Crohn's Disease

Topic Overview

Illustration of the lower digestive system

What is Crohn's disease?

Crohn's disease is a lifelong inflammatory bowel disease (IBD). Parts of the digestive system get swollen and have deep sores called ulcers. Crohn’s disease usually is found in the last part of the small intestine and the first part of the large intestine. But it can develop anywhere in the digestive tract, from the mouth to the anus.

What causes Crohn's disease?

Doctors don't know what causes Crohn’s disease. You may get it when the body’s immune system has an abnormal response to normal bacteria in your intestine. Other kinds of bacteria and viruses may also play a role in causing the disease.

Crohn’s disease can run in families. Your chances of getting it are higher if a close family member has it. People of Eastern European (Ashkenazi) Jewish family background may have a higher chance of getting Crohn’s disease. Smoking also puts you at a higher risk for the disease.

What are the symptoms?

The main symptoms of Crohn’s disease are belly pain and diarrhea (sometimes with blood). Some people may have diarrhea 10 to 20 times a day. Losing weight without trying is another common sign. Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and openings (fistulas) between organs.

Infections, hormonal changes, smoking, and stress can cause your symptoms to flare up. You may have only mild symptoms or go for long periods of time without any symptoms. A few people have ongoing, severe symptoms.

It’s important to be aware of signs that Crohn’s disease may be getting worse. Call your doctor right away if you have any of these signs:

  • You feel faint or have a fast and weak pulse.
  • You have severe belly pain.
  • You have a fever or shaking chills.
  • You are vomiting again and again.

How is Crohn's disease diagnosed?

Your doctor will ask you about your symptoms and do a physical exam. You may also have X-rays and lab tests to find out if you have Crohn’s.

Tests that may be done to diagnose Crohn's disease include:

  • Barium X-rays of the small intestine or colon.
  • Colonoscopy or flexible sigmoidoscopy. In these tests, the doctor uses a thin, lighted tube to look inside the colon.
  • Biopsy . The doctor takes a sample of tissue and tests it to find out if you have Crohn’s or another disease, such as cancer.
  • Stool analysis. This is a test to look for blood and signs of infection in a sample of your stool.

How is it treated?

Your treatment will depend on the type of symptoms you have and how bad they are.

The most common treatment for Crohn’s disease is medicine. Mild symptoms of Crohn's disease may be treated with over-the-counter medicines to stop diarrhea. But talk with your doctor before you take them because they may cause side effects.

You may also use prescription medicines. They help control inflammation in the intestines and keep the disease from causing symptoms. (When you don't have symptoms, you are in remission.) These medicines also help heal damaged tissue and can postpone the need for surgery.

If your symptoms are severe and these medicines don't help, you may need stronger treatment. You may get medicine through a vein (IV). In rare cases, you may need surgery to remove part of the intestine. Crohn's disease often comes back after surgery.

There are a few steps you can take to help yourself feel better. Take your medicine just as your doctor tells you to. Exercise, and eat healthy meals. Don't smoke. Smoking makes Crohn’s disease worse.

Crohn’s disease makes it hard for your body to absorb nutrients from food. A meal plan that focuses on high-calorie, high-protein foods can help you get the nutrients you need. Eating this way may be easier if you have regular meals plus two or three snacks each day.

How do you cope with Crohn's disease?

Having Crohn’s disease can be stressful. The disease affects every part of your life. Seek support from family and friends to help you cope. Get counseling if you need it.

Many people with inflammatory bowel diseases look to alternative treatments to improve their well-being. These treatments have not been proved effective for Crohn’s disease, but they may help you cope. They include massage, supplements such as vitamins D and B12, and herbs like aloe and ginseng.

Frequently Asked Questions

Learning about Crohn's disease:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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Cause

The cause of Crohn's disease is unknown. Studies suggest that this and other inflammatory bowel diseases may result from an abnormal response by the body's immune system to normal intestinal bacteria.1 Disease-causing bacteria and viruses also may play a role in causing the condition.

Crohn's disease can run in families, so some people may be more likely than others to develop the condition when exposed to something that triggers an immune reaction. Environmental factors may also play a role in causing the disease.

Symptoms

The main symptoms of Crohn's disease include:

  • Abdominal pain. The pain often is described as cramping and intermittent, and the abdomen may be sore when touched. Abdominal pain may turn to a dull, constant ache as the condition progresses.
  • Diarrhea. Some people may have diarrhea 10 to 20 times a day. They may wake up at night and need to go to the bathroom. Crohn's disease may cause blood in stools, but not always.
  • Loss of appetite.
  • Fever. In severe cases, fever or other symptoms that affect the entire body may develop. A high fever may mean that you have a complication involving infection, such as an abscess.
  • Weight loss. Ongoing symptoms, such as diarrhea, can lead to weight loss.
  • Too few red blood cells (anemia). Some people with Crohn's disease develop anemia because of low iron levels caused by bloody stools or the intestinal inflammation itself.

People with Crohn's disease also may have:

  • Sores in the mouth.
  • Nutritional deficiencies, such as lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food.
  • Bowel obstruction.
  • Signs of disease in or around the anus. These may include:
    • Abnormal tunnels or openings called fistulas that sometimes form between organs. These develop because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall. Fistulas may form between parts of the intestine or between the intestine and another organ such as the bladder, vagina, or skin. A fistula may be the first sign of Crohn's disease.
    • Pockets of infection (abscesses).
    • Small tears in the anus (anal fissures).
    • Skin tags that may resemble hemorrhoids. These are caused by inflamed skin.

Because there is some immune system involvement, you also may have symptoms and complications outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease.

Other conditions with symptoms similar to Crohn's disease include diverticulitis and ulcerative colitis.

What Happens

Crohn's disease is an ongoing (chronic) condition that may flare up throughout your life. The course of the disease varies greatly from one person to another. Some people may have only mild symptoms, while others may have severe symptoms or complications that, in unusual cases, may be life-threatening.

Crohn's disease may be mild, moderate, severe, or not active (in remission). It may be defined by the part of the digestive tract involved, such as the rectum and anus (perianal disease) or the area where the small intestine joins the large intestine (ileocecal disease). Some people may have features of both Crohn's disease and ulcerative colitis, the other major type of inflammatory bowel disease (IBD).

Crohn's disease can cause complications outside the digestive tract, such as joint pain, eye problems, a skin rash, or liver disease, suggesting a possible immune system response.

Because Crohn's disease can cause inflammation in parts of the intestines that absorb nutrients from food, it can cause deficiencies in vitamin B12, folic acid, or other nutrients. The disease can increase the risk of gallstones, kidney stones, and certain uncommon forms of anemia.

In long-term Crohn's disease, scar tissue may replace some of the inflamed or ulcerated intestines, forming blockages (bowel obstructions) or narrowed areas (strictures) that can prevent stool from passing through the intestines. Blockages in the intestines also can be caused by inflammation and swelling, which may improve with medicines. Sometimes blockages can only be treated with surgery.

If sores break through the wall of the intestines, abnormal connections or openings (fistulas) may develop between two parts of the intestines, between the intestines and other organs (such as the bladder or vagina), or between the intestines and the skin. In rare cases, this can lead to infection of the abdominal wall.

Crohn's disease of the colon and rectum that has been present for 8 to 10 years or longer increases the risk of cancer. But the risk of colorectal cancer may be higher with ulcerative colitis than with Crohn's disease. With regular screening, some cancers can be detected early and treated successfully.

Most women who have Crohn's disease are able to become pregnant and have healthy babies. Symptoms may become worse during the first 3 months of pregnancy. Some medicines used to treat the disease can be used during pregnancy.

What Increases Your Risk

Factors that may increase your risk of developing Crohn's disease include:

  • Having a family history of Crohn's disease. Your risk increases if an immediate family member, such as a parent, brother, or sister, has the disease.
  • Having Ashkenazi Jewish ancestry.
  • Smoking cigarettes.

Factors that may cause Crohn's disease symptoms to flare up include:

  • Medicines.
  • Infections.
  • Hormonal changes.
  • Lifestyle changes, including increased stress.
  • Smoking.

When To Call a Doctor

Call a doctor immediately if you have been diagnosed with Crohn's disease and you have one or more of the following:

  • Fever or shaking chills
  • Lightheadedness, passing out, or rapid heart rate
  • Stools that are almost always bloody
  • Severe dehydration
  • Severe abdominal pain or severe pain and bloating
  • Evidence of pus draining from the area around the anus or pain and swelling in the anal area
  • Repeated vomiting
  • Not passing any stools or gas

If you have any of these symptoms and you have been diagnosed with Crohn's disease, your condition may have become significantly worse. Some of these symptoms also may be signs of toxic megacolon, a rare complication of Crohn's disease that requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.

People who have Crohn's disease usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:

  • Your symptoms become significantly worse than usual.
  • You have persistent diarrhea for more than 2 weeks.
  • You have lost weight.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by Crohn's disease, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.

Even when the disease is not active (in remission), your doctor will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your doctor's office for advice.

Who To See

The following health professionals can diagnose most cases of Crohn's disease:

To help you manage Crohn's disease, you will probably be referred to a gastroenterologist.

To be evaluated for surgery, you may be referred to a:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Crohn's disease is diagnosed through a medical history and physical exam, imaging tests to look at the intestines, and laboratory tests.

Crohn's disease can be difficult to diagnose. The disease may go undiagnosed for years because symptoms usually develop gradually and the same part of the intestine is not always involved. Other diseases can also have the same symptoms as Crohn's disease. But Crohn's disease tends to cause the intestine to have a cobblestone appearance, which can help doctors diagnose it. The pattern results from the repeated formation and healing of sores (ulcers) in the intestine.

The colon and rectum can be examined with flexible sigmoidoscopy or colonoscopy, in which a lighted viewing instrument is used to examine the inside of the colon. In general, colonoscopy is the preferred test because it can be used to examine the entire colon. Sigmoidoscopy reaches only the last 2 ft (0.6 m) of the colon. Both procedures can be used to take a sample (biopsy) of intestinal tissue. Imaging tests such as barium enema, computed tomography (CT) scan, and magnetic resonance imaging (MRI) may be helpful in locating abnormal openings (fistulas).

A stool analysis is often done, depending on symptoms, to look for blood, signs of bacterial infection, malabsorption, parasites, or the presence of white blood cells. This test can be used to distinguish Crohn's disease from irritable bowel syndrome (IBS), which is a less serious condition that sometimes has similar symptoms. White blood cells in stool indicate inflammation and possibly infection and are also a sign of Crohn's disease. Having white blood cells in stool means you do not have IBS.

Stool analysis may be done during a flare-up if there is concern that new symptoms are caused by another problem. You can collect a stool sample, or the doctor may take a sample during sigmoidoscopy or colonoscopy.

Other exams and tests that may also be used to evaluate Crohn's disease include:

  • Abdominal X-ray, which provides a picture of possible obstruction in the abdomen.
  • Upper gastrointestinal (UGI) series with small-bowel follow-through to examine all of the small intestine. In this test the doctor examines the upper and part of the middle portions of the digestive tract. After you swallow a "shake" made of a white liquid (barium) and water, continuous X-rays (fluoroscopy) are taken to track the movement of the barium through the esophagus, stomach, and the small intestine. A video monitor displays the images.
  • Upper gastrointestinal endoscopy, which allows your doctor to look at the interior lining of your esophagus, stomach, and duodenum with a thin, flexible imaging instrument called an endoscope.
  • Barium enema, a test that allows the doctor to examine the large intestine (colon). For a barium enema, a white liquid (barium) is inserted through the rectum into the colon. The barium outlines the inside of the colon so that it can be more clearly seen on an X-ray.
  • Computed tomography (CT) scan, which uses X-rays to produce detailed pictures of structures inside the body.
  • Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.
  • Video capsule endoscopy (VCE), in which you swallow a tiny camera that records its trip through your digestive tract by sending images to a recording device that you wear on a belt. Your doctor later examines the images by downloading them from the recording device. The camera passes out of your body in stool within 10 to 48 hours. VCE is particularly useful in examining the small intestine, which is difficult to see with other endoscopic tests.
  • Small bowel enteroscopy, which uses a longer, lighted flexible tube with a tiny camera that sends pictures of the small intestine to a video screen. This helps the doctor look at the small intestine. The doctor can also take small samples (biopsy) of the tissue.

Standard blood tests and urine tests may be used to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) blood test may be done to look for infection or inflammation. C-reactive protein is a substance produced by the liver as a result of inflammation in the body.

A biopsy of a sample of tissue from the lining of the intestine, collected during sigmoidoscopy or colonoscopy, can be used to confirm the diagnosis of Crohn's disease. A biopsy also may be done to find out whether a tumor is present. Multiple biopsies for cancer screening are often done in people who have had Crohn's disease of the colon or rectum for 8 to 10 years or more. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and remove only a tiny piece of tissue.

Early Detection

No screening test exists for Crohn's disease at this time. But if you have had Crohn's disease affecting the colon or rectum for 8 to 10 years or longer, discuss with your doctor whether you need screening for colon cancer. Screening usually involves taking multiple-tissue biopsies during routine colonoscopy.

Treatment Overview

The main treatment for Crohn's disease is medicine to stop the inflammation in the intestine and medicine to prevent flare-ups and keep you in remission. A few people have severe, persistent symptoms or complications that may require a stronger medicine, a combination of medicines, or surgery. The type of symptoms you have and how bad they are will determine the treatment you need.

Initial treatment

Your doctor will most likely start with the traditional first-line treatment for Crohn's disease. He or she will then add or change medicines if you are not getting better.

Mild symptoms may respond to an antidiarrheal medicine such as loperamide (Imodium A-D, for example), which slows or stops the painful spasms in your intestines that cause symptoms.

For mild to moderate symptoms, your doctor will probably have you take:

  • Aminosalicylates (such as sulfasalazine or mesalamine). These medicines help manage symptoms for many people who have Crohn's disease.
  • Antibiotics such as ciprofloxacin and metronidazole. These may be tried if aminosalicylates are not helping your symptoms. These medicines work especially well for disease in the colon. Antibiotics are also used to treat fistulas, which are abnormal connections or openings between two organs or parts of the body. But 50% of fistulas come back when antibiotics are stopped.2
  • Corticosteroids (such as budesonide or prednisone). These may be given by mouth for a few weeks or months to control inflammation. But corticosteroids have serious side effects, such as high blood pressure, osteoporosis, and increased risk of infection.
    • Budesonide causes remission in mild or moderate Crohn's disease of the ileum and the right colon. It does not work as well as prednisone or other corticosteroids. But it also does not have as many side effects as other corticosteroids. The long-term side effects are not well known, so your doctor will probably not have you take it for a long time.
    • Prednisone may help if budesonide does not.
  • Medicines that suppress the immune system (called immunomodulator medicines), such as azathioprine (AZA), 6-mercaptopurine (6-MP), or methotrexate. You may take these if the medicines listed above do not work, if your symptoms come back when you stop taking corticosteroids, or if your symptoms come back often, even with treatment.
  • Tumor necrosis factor (TNF) antagonists, such as infliximab (Remicade). Your doctor may have you try these medicines if you have not had success with other medicines for Crohn's disease. In some cases, these medicines are tried before some of the other medicines that are listed above. Infliximab is also used to treat fistulas if antibiotics do not heal them. Other TNF antagonists may be used to treat Crohn's disease. They may work for people for whom infliximab has stopped working and for people who have a bad reaction to infliximab.

Severe symptoms may be treated with corticosteroids given through a vein (intravenous, IV) or TNF antagonists. With severe symptoms, the first step is to control the disease. When your symptoms are gone, your doctor will probably have you start taking one of the medicines listed above to keep you symptom-free (in remission).

Ongoing treatment

Ongoing treatment is designed to find a medicine or combination of medicines that keeps Crohn's disease in remission.

If aminosalicylates (such as sulfasalazine or mesalamine) or immune system suppressors (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or methotrexate) keep your disease in remission, you will continue taking the medicines. Your doctor will want to see you about every 6 months if your condition is stable or more frequently if you have flare-ups. You may have laboratory tests every 2 to 3 months.

Corticosteroids (such as budesonide, hydrocortisone, or prednisone) may be given to stop inflammation if you have flare-ups of symptoms. If you need to take corticosteroids for an extended time, you also may receive calcium, vitamin D, and prescription medicine to prevent osteoporosis.

Tumor necrosis factor (TNF) antagonists such as infliximab (Remicade) and adalimumab (Humira) are also used as maintenance medicines.

Treatment if the condition gets worse

If you have severe Crohn's disease, you will most likely be given infliximab (Remicade). This drug may be prescribed if Crohn's disease does not get better with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or methotrexate). Infliximab may also be given if your symptoms come back when you try to stop taking corticosteroids. Infliximab is given in a vein (intravenous, IV).

If infliximab does not work for you, or if you cannot take it because of a serious side effect, you may be given adalimumab (Humira) or certolizumab (Cimzia). These are both given as a shot under the skin (subcutaneous).

If you have a very bad flare-up of Crohn's disease, you will most likely need IV corticosteroids (like hydrocortisone) to get the disease under control.

Some severe cases of Crohn's disease need to be treated in the hospital where you would receive supplemental nutrition through a tube placed in your nose and down into the stomach (enteral nutrition). In other cases, the bowel may need to rest, and you will be fed liquid nutrients in a vein (total parenteral nutrition, TPN). Supplemental nutrition may be necessary if you are malnourished because of severe Crohn's disease in the small intestine. Nutritional support is especially important for children who are not growing normally because of severe disease.

Surgery may be needed if no medicine is effective, if you have serious side effects from medicine, if your symptoms can be controlled only with long-term use of corticosteroids, or if you develop complications such as fistulas, abscesses, or bowel obstructions. Surgery involves removing the affected portion of the intestines, preserving as much of the intestines as possible to maintain normal function. Crohn's disease tends to return to other areas of the intestines after surgery.

Prevention

Crohn's disease cannot be prevented because the cause is unknown. But you can take steps to reduce the severity of the disease.

  • Medicines taken regularly may reduce sudden (acute) attacks and keep the disease in remission (a period without symptoms).
  • Most experts recommend acetaminophen (Tylenol, for example) for pain relief rather than nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. NSAIDs have been linked to flare-ups.3
  • Do not smoke. Smoking makes Crohn's disease worse.
  • Eat a healthy diet.
  • Never use antibiotics unless they have been prescribed for you by a doctor.
  • Get regular exercise.

Home Treatment

If Crohn's disease does not cause symptoms, no treatment is needed. Mild symptoms may respond to antidiarrheal medicines or changes in diet and nutrition. For more information about making good food choices, see:

Click here to view an Actionset. Crohn's disease: Changing your diet.

In general, doctors recommend that you do not use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Studies have linked these pain relievers with flare-ups of Crohn's disease.3 But some people may be more likely to have flare-ups from NSAIDs than others. Talk to your doctor about whether to avoid these medicines.

If you have had or are planning to have surgery that will create an opening from the intestines to the outside of the body through which stool passes (ostomy), you may feel self-conscious or embarrassed. After a period of adjustment, most people are able to resume all of their usual activities. In fact, life may be better than it was before surgery because you may no longer suffer painful symptoms. Support groups are available for people with ostomies.

Click here to view an Actionset. Bowel disease: Caring for your ostomy

Children who have Crohn's disease may feel self-conscious if they do not grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing the disease than adults, so your support is especially important.

Medications

Medicines usually are the treatment of choice for Crohn's disease. They can control or prevent inflammation in the intestines and help:

  • Relieve symptoms.
  • Promote healing of damaged tissues.
  • Put the disease into remission and keep it from flaring up again.
  • Postpone the need for surgery.

Medication Choices

The choice of medicine usually depends on the severity of the disease, the part of the intestines that is affected, and whether complications are present.

  • Treatment of mild to moderate Crohn's disease often begins with aminosalicylates (such as sulfasalazine or mesalamine), which help prevent inflammation.
  • Antibiotics (ciprofloxacin or metronidazole) will probably be tried if aminosalicylates don't help your symptoms. Antibiotics are also useful for some complications of Crohn's disease and are used to treat fistulas.
  • Corticosteroids may be added if symptoms continue. Corticosteroids usually stop symptoms and put the disease in remission. But they are not used as long-term treatment to keep symptoms from coming back.
  • Stronger treatment with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], and methotrexate) may be needed to help keep the disease in remission.
  • Tumor necrosis factor (TNF) antagonists may be used for people who develop abnormal connections between the intestines and other organs (fistulas) or who have severe Crohn's disease that does not respond to other medicines. These medicines can be used to keep symptoms from coming back.
  • Cyclosporine and intravenous (IV) corticosteroids may be needed for severe cases.

What To Think About

Most of these medicines also can be used in children.

If you are pregnant or planning to become pregnant, talk to your doctor about which medicines might be okay to take for Crohn's disease. Sometimes, severe Crohn's disease can harm your baby more than the medicines you are taking to keep it under control. Some medicines, though, should never be taken when you are pregnant. Your doctor can tell you which medicines are okay for you while you are pregnant and nursing.

Surgery

Surgery is rarely done for Crohn's disease and it is not a cure. When surgery is needed, as little of the intestines as possible is removed to preserve normal function. The disease tends to return in areas that were previously not affected, and you may need surgery again.

Surgery may be needed for Crohn's disease if no medicine can control your symptoms, if you have serious side effects from medicines, if your symptoms can be controlled only with long-term use of corticosteroids, or if you develop complications such as fistulas, abscesses, or bowel obstructions.

Surgery may be needed when you have:

  • Bowel blockage (obstruction).
  • Abscesses or tears (fissures) in the anal area or when abnormal connections (fistulas) form between two parts of the intestine or between the intestine and other internal organs.
  • Holes (perforations) in the large intestine.
  • Cancer or precancerous tissue.
  • Severe disease that does not respond to other treatment.
  • Severe bleeding that requires ongoing blood transfusions.

Surgery Choices

Surgery is not usually done for Crohn's disease. If you do have surgery, it will most likely be one of the following:

  • Resection: The diseased portion of the intestines is removed, and the healthy ends of the intestine are reattached. Resection surgery does not cure Crohn's disease, which often comes back near the site of surgery.
  • Strictureplasty: The surgeon makes a lengthwise cut in the intestine and then sews the opening together in the opposite direction. This makes the intestine wider and helps with obstruction of the bowels. This is sometimes done at the same time as resection or when a person has had resection in the past. Strictureplasty is used when the doctor is trying to save as much of the intestine as possible.
  • Proctocolectomy and ileostomy: The surgeon removes the large intestine and rectum, leaving the lower end of the small intestine (the ileum). The anus is sewn closed, and a small opening called a stoma is made in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body, where stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.

Another procedure that may be done is balloon dilation. This is not a surgery. The doctor runs an endoscope through your intestines from your anus. The endoscope is a long, thin tube that has a video camera on the end. Next, the doctor uses the endoscope to thread an uninflated balloon across the stricture (the narrowed part of the intestine). When the balloon is inflated, it makes that part of the intestine wider. The balloon is deflated and then removed. Balloon dilation is a new technique and not as much is known about its long-term success compared to the surgical procedures listed above. Balloon dilation might be done if you want to put off a more complicated surgery for a while or if you have had surgery before and the doctor wants to save as much of the intestines as possible.

What To Think About

These surgeries can be done on children. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.

In rare cases, intestinal transplant is used to treat Crohn's disease. In this complex procedure, the small intestine is removed and replaced with the small intestine of a person who has recently died and donated his or her organs.

Other Treatment

Some people who have Crohn's disease need additional nutrition because severe disease prevents their small intestine from absorbing nutrients. Supplemental liquid feedings may be done through a tube placed in the nose and down into the stomach (enteral nutrition) or through a vein (total parenteral nutrition, or TPN). Supplemental feeding may be needed when:

  • Crohn's disease is not controlled with standard treatment.
  • Short bowel syndrome occurs. This happens when so much of the small intestine has been surgically removed or is affected by the disease that you cannot properly digest food and absorb enough nutrients.
  • Bowel blockage occurs.

Nutritional therapy may restore good nutrition to children who are growing more slowly than normal. It also can build strength if you need surgery or have been weakened because of severe diarrhea and poor nutrition.

Total parenteral nutrition allows the intestines to rest and heal. It may relieve an acute attack and allow surgery to be delayed or avoided. But it is common for symptoms to return when TPN is stopped and you go back to a regular diet. TPN does not change the long-term outcome of Crohn's disease.

Counseling for Crohn's disease

Crohn's disease can affect every aspect of your life. It may make you feel isolated or depressed. But you can take steps to improve your outlook and coping skills. You may want to seek professional counseling and social support from family, friends, or clergy. Research has shown that strong social support can reduce stress and disease activity.4

Other Treatment Choices

Nutritional supplements

Complementary medicine

Many people with inflammatory bowel disease consider nontraditional or complementary medicine in addition to prescription medicines. They may turn to these alternatives because there is no cure for Crohn's disease. People may also use complementary medicine to help in coping with:

  • The difficult side effects from standard medicines.
  • The emotional strain of dealing with a chronic illness.
  • The negative impact of severe disease on daily life.

These therapies have not been proven effective for Crohn's disease, but they may improve your overall well-being.

The various complementary therapies include:

  • Special diets or nutritional supplements, such as probiotics, evening primrose, and fish oils.
  • Vitamin supplements, such as vitamins D and B12.
  • Herbs, such as aloe and ginseng.
  • Massage.
  • Stimulation of the feet, hands, and ears to try to affect parts of the body (reflexology).

What To Think About

Nutritional supplements can help people receive enough essential nutrients but they are expensive.

TPN can cause metabolic imbalances. It also can raise the risk of a bloodstream infection from the catheter in the vein, which is needed to give TPN. Long-term use of TPN may raise the risk of liver problems or liver failure.

Related Information

References

Citations

  1. Sands BE (2006). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 2459–2498. Philadelphia: Saunders Elsevier.
  2. Friedman S, Lichtenstein GR (2006). Crohn's disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 785–801. Philadelphia: Saunders Elsevier.
  3. Hanauer SB (2005). Inflammatory bowel diseases. In DC Dale, DD Federman, eds., ACP Medicine, section 4, chap. 4. New York: WebMD.
  4. Sewitch MJ, et al. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. American Journal of Gastroenterology, 96(5): 1470–1479.

Other Works Consulted

  • Baert F, et al. (2003). Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease. New England Journal of Medicine, 348(7): 601–608.
  • Su C, Lichtenstein GR (2002). Recent developments in inflammatory bowel disease. Medical Clinics of North America, 86(6): 1497–1523.

Credits

Author Monica Rhodes
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
Last Updated October 9, 2008

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