Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT).

Crohn’s disease is a type of inflammatory bowel disease (IBD). It is an immune-mediated condition that affects many body systems, especially the digestive system. It is a chronic condition that causes inflammation and alternates between periods of active and inactive disease. There is currently no cure, but it is often manageable with medication and lifestyle changes.

The symptoms of Crohn’s disease mainly affect the digestive system. However, there can also be signs of the disease outside the digestive tract, called extraintestinal manifestations.

Signs and symptoms people with Crohn’s disease may experience include:  

Some of the more common signs and other conditions that may occur in people with Crohn’s disease are:

These other signs, symptoms, complications, and extraintestinal manifestations of Crohn’s disease can occur because the effects of the disease reach throughout the body. 

No single accepted theory explains the cause of Crohn’s disease (or other forms of IBD). However, one general theory is that in people with genes for IBD, the immune system reacts to something in the digestive tract and causes inflammation.

Environmental factors: Genetics don’t tell the entire story of why some people develop Crohn’s disease and others don’t. It’s thought that outside factors also play a role. What exactly these things are is not settled science, but some are better studied than others.

A few of the potential environmental risk factors include:

Genetics: Some genes are found more commonly in people with Crohn’s disease. However, not all family members don’t always go on to develop a form of IBD. This is because the causes of Crohn’s disease are partly genetic and partly due to environmental factors.  

Immune system changes: Crohn’s disease is considered an immune-mediated condition, meaning the immune system, which is supposed to protect the body from germs and toxins, reacts abnormally, leading to digestive system inflammation. This immune reaction may be tied to a disruption in the gut microbiome (community of microbes) and other factors, which may lead to the development of Crohn’s disease.

Microbiome: The digestive system is home to many different types of germs: bacteria, viruses, and fungi. People with IBD may have a different makeup of microbes than what’s considered normal. A disturbance in the balance of the microbiome (called dysbiosis) may be a part of the development of IBD and how the disease continues.

Smoking: People who smoke might have twice the risk of developing Crohn’s disease. Risks also include secondhand smoke and being exposed to secondhand smoke at a young age. Some research has also shown that people with Crohn’s disease who are exposed to cigarette smoke have more aggressive disease with a greater need for surgery.

Crohn's disease goes through periods of active disease (flare-up) and periods of fewer symptoms and possible remission. What causes Crohn's disease to flare is different from person to person. However, some common factors causing or adding to a flare-up are:

No single test can diagnose Crohn’s disease. This form of IBD is usually diagnosed using results from several different tests and taking signs and symptoms into account. The list of potential tests is long, however, not every test will be needed in everyone.

A colonoscopy in which biopsies (tissue samples) are taken is usually the test that offers the most information and helps in making a diagnosis. This procedure is done by inserting a thin, flexible tube into the rectum and up through the colon.

Other tests may be performed to support the diagnosis, rule out other issues, and look for any complications. Tests may include:

Crohn’s disease is treated in a variety of ways, using medication, surgery, and changes to diet and lifestyle. Because the disease affects people in such an individual way, there’s no one treatment plan that’s used for everyone. Instead, healthcare providers and patients work together to create a plan that will be the best fit.

Several different types of medications are approved to treat Crohn’s disease. Sometimes more than one drug is prescribed, especially during a flare-up of the disease. 

Surgery is a valid treatment option for Crohn’s disease. The type of surgery used will depend on where the disease is located in the intestine and the goals of treatment. These include:

Multiple lifestyle changes might be used to help manage Crohn’s disease. People work with their healthcare providers to understand which factors will be effective while also fitting into their lifestyle.

Lifestyle changes that have some evidence for their use in managing Crohn’s disease include:

Diet is a major topic of study and discussion for people with Crohn’s disease. However, no one diet has been identified as being useful for everyone with the condition. Every person will have their own diet needs, which will change as they go through periods of active disease and remission. 

Ask for a referral to a dietitian who specializes in digestive conditions and can help people with IBD. Unfortunately, though, dietitians are in high demand and are not available to everyone, especially in underserved communities.

If you are unable to get individualized dietary guidance, you may wish to follow a Mediterranean diet . This diet emphasizes whole grains, fruits, vegetables, nuts, olive oil, and fish, with fewer servings of saturated fat, refined sugars, and meat.

Some of the diets that are under study or have been used by people with Crohn’s disease include:  

Enteral nutrition is liquid nutrition, which may be in the form of drinks or tube feeding.

Crohn’s can go into remission, though there are various definitions of remission. They differ depending on the criteria used or the goals of the patient. Remission is often thought of as a time with few or no symptoms, but there is more to the story.

Clinical remission is when a person has few or no signs or symptoms of the disease. However, a person can feel well but still have inflammation in their body. This inflammation can cause complications months or years in the future.

For that reason, gastroenterologists and other healthcare providers may look for other types of remission, as well as clinical remission. 

Types of remission that may be discussed in relation to Crohn’s disease may include:  

One of the more influential studies done on remission in Crohn’s disease showed that about 30% of people with Crohn's were in deep remission (clinical remission, biochemical remission and mucosal healing) at the start of the trial. Another 40% were in endoscopic remission.

Living with Crohn’s disease will mean focusing on a lifestyle that will help prevent flare-ups and limit the potential for complications. As treatments for Crohn’s disease improve, more people can get effective care early in the disease course.

It may not always be possible to avoid flare-ups. However, getting regular care from a specialist and following a management plan that includes diet, lifestyle, and medications may help. 

Some of the practical measures you can take to help manage the disease and also give yourself a degree of control include:

People will want to talk with their healthcare providers about how to achieve their goals. In the IBD space, this is called treat to target. A person and their provider should together decide on how treatment can help reach milestones. This could mean anything from going to the bathroom fewer times a day to having less pain to achieving long-term remission.

Receiving a diagnosis of Crohn’s disease can bring on a host of emotions and worries. It’s helpful to know that there are many treatment options already, research is ongoing, and more is being understood all the time.

Medications are an important tool in the management of Crohn’s, and the pipeline of new medications and therapies is strong. Multiple drugs across many different classes of medications are being studied for use in Crohn’s disease.

Lifestyle factors and mental health are now also taking a larger role in the discussion around disease management. Diet, lifestyle, sexual health, and quality of life are being studied and discussed openly. Healthcare providers are available who specialize in IBD and can help people develop a holistic plan to manage Crohn’s disease from day to day.

With all that in mind, it is possible to live a full life while managing Crohn’s disease effectively and avoiding complications.

Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113:481-517. doi:10.1038/ajg.2018.27

Zhang YZ, Li YY. Inflammatory bowel disease: pathogenesis. World J Gastroenterol. 2014;20:91–99. doi:10.3748/wjg.v20.i1.91

Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nat Rev Gastroentero. 2015;12:205-217. doi:10.1038/nrgastro.2015.34. 

Uchiyama K, Haruyama Y, Shiraishi H. Association between passive smoking from the mother and pediatric Crohn's disease: a Japanese multicenter study. Int J Environ Res Public Health. 2020;17(8):2926. doi:10.3390/ijerph17082926

Rogler G, Zeitz J, Biedermann L. The search for causative environmental factors in inflammatory bowel disease. Dig Dis. 2016;34 Suppl 1:48-55. doi:10.1159/000447283

Park J, Yoon H, Shin CM, et al. Clinical factors to predict flare-up in patients with inflammatory bowel disease during international air travel: A prospective study. PLoS One. 2022;17(1):e0262571. doi:10.1371/journal.pone.0262571. 

Feagins LA, Iqbal R, Spechler SJ. Case-control study of factors that trigger inflammatory bowel disease flares. World J Gastroenterol. 2014;20:4329-34. doi: 10.3748/wjg.v20.i15.4329

Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68(Suppl 3):s1-s106. doi:10.1136/gutjnl-2019-318484

Feuerstein JD, Cheifetz AS. Crohn disease: Epidemiology, diagnosis, and management. Mayo Clin Proc. 2017;92:1088-1103. doi:10.1016/j.mayocp.2017.04.010

Papada E, Amerikanou C, Forbes A, Kaliora AC. Adherence to Mediterranean diet in Crohn's disease. Eur J Nutr. 2020;59(3):1115-1121. doi:10.1007/s00394-019-01972-z

Olendzki B, Bucci V, Cawley C, et al. Dietary manipulation of the gut microbiome in inflammatory bowel disease patients: Pilot study. Gut Microbes. 2022;14:2046244. doi:10.1080/19490976.2022.2046244

Cox SR, Lindsay JO, Fromentin S, et al. Effects of low FODMAP diet on symptoms, fecal microbiome, and markers of inflammation in patients with quiescent inflammatory bowel disease in a randomized trial. Gastroenterology. 2020;158:176-188.e7. doi:10.1053/j.gastro.2019.09.024. 

Ungaro RC, Yzet C, Bossuyt P, et al. Deep remission at 1 year prevents progression of early Crohn’s disease. Gastroenterology. 2020;159:139-147. doi: 10.1053/j.gastro.2020.03.039.  

Jedel S, Hoffman A, Merriman P, et al. A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. Digestion. 2014;89:142-155. doi:10.1159/000356316

Kish T. Targeting remission in moderate-to-severe Crohn’s disease. P T. 2018;43:358-361.  

By Amber J. Tresca Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.

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