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Crohn disease

Crohn disease; Inflammatory bowel disease - Crohn disease; Regional enteritis; Ileitis; Granulomatous ileocolitis; IBD - Crohn disease

Crohn disease is a disease where parts of the digestive tract become inflamed.

  • It most often involves the lower end of the small intestine and the beginning of the large intestine.
  • It may also occur in any part of the digestive system from the mouth to the end of the rectum (anus).

Crohn disease is a form of inflammatory bowel disease (IBD).

Ulcerative colitis is a related condition.

Causes

The exact cause of Crohn disease is unknown. It occurs when your body's immune system mistakenly attacks and destroys healthy body tissue (autoimmune disorder).

When parts of the digestive tract remain swollen or inflamed, the walls of the intestines become thickened.

Factors that may play a role in Crohn disease include:

  • Your genes and family history. (People who are white or of Eastern European Jewish descent are at a higher risk.)
  • Environmental factors.
  • Tendency of your body to over-react to normal bacteria in the intestines.
  • Smoking.

Crohn disease may occur at any age. It mostly occurs in people between ages 15 and 35.

Symptoms

Symptoms depend on the part of the digestive tract involved. Symptoms range from mild to severe, and can come and go, with periods of flare-ups.

The main symptoms of Crohn disease are:

  • Crampy pain in the abdomen (belly area).
  • Fever.
  • Fatigue.
  • Loss of appetite and weight loss.
  • Feeling that you need to pass stools, even though your bowels are already empty. It may involve straining, pain, and cramping.
  • Watery diarrhea, which may be bloody.

Other symptoms may include:

  • Constipation
  • Sores or swelling in the eyes
  • Draining of pus, mucus, or stools from around the rectum or anus (caused by something called a fistula)
  • Joint pain and swelling
  • Mouth ulcers
  • Rectal bleeding and bloody stools
  • Swollen gums
  • Tender, red bumps (nodules) under the skin, which may turn into skin ulcers

Exams and Tests

A physical exam may show a mass or tenderness in the abdomen, skin rash, swollen joints, or mouth ulcers.

Tests to diagnose Crohn disease include:

A stool culture may be done to rule out other possible causes of the symptoms.

This disease may also alter the results of the following tests:

  • Low albumin level
  • High sed rate
  • Fecal fat
  • Low blood count (hemoglobin and hematocrit)
  • Abnormal liver blood tests
  • High white blood cell count
  • Elevated fecal calprotectin level in stool 

Treatment

Tips for managing Crohn disease at home:

DIET AND NUTRITION

You should eat a well-balanced, healthy diet. Include enough calories, protein, and nutrients from a variety of food groups.

No specific diet has been shown to make Crohn symptoms better or worse. Types of food problems may vary from person to person.

Some foods can make diarrhea and gas worse. To help ease symptoms, try:

  • Eating small amounts of food throughout the day.
  • Drinking lots of water (drink small amounts often throughout the day).
  • Avoiding high-fiber foods (bran, beans, nuts, seeds, and popcorn).
  • Avoiding fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
  • Limiting dairy products if you have problems digesting dairy fats. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
  • Avoiding foods that you know cause gas, such as beans and vegetables in the cabbage family, such as broccoli.

Ask your health care provider about extra vitamins and minerals you may need, such as:

  • Iron supplements (if you are anemic)
  • Calcium and vitamin D supplements to help keep your bones strong
  • Vitamin B12 to prevent anemia

If you have an ileostomy, you will need to learn:

STRESS

You may feel worried, embarrassed, or even sad and depressed about having a bowel disease. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can worsen digestive problems.

Ask your provider for tips on how to manage your stress.

MEDICINES

You can take medicine to treat very bad diarrhea. Loperamide (Imodium) can be bought without a prescription. Always talk to your provider before using these drugs.

Other medicines to help with symptoms include:

  • Fiber supplements, such as psyllium powder (Metamucil) or methylcellulose (Citrucel). Ask your provider before taking these products or laxatives.
  • Acetaminophen (Tylenol) for mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) which can make your symptoms worse.

Your provider may also prescribe medicines to help control Crohn disease:

  • Aminosalicylates (5-ASAs), medicines that help control mild to moderate symptoms. Some forms of the drug are taken by mouth, and others must be given rectally.
  • Corticosteroids, such as prednisone, treat moderate to severe Crohn disease. They may be taken by mouth or inserted into the rectum.
  • Medicines that quiet the immune system's reaction.
  • Antibiotics to treat abscesses or fistulas.
  • Immunosuppressive drugs such as Imuran, 6-MP, and others to avoid long-term use of corticosteroids.
  • Biologic therapy may be used for severe Crohn disease that does not respond to any other types of medicines.

SURGERY

Some people with Crohn disease may need surgery to remove a damaged or diseased part of the intestine. In some cases, the entire large intestine is removed, with or without the rectum.

People who have Crohn disease that does not respond to medicines may need surgery to treat problems such as:

  • Bleeding
  • Failure to grow (in children)
  • Fistulas (abnormal connections between the intestines and another area of the body)
  • Infections
  • Narrowing of the intestine

Surgeries that may be done include:

Crohn's Disease Treatment Facts

  • Crohn's disease can involve the:

     

    A. Large intestine

     

    B. Small intestine

     

    C. Stomach and esophagus

     

    D. Rectum

     

    E. Mouth

     

    F. All of the above

    Correct Answer
    The correct answer is all of the above. In people with Crohn's disease, the immune system mistakenly attacks the digestive tract--the part of your body that food and waste pass through. This leads to swollen and inflamed tissue, most often in the small intestines. But these changes may occur anywhere from the mouth to the end of the rectum.
  • Which is NOT a goal of Crohn's disease treatment?

     

    A. Pain relief

     

    B. Weight loss

     

    C. Reduced inflammation

     

    D. Improved nutritional intake

    Correct Answer
    The correct answer is weight loss. Many people with Crohn's disease lose too much weight, either because of poor appetite or poor absorption of nutrients. The goals of treatment are to reduce inflammation, pain, and diarrhea, and to improve nutrition. Tell your doctor if you're losing weight.
  • Diet changes are an important part of treating Crohn's disease.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. No specific diet has been shown to improve Crohn's in everyone. But you can learn to avoid foods that make your symptoms worse. You should eat a well-balanced diet with enough calories, protein, and essential nutrients. Ask your health care provider to help you plan balanced meals.
  • Which is a good food choice for people with Crohn's disease?

     

    A. Beans

     

    B. Cabbage

     

    C. Broccoli

     

    D. Citrus fruit

     

    E. None of the above

    Correct Answer
    The correct answer is none of the above. All of these foods can cause gas. Because people with Crohn's are prone to gas, avoiding these foods is a good idea. Talk with your health care provider about which foods are better for people with Crohn's disease.
  • People with Crohn's disease should eat plenty of fiber.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Too much fiber may make your symptoms worse. Try baking or stewing fruits and vegetables if eating them raw bothers you. Eat low-fiber foods if that does not help enough. Ask your doctor about any extra vitamins or mineral supplements you may need.
  • For mild pain, people with Crohn's disease can take:

     

    A. Acetaminophen

     

    B. Aspirin

     

    C. Ibuprofen

     

    D. Naproxen

     

    E. All of the above

    Correct Answer
    The correct answer is acetaminophen (Tylenol). It's best to avoid aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). These medicines may make your symptoms worse. If you have Crohn's disease, check with your doctor before taking any over-the-counter medicines.
  • Prescription medicines for Crohn's disease can:

     

    A. Reduce swelling and damage in the digestive tract

     

    B. Calm the immune system

     

    C. Both

    Correct Answer
    The correct answer is both. Some medicines reduce inflammation in the intestines, which can relieve pain and diarrhea. Others keep the immune system from attacking the digestive tract. These medicines can have serious side effects, so talk to your doctor about the pros and cons.
  • Biologic therapy may help when other treatments don't provide enough relief.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Biologic therapies are given by injection. Your doctor may recommend biologic therapy if other medicines don't reduce inflammation enough or if you develop certain complications.
  • Surgery to remove part of the intestine will cure Crohn's disease.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Some people with Crohn's disease may need surgery to remove a damaged part of the intestine or rectum. This can correct bleeding, blockages, and other serious intestinal problems. But it is not a cure. Discuss the risks and benefits of surgery with your doctor.
  • Patients with Crohn's disease who smoke are more likely to need surgery.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Smoking can make Crohn's symptoms worse and increase the chances of needing surgery. Quitting smoking can make Crohn's less severe. Ask your doctor about strategies that can help you quit.
  • What else can help manage Crohn's disease?

     

    A. Reducing stress

     

    B. Getting enough rest

     

    C. Joining a support group

     

    D. All of the above

    Correct Answer
    The correct answer is all of the above. Stress can make Crohn's symptoms worse, so it's important to find ways to relax. You may find it helpful to join a support group. The Crohn's and Colitis Foundation of America offers support groups throughout the United States.

Support Groups

The Crohn's and Colitis Foundation of America offers support groups all over the United States -- www.crohnscolitisfoundation.org

Outlook (Prognosis)

There is no cure for Crohn disease. The condition is marked by periods of improvement followed by flare-ups of symptoms. Crohn disease cannot be cured, even with surgery. But the surgical treatment can offer major help.

Possible Complications

You have more risk for small bowel and colon cancer if you have Crohn disease. Your provider may suggest tests to screen for colon cancer.

Those with more severe Crohn disease may have these problems:

  • Abscess or infection in the intestines
  • Anemia, a lack of red blood cells
  • Bowel blockage
  • Fistulas in the bladder, skin, or vagina
  • Slow growth and sexual development in children
  • Swelling of the joints
  • Lack of important nutrients, such as vitamin B12 and iron
  • Problems with maintaining a healthy weight
  • Swelling of the bile ducts (primary sclerosing cholangitis)

When to Contact a Medical Professional

Call your provider if you:

  • Have very bad abdominal pain
  • Cannot control your diarrhea with diet changes and drugs
  • Have lost weight, or a child is not gaining weight
  • Have rectal bleeding, drainage, or sores
  • Have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without an illness
  • Have nausea and vomiting that lasts for more than a day
  • Have skin sores that do not heal
  • Have joint pain that prevents you from doing your everyday activities
  • Have side effects from medicines you are taking for your condition

References

Fleshman JW, Peters WR. The management of Crohn's colitis. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:164-171.

Lichenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Mahmoud NN, Bleier JIS, Aarons CB, Paulson EC, Shanmugan S, Fry RD. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 51.

Sandborn WJ. Crohn's disease evaluation and treatment: clinical decision tool. Gastroenterology. 2014;147(3):702-705. PMID: 25046160 www.ncbi.nlm.nih.gov/pubmed/25046160.

Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 115.

  • Crohn disease

    Crohn disease

    Animation

  •  

    Crohn disease - Animation

    Living with Crohn's disease can be a constant gamble, hoping this won't be the day when your disease flares up. Crohn's disease is a type of inflammatory bowel disease. It's caused by a malfunction in the body's immune system. Normally, the immune system protects against bacteria and other foreign invaders. But in people with Crohn's disease, it mistakenly attacks the intestines, causing them to swell up and thicken. As a result, people with Crohn's disease have bouts of severe abdominal pain, diarrhea, and pain with bowel movements. They can lose their appetite, feel tired, and lose weight without meaning to. Some have severe mouth sores. If you've been experiencing any of these symptoms, your doctor can test for Crohn's with a colonoscopy using a scope to look at your colon from the inside. A wireless video capsule may be swallowed to look at the small intestine. Blood tests or other imaging studies may be needed as well. If you're concerned about Crohn's, stop smoking. Smoking can increase your chance of getting Crohn's disease and once you have it smoking can make the condition worse. Medicines can help with the symptoms of Crohn's disease. There are medicines to control diarrhea, and pain relievers to help with abdominal cramps. There are also medicines that quiet the overactive immune response that causes Crohn's. Changing your diet may make a big difference in preventing or reducing symptoms. But as diet that works well for you may be different than the one that works for others. Eating several small meals a day instead of three big ones prevents your intestines from having to process large amounts of food at once. Your doctor may also recommend that you drink lots of water, and avoid high-fiber and high-fatty foods, as well as any foods that you know make you gassy, perhaps beans or broccoli. You may also need to take iron, B12, and other vitamin and mineral supplements if your Crohn's is preventing you from getting enough nutrients through your diet. If medicines and diet changes aren't enough to reduce your symptoms, and you develop bleeding or an infection in your intestines, you may need a procedure called a bowel resection to remove the diseased part of your intestines. This procedure won't cure Crohn's, but it can help control the complications of the disease. If you're experiencing Crohn's symptoms, like stomach pain, severe diarrhea, or unplanned weight loss, call your doctor. Although there's no cure for Crohn's, treatments can relieve some of the uncomfortable symptoms, prevent complications, helping improve your quality of life.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Crohn disease, X-ray

    Crohn disease, X-ray - illustration

    This lower abdominal X-ray shows narrowing (stenosis) of the end of the small intestine (ileum), caused by Crohn disease. Crohn disease typically affects the small intestine, whereas ulcerative colitis typically affects the large intestine. A solution containing a dye (barium), was swallowed by the patient. When it passed into the small intestines, this X-ray was taken (lower GI series).

    Crohn disease, X-ray

    illustration

  • Inflammatory bowel disease

    Inflammatory bowel disease - illustration

    Crohn disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.

    Inflammatory bowel disease

    illustration

  • Anorectal fistulas

    Anorectal fistulas - illustration

    Crohn disease is an inflammation of the intestines caused by immune response to an infection. The lining of the intestine may ulcerate and form channels of infection, called fistulas. Fistulas tunnel from the area of ulceration, creating a hole which may continue until it reaches the surface of the organ, or the surface of nearby skin. These holes typically spread the infection that creates them, and life-threatening conditions such as peritonitis (inflammation of the lining of the abdomen) may occur.

    Anorectal fistulas

    illustration

  • Crohn disease - affected areas

    Crohn disease - affected areas - illustration

    The inflammation of Crohn disease is nearly always found in the ileocecal region. The ileocecal region consists of the last few inches of the small intestine (the ileum), which moves digesting food to the beginning portion of the large intestine (the cecum). However, Crohn disease can occur anywhere along the digestive tract.

    Crohn disease - affected areas

    illustration

  • Ulcerative colitis

    Ulcerative colitis - illustration

    Ulcerative colitis is categorized according to location. Proctitis involves only the rectum. Proctosigmoiditis affects the rectum and sigmoid colon. Left-sided colitis encompasses the entire left side of the large intestine. Pancolitis inflames the entire colon.

    Ulcerative colitis

    illustration

  • Inflammatory bowel disease - series

    Inflammatory bowel disease - series

    Presentation

  • Crohn disease

    Animation

  •  

    Crohn disease - Animation

    Living with Crohn's disease can be a constant gamble, hoping this won't be the day when your disease flares up. Crohn's disease is a type of inflammatory bowel disease. It's caused by a malfunction in the body's immune system. Normally, the immune system protects against bacteria and other foreign invaders. But in people with Crohn's disease, it mistakenly attacks the intestines, causing them to swell up and thicken. As a result, people with Crohn's disease have bouts of severe abdominal pain, diarrhea, and pain with bowel movements. They can lose their appetite, feel tired, and lose weight without meaning to. Some have severe mouth sores. If you've been experiencing any of these symptoms, your doctor can test for Crohn's with a colonoscopy using a scope to look at your colon from the inside. A wireless video capsule may be swallowed to look at the small intestine. Blood tests or other imaging studies may be needed as well. If you're concerned about Crohn's, stop smoking. Smoking can increase your chance of getting Crohn's disease and once you have it smoking can make the condition worse. Medicines can help with the symptoms of Crohn's disease. There are medicines to control diarrhea, and pain relievers to help with abdominal cramps. There are also medicines that quiet the overactive immune response that causes Crohn's. Changing your diet may make a big difference in preventing or reducing symptoms. But as diet that works well for you may be different than the one that works for others. Eating several small meals a day instead of three big ones prevents your intestines from having to process large amounts of food at once. Your doctor may also recommend that you drink lots of water, and avoid high-fiber and high-fatty foods, as well as any foods that you know make you gassy, perhaps beans or broccoli. You may also need to take iron, B12, and other vitamin and mineral supplements if your Crohn's is preventing you from getting enough nutrients through your diet. If medicines and diet changes aren't enough to reduce your symptoms, and you develop bleeding or an infection in your intestines, you may need a procedure called a bowel resection to remove the diseased part of your intestines. This procedure won't cure Crohn's, but it can help control the complications of the disease. If you're experiencing Crohn's symptoms, like stomach pain, severe diarrhea, or unplanned weight loss, call your doctor. Although there's no cure for Crohn's, treatments can relieve some of the uncomfortable symptoms, prevent complications, helping improve your quality of life.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Crohn disease, X-ray

    Crohn disease, X-ray - illustration

    This lower abdominal X-ray shows narrowing (stenosis) of the end of the small intestine (ileum), caused by Crohn disease. Crohn disease typically affects the small intestine, whereas ulcerative colitis typically affects the large intestine. A solution containing a dye (barium), was swallowed by the patient. When it passed into the small intestines, this X-ray was taken (lower GI series).

    Crohn disease, X-ray

    illustration

  • Inflammatory bowel disease

    Inflammatory bowel disease - illustration

    Crohn disease, also called regional enteritis, is a chronic inflammation of the intestines which is usually confined to the terminal portion of the small intestine, the ileum. Ulcerative colitis is a similar inflammation of the colon, or large intestine. These and other IBDs (inflammatory bowel disease) have been linked with an increased risk of colorectal cancer.

    Inflammatory bowel disease

    illustration

  • Anorectal fistulas

    Anorectal fistulas - illustration

    Crohn disease is an inflammation of the intestines caused by immune response to an infection. The lining of the intestine may ulcerate and form channels of infection, called fistulas. Fistulas tunnel from the area of ulceration, creating a hole which may continue until it reaches the surface of the organ, or the surface of nearby skin. These holes typically spread the infection that creates them, and life-threatening conditions such as peritonitis (inflammation of the lining of the abdomen) may occur.

    Anorectal fistulas

    illustration

  • Crohn disease - affected areas

    Crohn disease - affected areas - illustration

    The inflammation of Crohn disease is nearly always found in the ileocecal region. The ileocecal region consists of the last few inches of the small intestine (the ileum), which moves digesting food to the beginning portion of the large intestine (the cecum). However, Crohn disease can occur anywhere along the digestive tract.

    Crohn disease - affected areas

    illustration

  • Ulcerative colitis

    Ulcerative colitis - illustration

    Ulcerative colitis is categorized according to location. Proctitis involves only the rectum. Proctosigmoiditis affects the rectum and sigmoid colon. Left-sided colitis encompasses the entire left side of the large intestine. Pancolitis inflames the entire colon.

    Ulcerative colitis

    illustration

  • Inflammatory bowel disease - series

    Presentation

A Closer Look

 

Self Care

 

Tests for Crohn disease

 

 

Review Date: 7/9/2017

Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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