Crohn's Disease

What Is Crohn's Disease?

Crohn's disease is a chronic inflammatory bowel disease (IBD) that causes inflammation anywhere along the digestive tract, from the mouth to the anus. Most commonly, it affects the end of the small intestine (the ileum) and the beginning of the large intestine (the colon). Unlike ulcerative colitis, which only affects the inner lining of the colon, Crohn's disease can involve the full thickness of the bowel wall and may occur in patches, with healthy segments of intestine between inflamed areas.

Crohn's disease affects approximately 780,000 Americans and is most frequently diagnosed in people between the ages of 15 and 35. It is a lifelong condition characterized by periods of active disease (flares) alternating with periods of remission. While there is currently no cure, modern treatments can effectively control symptoms and maintain remission for extended periods.

Common Symptoms

Symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly. Common symptoms include:

• Persistent diarrhea: Often watery and sometimes containing blood or mucus
• Abdominal pain and cramping: Frequently in the lower right abdomen, often worsening after meals
• Rectal bleeding: Blood in the stool or on toilet paper
• Unintended weight loss: Due to reduced appetite, malabsorption, or active inflammation
• Fatigue: Persistent tiredness that interferes with daily activities
• Fever: Low-grade fever during flares, sometimes accompanied by night sweats
• Mouth sores: Ulcerations similar to canker sores, particularly in the inner lining of the mouth
• Reduced appetite and nausea
• Perianal disease: Fistulas, abscesses, or skin tags around the anus

Crohn's disease can also cause extraintestinal symptoms affecting the joints (arthritis), skin (erythema nodosum, pyoderma gangrenosum), eyes (uveitis), and liver (primary sclerosing cholangitis).

Causes and Risk Factors

The exact cause of Crohn's disease remains unknown, but research indicates it results from a complex interaction of several factors:

• Immune system dysfunction: An abnormal immune response attacks the cells of the digestive tract, causing chronic inflammation. This may be triggered by bacteria or viruses that cause the immune system to attack the intestinal lining
• Genetics: Up to 20% of people with Crohn's disease have a first-degree relative with IBD. Specific gene mutations, particularly in the NOD2/CARD15 gene, have been associated with increased risk
• Environmental factors: Living in an industrialized country, urban environment, or northern climate increases risk. Diet high in processed foods, smoking, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) may contribute
• Smoking: The single most important controllable risk factor. Smokers are twice as likely to develop Crohn's disease and tend to have more severe symptoms
• Age: Although Crohn's can occur at any age, most people are diagnosed before age 30
• Ethnicity: People of Eastern European (Ashkenazi) Jewish descent have a higher risk, though the disease can affect any ethnic group

Diagnosis

Diagnosing Crohn's disease typically requires a combination of tests, as no single test can confirm the diagnosis definitively. Dr. Khan may recommend:

• Blood tests: To check for anemia, elevated inflammatory markers (C-reactive protein, erythrocyte sedimentation rate), and nutritional deficiencies
• Stool tests: To detect fecal calprotectin or lactoferrin, which indicate intestinal inflammation, and to rule out infections
• Colonoscopy with biopsies: The gold standard for evaluating the colon and terminal ileum, allowing direct visualization and tissue sampling for microscopic examination
• Upper endoscopy: To assess involvement of the upper digestive tract
• Capsule endoscopy (PillCam): A swallowed camera capsule that captures images of the entire small intestine, helpful for detecting Crohn's disease in areas not reachable by standard endoscopy
• CT enterography or MR enterography: Advanced imaging that provides detailed views of the small bowel to detect inflammation, strictures, fistulas, and abscesses

Treatment Options

Treatment goals for Crohn's disease focus on reducing inflammation, controlling symptoms, achieving and maintaining remission, and preventing complications. Dr. Khan creates individualized treatment plans that may include:

Medications

• Aminosalicylates (5-ASA): Sulfasalazine or mesalamine for mild disease, particularly when the colon is involved
• Corticosteroids: Prednisone or budesonide for short-term control of moderate to severe flares
• Immunomodulators: Azathioprine, 6-mercaptopurine, or methotrexate to suppress the immune response and maintain remission
• Biologic therapies: Targeted medications including anti-TNF agents (infliximab, adalimumab), integrin inhibitors (vedolizumab), and interleukin inhibitors (ustekinumab, risankizumab) that block specific pathways of inflammation
• Small molecule therapies: Newer oral medications such as JAK inhibitors (upadacitinib) that offer additional treatment options
• Antibiotics: Metronidazole or ciprofloxacin for perianal disease or secondary infections

Nutritional Therapy

Nutritional support is an important component of Crohn's management. Exclusive enteral nutrition (a liquid diet formula) can be effective in inducing remission, particularly in children. Dr. Khan may also recommend specific dietary modifications, supplementation for nutritional deficiencies, and working with a registered dietitian.

Surgery

Up to 75% of people with Crohn's disease will eventually require surgery. Common procedures include:

• Bowel resection: Removal of the diseased segment of intestine and reconnection of healthy ends
• Strictureplasty: Widening a narrowed section of bowel without removing tissue
• Fistula repair or abscess drainage

Surgery is not curative, and recurrence at the surgical site is common, which is why ongoing medical therapy after surgery is often recommended.

When to See a Doctor

Contact a gastroenterologist promptly if you experience:

• Persistent changes in bowel habits lasting more than a few weeks
• Abdominal pain that does not resolve or worsens over time
• Blood in your stool
• Unexplained weight loss or fever
• Ongoing diarrhea that does not respond to over-the-counter medications
• A family history of inflammatory bowel disease combined with GI symptoms
• Signs of complications such as bowel obstruction (severe cramping, vomiting, inability to pass stool or gas)

Dr. Amber Khan at GastroCares has extensive experience managing Crohn's disease and works closely with each patient to develop a comprehensive, personalized treatment plan aimed at achieving lasting remission and improving quality of life.