Crohn's disease

Diagnosis

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

Lab tests

• Blood tests. Blood tests can check for signs of anemia — a condition in which there is a low number of red blood cells.
• Stool studies. A stool sample may be used to test for blood, inflammation or organisms such as infection-causing bacteria or, rarely, parasites in the stool. 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, a small sample of tissue, called a biopsy, may be taken for laboratory analysis. This is helpful to make a diagnosis.

Imaging tests

• 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 magnetic resonance (MR) enterography, is particularly useful for evaluating a fistula around the anal area or the small intestine.

  Sometimes, MR enterography can 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.

• Ultrasound. Similar to CT or MRI, an ultrasound of your intestines can assess inflammation and complications related to Crohn's disease.

• 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.

  You may still need endoscopy with biopsy 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 are many treatment options available for Crohn's disease. Treatment aims to reduce inflammation that causes symptoms and to prevent complications. Sometimes, treatment can lead to long-term healing of inflammation. Treatment may include medicines, surgery and nutrition therapy. It is important to work with your healthcare team to develop a treatment plan that is right for you.

Medicines

Medicines used to treat Crohn's disease may include:

• Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation. However, they do not work for everyone. These medicines are typically used for short-term symptom relief and to induce remission. Sometimes, intravenous steroids may be used in the hospital for a short time.
• Immune system suppressors. These medicines lower immune system activity that contributes to inflammation. Some examples of immunosuppressant medicines include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan) and methotrexate (Trexall).

• Biologics. These medicines target proteins in the body that cause inflammation. Some are given by infusion, and some are given by shot. Examples include infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), vedolizumab (Entyvio), ustekinumab (Stelara), risankizumab (Skyrizi), mirikizumab (Omvoh) and guselkumab (Tremfya).

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

• Small-molecule medicines. Janus kinase (JAK) inhibitors are a type of small molecule medicine taken by mouth. They reduce inflammation by targeting parts of the immune system. These medicines may be used when other treatments have not worked. The U.S. Food and Drug Administration has approved the JAK inhibitor upadacitinib to treat Crohn's disease. JAK inhibitors should not be used during pregnancy.
• Antibiotics. Antibiotics are mainly used to treat complications such as infections, abscesses and fistulas rather than Crohn's disease affecting the intestine alone. Antibiotics can reduce the amount of drainage from fistulas and abscesses and sometimes heal them in people with Crohn's disease. Commonly prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Nutrition therapy

A health professional may recommend a special diet given by mouth or a feeding tube, called enteral nutrition. Nutrients also can be given in 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 healthcare professional may use nutrition therapy short-term and combine it with medicines. 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-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.

If you're not absorbing enough nutrients, your health professional also may recommend vitamins and nutritional supplements.

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.

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 frequently recurs, often near the reconnected tissue.

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. You are not alone. Mental health is extremely important and should be discussed regularly with your team.

Diet

No specific foods are known to cause Crohn's disease, but some foods may worsen symptoms during flares.

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 cause your symptoms to flare, you can try taking them out of your diet.

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

• Limit trigger foods. Some foods may cause symptoms such as diarrhea, bloating or cramping. Common triggers can include high-fiber foods, high-fat foods, lactose-containing foods, caffeine, alcohol and processed foods.
• Maintain good nutrition. Crohn's disease can affect how your body digests food and absorbs nutrients, which may lead to vitamin deficiencies and malnutrition.
• Drink plenty of liquids. Drink enough fluids to stay hydrated, especially if you have symptoms such as diarrhea or frequent passing of stool.
• 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 with a dietitian. If you begin to lose weight or your diet has become very limited, talk with a registered dietitian.

Smoking

Smoking increases your risk of developing Crohn's disease and its complications. 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, learning ways to manage it may help improve your overall well-being and ability to cope with the condition.

• Exercise. Physical activity may help reduce stress, improve mood, and increase energy and motivation.
• Cognitive behavioral therapy. This type of therapy helps you identify and change negative thought patterns and behaviors and has been shown to improve quality of life in people with inflammatory bowel disease.
• Relaxation and breathing exercises. Techniques such as deep breathing, also called diaphragmatic breathing, can help reduce stress, lower heart rate and muscle tension, and improve concentration and overall well-being.

Alternative medicine

Many people with Crohn's disease use complementary and alternative medicine along with standard treatments. These approaches may include supplements, mind-body practices or other therapies.

Some complementary therapies may help improve symptoms, quality of life or overall well-being. But there are relatively few well-designed studies showing that these therapies are safe and effective.

Complementary and alternative therapies should not replace standard medical treatment. Talk with your healthcare team before using supplements or alternative therapies, especially if you take medicines that affect the immune system.

Coping and support

Crohn's disease doesn't just affect you physically — it takes an emotional toll as well. If symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, gas and belly 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 also may find it reassuring to be among others with Crohn's disease.
• Talk with a therapist. Some people find it helpful to consult a mental health professional who's familiar with inflammatory bowel disease and the emotional challenges it can cause.

Although living with Crohn's disease can be challenging, 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 health 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 talk about, 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 anything you need to do ahead of time. 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 your symptoms, including any that may seem unrelated to the reason for the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements that you're taking.
• Ask a family member or friend to come with you to your appointment. Sometimes it can be hard to take in all the information you get during an appointment. Someone who goes with 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 short-term 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 change my diet?
• 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?

Don't hesitate to ask other questions that come up during your appointment.

What to expect from your doctor

Your healthcare professional will likely asked number of questions, including:

• When did you first begin having symptoms?
• Have your symptoms been continuous or do they come and go?
• How bad 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 seems to make your symptoms worse?
• Do you smoke?
• Do you take nonprescription or prescription nonsteroidal anti-inflammatory medicines (NSAIDs) — for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium?