Brief Overview: According to NIDDK, “Crohn’s disease is a chronic disease in which abnormal reactions of the immune system cause inflammation in your digestive tract. Most commonly, Crohn’s disease affects your small intestine and the beginning of your large intestine. However, the disease may affect any part of your digestive tract, from your mouth to your anus. Crohn’s disease is an inflammatory bowel disease (IBD). Crohn’s disease most often begins slowly and may get worse over time. Symptoms can range from mild to severe. When people have symptoms, it’s called a flare. In between flares, most people have periods of remission—times when symptoms disappear. Periods of remission can last for weeks or years. The goal of treatment is to keep people in remission long term.”
Prevalence: According to NIDDK, “Researchers estimate that 1 million people in the United States have Crohn’s disease.”
Etiology: The exact etiology is unknown, but it’s believed that a combination of genetic, environmental, and gut-immune system factors play a role.
Risk Factors:
- Smoking
- Age 15-30 years old, and 50-80 years old
- Sedentary lifestyle/physical inactivity
- Family history
Commonly Associated Conditions:
- Primary sclerosing cholangitis
- Uveitis, iritis, episcleritis
- Arthritis
- Bone loss disorders
- Interstitial lung disease
Common Medications:
- Oral 5-aminosalicylates: sulfasalazine, mesalamine
- Glucocorticoids: prednisone, budesonide
- Immunomodulators: azathioprine, 6-mercaptopurine, methotrexate
- Biologics: infliximab, adalimumab, vedolizumab, etc.
- JAK inhibitors: upadacitinib
Common Labs, Imaging, and Tests:
- Labs: CBC, CMP, CRP, Vitamin B12, iron studies, Vitamin D
- Stool studies
- Imaging/other tests: small bowel imaging (CTE, MRE), colonoscopy, endoscopy, CT, MRI, upper GI series
Common Symptoms:
- Crampy abdominal pain
- Diarrhea
- Fatigue
- Weight loss
- Sores in the mouth
- Rash
- Joint pain
- Eye redness
Common Treatments:
- Medication (see above)
- Vitamin, nutrient supplementation as needed
- Surgical intervention may be indicated
Physical Findings:
- Can be normal physical exam
- Weight loss
- Can have perianal skin tags, sinus tracts, abdominal tenderness, palpable abdominal mass
Potential Complications and Contraindications:
- Strictures, fistula, abscess, anal fissures
- Increased risk of colorectal cancer
- Increased risk for bone loss
- Anemia
- Malnutrition
- Intestinal obstruction
- Ulcers in the mouth, intestines, anus, or perineum
General Health and Lifestyle Guidance:
- Smoking cessation
- Ask your healthcare provider if you need to avoid NSAIDs
- Exercise regularly, as directed by your healthcare provider
- Lactose avoidance if lactose intolerance is suspected
- Ask your healthcare provider if you should take a multivitamin or any other vitamins/supplements
- Consider trying an “elimination diet” to determine any dietary triggers
- Stay up to date on all age-appropriate vaccinations (flu vaccine, pneumonia vaccine, RSV vaccine, shingles vaccine, etc.). Discuss this with your healthcare provider to determine which vaccines you may need/are appropriate for you based on your specific circumstances.
- Annual skin exam by a dermatologist if taking immunomodulators, anti-TNFs, or small molecules
- Discuss any necessary screenings with your healthcare provider – colorectal cancer screening, osteoporosis screening, cervical cancer screening
Suggested Questions to Ask Patients:
- Are you currently experiencing diarrhea, pain, or fatigue?
- Have you had any weight loss or changes in appetite?
- Are you taking your medications consistently?
- Do you have a history of fistulas, strictures, or past surgeries?
- Have you experienced joint pain, skin rashes, or eye issues?
Suggested Talking Points:
- Make sure to report any new, worsening, or persistent symptoms to your healthcare provider
- Make sure to follow up with all healthcare providers as directed. Complete any blood work, imaging, or tests that are ordered.
- Make sure to take all mediations as directed, even when you’re feeling well.
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