcium in your diet to help keep your bones healthy. You may also consider taking a calcium supplement with vitamin D.
- Keep a food diary to identify foods that make your symptoms better or worse.
- Avoid foods that cause symptoms.
- Follow instructions from your healthcare provider about eating or drinking restrictions if you have worsening symptoms (flare-up).
- Limit alcohol intake to no more than 1 drink a day for non-pregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.
- Make sure you get all the vaccines that your healthcare provider recommends, especially pneumonia (pneumococcal) and flu (influenza) vaccines.
- Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your healthcare provider.
- Exercise every day, or as often told by your healthcare provider.
- Keep all follow-up visits as told by your healthcare provider. This is important.
Contact a healthcare provider if:
- You have diarrhoea, cramps in your abdomen, and other GI problems that are present almost all the time.
- Your symptoms do not improve with treatment.
- You continue to lose weight.
- You develop a rash or sores on your skin.
- You develop eye problems.
- You have a fever.
- Your symptoms get worse.
- You develop new symptoms.
Get help right away if:
- You have bloody diarrhoea.
- You have severe pain in your abdomen.
- You cannot pass stools.
- Crohn's disease affects each person differently. There are multiple treatment options that can help you manage the condition.
- Talk with your healthcare provider or diet and nutrition specialist (registered dietitian) about what diet is best for you.
- Make sure you get all the vaccines that your health care provider recommends, especially pneumonia (pneumococcal) and flu (influenza) vaccines.
This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.
Bressler B., Marshall J.K., Bernstein C.N., et. al.: Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology 2015; 148: pp. 1035-1058 e3.
Gomollon F., Dignass A., Annese V., et. al.: 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: part 1—diagnosis and medical management. J Crohns Colitis 2017; 11: pp. 3-25.
Torres J., Mehandru S., Colombel J.-F., Peyrin-Biroulet L: Crohn's disease. Lancet 2017; 389: pp. 1741-1755.
van Deen W.K., Nguyen D., Duran N.E., et. al.: Value redefined for inflammatory bowel disease patients: a choice-based conjoint analysis of patients' preferences. Qual Life Res 2017; 26: pp. 455-465.
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