Crohn's disease

Diagnosis

A healthcare professional will likely diagnose Crohn's disease only after ruling out other possible causes for symptoms. There is no single test to diagnose Crohn's disease.

A combination of tests may be used to help confirm a diagnosis of Crohn's disease, including:

Lab tests

• Blood tests. Blood tests can check for signs of infection or anemia — a condition in which there aren't enough red blood cells to carry enough oxygen to the tissues.

  These tests also may be used to check for levels of inflammation, liver function or the presence of inactive infections, such as tuberculosis. Blood also may be screened for the presence of immunity against infections.

• Stool studies. A stool sample may be used to test for blood or organisms, such as infection-causing bacteria or, rarely, parasites in the stool, to look for causes of diarrhea and symptoms. Sometimes looking for stool markers of inflammation, such as calprotectin, can be helpful.

Procedures

• Colonoscopy. A colonoscopy uses a tiny camera on the end of a flexible tube to visually examine the entire colon and the very end of the ileum. During the procedure, small samples of tissue, called a biopsy, may be taken for laboratory analysis. This may help to make a diagnosis. Clusters of inflammatory cells called granulomas may suggest a diagnosis of Crohn's disease.

• CT scan. A CT scan is a special X-ray technique that provides more detail than a standard X-ray does. This test looks at the entire bowel as well as at tissues outside the bowel.

  CT enterography is a special CT scan that involves drinking an oral contrast material and getting intravenous contrast images of the intestines. This test provides better images of the small bowel and has replaced barium X-rays in many medical centers.

• MRI. An MRI scan uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI used with a contrast fluid, called MR enterography, is particularly useful for evaluating a fistula around the anal area or the small intestine.

  Sometimes MR enterography can be performed to check for disease status or progression. This test may be used instead of CT enterography to reduce the risk of radiation, especially in younger people.

• Capsule endoscopy. This test involves swallowing a capsule with a camera in it. The camera takes pictures of the small intestine and sends them to a recorder worn on a belt. The images are then downloaded to a computer, displayed on a monitor and checked for signs of Crohn's disease. The camera exits the body painlessly in stool.

  Endoscopy with biopsy may still be necessary to confirm a diagnosis of Crohn's disease. Those with Crohn's disease of the small intestine may be at a higher risk of the capsule getting stuck in the intestine, especially if there is a history of narrowing or surgery of the small intestine. Capsule endoscopy should not be done if there is a suspected stricture or blockage, also called an obstruction, in the bowel.

Treatment

There is currently no cure for Crohn's disease, and there is no single treatment that works for everyone. However, there are several medicines that have been approved for treatment of Crohn's disease. One goal of medical treatment is to reduce the inflammation that triggers symptoms. Another goal is to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.

Anti-inflammatory medicines

Anti-inflammatory medicines are often the first step in the treatment of inflammatory bowel disease. They include:

• Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in the body, but they don't work for everyone with Crohn's disease. Sometimes, intravenous steroids are used in the hospital setting for short duration.

  Corticosteroids may be used for short term (3 to 4 months) symptom improvement and to induce remission. Corticosteroids also may be used in combination with an immune system suppressor to induce the benefit from other medicines. They are then eventually tapered off.

• Oral 5-aminosalicylates. These medicines are sometimes used for mild to moderate Crohn's disease. They include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Delzicol, Pentasa, others). Oral 5-aminosalicylates work best for Crohn's disease in the colon but don't work as well if the disease is in the small intestine.

Immune system suppressors

These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone.

Immune system suppressors include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with a healthcare professional and have your blood checked regularly. This is to look for side effects, such as a lowered resistance to infection and inflammation of the liver. These medicines also may cause nausea and vomiting.
• Methotrexate (Trexall). This medicine is sometimes used for people with Crohn's disease who don't respond well to other medicines. You will need to be followed closely for side effects.

Biologics

This class of therapies targets proteins made by the immune system. Types of biologics used to treat Crohn's disease include:

• Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Also known as TNF inhibitors, these medicines work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
• Ustekinumab (Stelara). This treats Crohn's disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
• Vedolizumab (Entyvio). This is a type of medicine known as a monoclonal antibody. It works by stopping certain immune cell molecules — integrins — from binding to other cells in the intestinal lining. Vedolizumab is a gut-specific agent and is approved for Crohn's disease.
• Risankizumab (Skyrizi). Risankizumab also is a monoclonal antibody. This medicine acts against a molecule known as interleukin-23. Risankizumab was recently approved for treating moderate to severe Crohn's disease.

Synthetic versions of biologics, called biosimilars, are available to treat Crohn's disease. These medicines work like the original versions of biologics, and they may cost less.

Janus kinase (JAK) inhibitors

JAK inhibitors are a type of medicine known as small molecules. These newer medicines help reduce inflammation by targeting parts of the immune system that cause inflammation in the intestines. They are taken by mouth. JAK inhibitors may be recommended for Crohn's disease that hasn't responded to other therapies. The U.S. Food and Drug Administration has approved the JAK inhibitor upadacitinib to treat Crohn's disease. JAK inhibitors are not recommended for use in pregnancy.

Antibiotics

Antibiotics can reduce the amount of drainage from fistulas and abscesses and sometimes heal them in people with Crohn's disease. Some researchers also think that antibiotics help reduce harmful bacteria that may be causing inflammation in the intestine. Commonly prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medicines

In addition to controlling inflammation, some medicines may help relieve symptoms. But talk to a healthcare professional before taking any medicines you can buy without a prescription. Depending on the severity of Crohn's disease, a health professional may recommend one or more of the following:

• Anti-diarrheals. A fiber supplement, such as psyllium husk (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.

  These medicines could be ineffective or even harmful in some people with strictures or certain infections. Please consult a healthcare professional before taking these medicines.

• Pain relievers. For mild pain, a health professional may recommend acetaminophen (Tylenol, others) — but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These medicines are likely to make symptoms worse and can make the disease worse as well.
• Vitamins and supplements. If you're not absorbing enough nutrients, your health professional may recommend vitamins and nutritional supplements.

Nutrition therapy

A health professional may recommend a special diet given by mouth or a feeding tube, called enteral nutrition. Nutrients also can be delivered into a vein, called parenteral nutrition. This can improve overall health and allow the bowel to rest. Bowel rest may reduce inflammation in the short term.

Your care professional may use nutrition therapy short term and combine it with medicines, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier before surgery or when other medicines fail to control symptoms.

Your care professional also may recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel, called a stricture. A low residue diet is designed to reduce the size and number of your stools.

Surgery

If diet and lifestyle changes, medicines, or other treatments don't relieve symptoms, a healthcare professional may recommend surgery. Nearly half of those with Crohn's disease might require at least one surgery. However, surgery does not cure Crohn's disease.

During surgery, the surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery also may be used to close fistulas and drain abscesses.

The benefits of surgery for Crohn's disease are usually temporary. The disease often recurs, often near the reconnected tissue. The best approach is to follow surgery with medicine to reduce the risk of recurrence.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Sometimes you may feel helpless when facing Crohn's disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet

There's no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up.

It can be helpful to keep a food diary to track what you're eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them.

Here are some general dietary suggestions that may help to manage your condition:

• Limit dairy products. Many people with inflammatory bowel disease find that problems such as diarrhea, belly pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can't digest the milk sugar, called lactose, in dairy foods. Using an enzyme product such as Lactaid may help.
• Eat small meals. You may feel better eating five or six small meals a day rather than two or three larger ones.
• Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
• Consider multivitamins. Because Crohn's disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with a healthcare professional before taking any vitamins or supplements.
• Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Smoking

Smoking increases your risk of developing Crohn's disease. And once you have Crohn's disease, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and need medicines and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.

Stress

Although stress doesn't cause Crohn's disease, it can make your symptoms worse and may trigger flare-ups. Although it's not always possible to avoid stress, you can learn ways to help manage it, such as:

• Exercise. Even mild exercise can help reduce stress, relieve depression and regulate bowel function. Talk to a healthcare professional about an exercise plan that's right for you.
• Biofeedback. This stress-reduction technique may help you decrease muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
• Regular relaxation and breathing exercises. One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. Many helpful books and online videos are available to help with relaxation and meditation.

Alternative medicine

Many people with Crohn's disease have used some form of complementary and alternative medicine to treat their condition. However, there are few well-designed studies of the safety and effectiveness of these treatments.

Coping and support

Crohn's disease doesn't just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:

• Be informed. One of the best ways to be more in control is to find out as much as possible about Crohn's disease. Look for information from the Crohn's & Colitis Foundation.
• Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with Crohn's disease.
• Talk to a therapist. Some people find it helpful to consult a mental health professional who's familiar with inflammatory bowel disease and the emotional difficulties it can cause.

Although living with Crohn's disease can be discouraging, research is ongoing and the outlook is improving.

Preparing for your appointment

Symptoms of Crohn's disease may first prompt you to visit your primary healthcare professional. Your care professional may recommend that you see a specialist who treats digestive diseases, called a gastroenterologist.

Because appointments can be brief, and there's often a lot of information to discuss, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your visit.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you're taking.
• Ask a family member or friend to come with you to your appointment. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Preparing a list of questions before you go can help you make the most of your visit. List your questions from most important to least important in case time runs out. For Crohn's disease, some basic questions to ask include:

• What's causing these symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• Are there any medicines that I should avoid?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Do I need to follow any dietary restrictions?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• If I have Crohn's disease, what is the risk that my child will develop it?
• What kind of follow-up testing do I need in the future?

In addition to the questions that you've prepared, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

You'll likely be asked a number of questions, including:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or off and on?
• How severe are your symptoms?
• Do your symptoms affect your ability to work or do other activities?
• Does anything seem to improve your symptoms?
• Is there anything that you've noticed that makes your symptoms worse?
• Do you smoke?
• Do you take over the counter or prescription nonsteroidal anti-inflammatory medicines (NSAIDs) — for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium?