Crohn’s Disease – Diagnosis and Treatment
Diagnosis
Blood and Stool Examinations
Doctors start by ordering blood tests to check for signs of inflammation or infection. They look at red and white blood cell counts because low red cells can mean anemia, while high white cells may show inflammation or infection.
Tests like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) help measure the amount of inflammation in the body. Blood tests also check liver function and look for infections or signs specific to inflammatory bowel disease (IBD), which includes Crohnâs.
Doctors use stool samples to find more clues. They check for hidden blood, bacteria, or parasites that could explain ongoing diarrhea or stomach pain.
They also look for stool markers of inflammation, such as fecal calprotectin. These markers help decide if there is irritation in the gut, which may point toward IBD.
Here’s a summary table of methods:
| Test Type | What It Checks For |
|---|---|
| Blood Test | Anemia, infection, inflammation, liver function |
| ESR/CRP | Level of inflammation |
| Stool Sample | Blood, bacteria, parasites, inflammation markers |
Diagnostic Techniques
Doctors use physical exams and family history to decide which tests to order. To check for Crohnâs disease, they use several main methods to look inside the body.
Colonoscopy lets doctors see the colon and the end of the small intestine with a flexible tube and camera. They can take small tissue samples (biopsies) during the test.
If they find clusters of cells called granulomas in the tissue, this supports a Crohnâs diagnosis.
Capsule endoscopy involves swallowing a tiny camera capsule. As it moves through the digestive tract, it takes thousands of pictures, especially of the small intestine, and sends them to a recorder.
This test helps find trouble areas that other tests might miss. Doctors avoid capsule endoscopy if there is a risk of a blockage in the intestine.
Cross-sectional imaging helps doctors see inside and around the bowels.
- CT scans use X-rays to take detailed pictures of the abdomen and pelvis.
- CT enterography focuses on the small intestine and uses contrast liquid for clearer images.
- MRI scans use magnets and radio waves to create images. MRI enterography is useful for finding problems in the small intestine or around the anus, including fistulas, without using X-rays.
Doctors sometimes use a combination of these methods. Older tests like a barium enema are less common today.
Doctors review all the test results and symptoms such as abdominal pain, diarrhea, or unexplained weight loss to decide if Crohnâs disease is present. No single test is enough, so doctors use several steps to reach a diagnosis.
Treatment
Medications That Lower Inflammation
Doctors begin with anti-inflammatory medicines to calm swelling caused by Crohnâs disease. These include corticosteroids, which help control symptoms for a few months.
Doctors may give corticosteroids in the hospital for severe flares. They taper these drugs off once symptoms improve and avoid long-term use because of possible side effects.
Oral aminosalicylates can help people with mild or moderate disease, especially if Crohnâs affects the colon. These medicines do not work as well for disease mainly in the small intestine.
The table below summarizes key anti-inflammatory drugs:
| Medicine Name | Major Use | Notes |
|---|---|---|
| Systemic corticosteroids | Short-term symptom control. | Not for long-term use, can cause side effects. |
| Targeted corticosteroids | Short-term for mild to moderate symptoms. | Less side effects than prednisone. |
| Aminosalicylates (5-ASAs) | For disease in the colon. | May not work in the small intestine. |
| Extended-release aminosalicylates | Mild to moderate Crohnâs in the colon. | Also has extended-release forms. |
Medicines That Calm the Immune Response
If standard anti-inflammatories do not help, doctors use immune suppressant medicines to target the cause of inflammation. These drugs lower the immune response but can cause side effects like infection risk, liver problems, nausea, and vomiting.
Doctors monitor patients with regular blood tests to keep treatment safe. Sometimes, they use more than one medicine together, such as a short course of corticosteroids with an immune suppressor to control symptoms quickly.
Biologic Therapy Options
Biologic therapies are advanced medications that target specific parts of the immune system involved in Crohnâs disease. These treatments are usually given by injection or infusion.
Biologics are often used when other treatments havenât worked or are no longer effective.
Types of Biologic Therapies:
- TNF Inhibitors: These biologics block a protein called tumor necrosis factor (TNF), which contributes to inflammation.
- Interleukin Inhibitors: This class targets interleukinsâproteins that drive immune responsesâto help reduce inflammation.
- Integrin Blockers: These therapies prevent certain immune cells from reaching the lining of the gut, helping reduce localized inflammation.
- IL-23 Blockers: These medications target interleukin-23 to manage moderate to severe Crohnâs symptoms by limiting immune overactivity.
Biosimilars, which are lower-cost versions of original biologic therapies, may also be available once patents expire.
Oral JAK Blockers
Janus kinase (JAK) inhibitors are newer drugs for Crohnâs disease when other treatments have not worked. Patients take these medicines by mouth to reduce gut inflammation by blocking certain immune signals.
Doctors do not recommend these medicines during pregnancy.
Use of Antibiotics
Doctors may prescribe antibiotics to treat infections related to Crohnâs, such as fistulas or abscesses. Antibiotics can also lower the number of harmful bacteria in the intestines, which may reduce inflammation.
Cautions:
- Doctors usually do not use antibiotics long-term.
- Side effects can include nausea, tingling in fingers, or a metallic taste.
- Doctors prescribe antibiotics if there are signs of infection.
Other Helpful Medicines and Supplements
People with Crohnâs disease may need extra medicines for specific symptoms. Always check with a healthcare provider before starting over-the-counter treatments.
- Medicines for Diarrhea: Fiber supplements such as bulk-forming agents may help manage mild diarrhea by absorbing excess fluid and adding bulk to stools. For more severe cases, anti-motility agents may be used to slow bowel movementsâbut these should be avoided if there is any risk of bowel obstruction.
- Pain Relief: Acetaminophen can be used for mild pain. Doctors advise against using NSAIDs like ibuprofen or naproxen, as they can worsen symptoms.
- Vitamins and Supplements: People may need supplements if Crohnâs disease prevents the gut from absorbing iron, calcium, vitamin D, B12, or other nutrients. Some patients receive iron by vein.
Special Eating Plans and Nutrition
Doctors may recommend a special diet to help treat Crohnâs disease. Enteral nutrition involves feeding through a tube to the stomach or small intestine, whereas parenteral nutrition provides nutrients directly into a vein.
These techniques assist in providing relief to the bowel and may reduce inflammation during a flare-up. Short-term nutrition therapy is sometimes used before surgery or when a person cannot eat normally.
Doctors may suggest a low-residue or low-fiber diet to avoid blockages, especially when the bowel is narrowed. Food choices are adjusted to create smaller stools and less irritation.
Surgical Procedures
If medicine and lifestyle changes do not help enough, surgery may be needed. Nearly half of people with Crohn’s will need at least one surgery during their lifetime.
Surgery does not cure Crohn’s disease. Doctors use surgery to:
- Remove damaged or diseased parts of the bowel
- Reconnect healthy sections of intestine
- Drain abscesses
- Fix fistulas
After surgery, Crohn’s can return, often where the intestine was re-joined. Doctors usually prescribe medicine afterward to reduce the chance of symptoms returning.
Common Reasons for Surgery:
- Severe symptoms that do not improve with medicine
- Bleeding, blockages, or life-threatening problems
- Fistulas or abscesses that do not heal
Types of procedures:
| Surgery Type | Purpose | Notes |
|---|---|---|
| Resection | Remove damaged bowel | Most common type |
| Strictureplasty | Open narrowed areas | Keeps more bowel in place |
| Abscess drainage | Remove infection pockets | Done with or without other surgery |
Daily Habits and At-Home Strategies
Eating Choices
What someone eats does not cause Crohn’s disease. However, diet can affect how a person feels with the condition.
Certain foods or drinks can set off symptoms or make flare-ups worse, especially if someone eats them in large amounts. Keeping a food journal helps people track which foods cause discomfort.
By checking these notes, people can avoid foods that lead to pain or bloating.
A few simple tips can make meals easier to tolerate:
Reduce or Remove Dairy: Many people notice fewer problems with gas, belly pain, and diarrhea when they lower their intake of milk and cheese. Some people are lactose intolerant and cannot handle the sugars in dairy. Enzyme products can help digest dairy if needed.
Choose Smaller Meals: Eating five or six small meals each day is gentler on the gut than having two or three large meals.
Stay Hydrated: Drinking plenty of water keeps the body healthy. Alcohol, fizzy soda, and drinks with caffeine can make diarrhea and gas worse, so it is best to limit these.
Consider Supplements: Crohn’s can stop the body from absorbing some nutrients, so multivitamins and mineral supplements may help. Always talk with a doctor or registered dietitian before starting any supplements.
Ask for Expert Advice: If you are losing weight or have a limited diet, a dietitian can make sure you meet all your nutritional needs.
| Food Choices to Try | Foods/Drinks to Limit |
|---|---|
| Lean proteins (eggs, fish) | Dairy (if sensitive) |
| Cooked vegetables | High-fiber raw vegetables (during flares) |
| White rice, plain pasta | Caffeinated drinks |
| Oatmeal, bananas | Alcohol, carbonated drinks |
Avoiding Tobacco
Smoking increases the risk of Crohn’s disease. People who smoke are more likely to have flare-ups and need hospital visits.
Those with Crohn’s who smoke often need stronger medicine or surgery. Quitting smoking is one of the best steps for people with Crohn’s. Stopping helps manage the disease and improves heart and lung health.
People can get help to quit through support groups, counseling, or by talking with a healthcare provider about stop-smoking aids.
Managing Worry and Pressure
Stress does not cause Crohn’s disease, but it can make symptoms worse or trigger flare-ups. Learning to handle stress helps reduce rough days and improves well-being.
Several activities can help manage stress:
Physical Activity: Moving each day, even with a short walk, can lighten stress, lift mood, and support digestion.
Biofeedback: This method uses a machine to teach control over body functions like heart rate and muscle tension. Learning this skill can make it easier to stay calm during stress.
Relaxation and Breathing: Deep breathing, meditation, and calming techniques can settle the mind and body. Many free guides and videos show how to practice these methods.
A sample daily routine to lower stress:
| Time | Activity |
|---|---|
| Morning | 10-minute stretching |
| Afternoon | Short walk outdoors |
| Evening | Guided breathing or meditation |
Alternative medicine
Some people try therapies alongside their regular treatment. These may include herbal supplements, probiotics, dietary changes, or acupuncture.
While some people report mild benefits, strong evidence for their safety and effectiveness is limited.
Coping and support
Managing Crohn’s disease can be challenging both physically and emotionally. People may struggle with symptoms in public or feel isolated.
Taking care of both mental and physical health is important.
Helpful ways to manage Crohn’s disease include:
Learning More: Trusted sources help people understand their options and feel more confident about their health.
Sharing Experiences: Support groups offer emotional support, daily tips, and updates on new treatments.
Seeking Professional Help: Talking to a therapist, especially one familiar with chronic illness, can help with sadness, stress, or anxiety linked to Crohn’s.
| Strategy | Possible Benefits |
|---|---|
| Gathering information | Increases knowledge, improves self-care |
| Support groups | Emotional support, new ideas, shared experiences |
| Mental health counseling | Reduces stress, improves mood, coping skills |
Small changes, like practicing relaxation or reaching out for help, can make a big difference in well-being.
Getting Ready for Your Doctor Visit
Steps You Can Take Beforehand
Being prepared helps patients make the most of their doctor visits.
Here are some simple actions to consider:
Check for any rules before your visit. Ask if you need to avoid certain foods or drinks, or follow special instructions before tests.
Keep track of your symptoms. Write a list of all symptoms, even those that do not seem related. Dates and descriptions help the doctor understand your situation.
Share any important personal events. Note stressful events, changes in routine, or anything that could affect your health.
Bring a full list of medications. Include all prescribed medicine, over-the-counter drugs, vitamins, and herbal supplements.
Have someone come with you. A family member or friend can help remember details, ask questions, or provide support.
Prepare your questions. List what you want to ask the doctor, starting with the most important. If time runs out, you will still cover key points.
| Question Topic | Example Question |
|---|---|
| Cause of symptoms | What could be causing the issues I am having? |
| Possible tests | What tests should I expect? |
| Length of condition | Is this problem usually short-term or ongoing? |
| Treatment details | What treatments do you think are best for me? |
| Medicine concerns | Are there medications I should not use? |
| Side effects | What side effects might I get from treatments? |
| Alternatives | Are there other ways to handle my condition? |
| Existing health concerns | How can I manage my other health problems, too? |
| Diet | Do I need to follow any food limits? |
| Medication options | Is there a lower-cost or generic choice for drugs? |
| Resources | Are there helpful printed materials or websites? |
| Family risk | Could this condition affect my children? |
| Follow-up | Will I need more tests later on? |
- Take notes or record instructions: Written notes help remember advice. Some people use their phone to record information if allowed.
What The Doctor May Ask You
Doctors ask certain questions to better understand symptoms. They use this information to find the right diagnosis.
Patients can expect questions like these:
When did your symptoms start? The doctor wants to know the timeline.
Have your symptoms been steady, or do they come and go? Consistency helps decide what tests or treatments are best.
How bad are the symptoms? Describing mild, moderate, or severe issues helps guide care.
Are daily activities harder now? Trouble at work or school, or changes in routines, matter.
What makes the symptoms better or worse? This information helps pinpoint triggers.
- Do you use substances like tobacco or over-the-counter pain relievers? Some drugs or habits may affect symptoms or treatment options.
The doctor may also ask about other health conditions. They might suggest tests or future visits. You can pause and ask for explanations at any time. This helps you feel more comfortable and prepared for your appointment.
