Crohn’s disease is one form of the debilitating intestinal condition known as inflammatory bowel disease, or IBD. How is it diagnosed and treated, and what other strategies might help manage its symptoms? Read on to find out.
What Is Crohn’s Disease?
Inflammatory bowel disease (IBD) is an umbrella term for two types of debilitating intestinal disease. Crohn’s disease differs from ulcerative colitis in that it is centered higher in the digestive tract (typically in the small intestine, though it can occur anywhere between the mouth and anus) and may damage broader swaths of tissue [1, 2].
UC and Crohn’s are very similar diseases, which is why they are grouped together under the IBD diagnosis. They must both be diagnosed by a doctor, often a specialist.
How is IBD Diagnosed?
IBD is relatively poorly understood and will often be diagnosed by ruling out other possible explanations for gastrointestinal symptoms. To confirm a diagnosis of IBD, your doctor may order some of the following tests.
Blood Tests
Your doctor may order blood tests to detect anemia or infection, or they may order a fecal occult blood test, which checks for blood in the stool. These tests screen for both intestinal bleeding and the anemia that may result from chronic blood loss [3, 4, 5, 6, 7, 8].
Endoscopy
Endoscopic procedures use a tiny camera and light to visually inspect diseased tissues. There are many types of endoscopy that may be useful to diagnose IBD, including:
- Colonoscopy: this procedure is considered the most important and the most reliable for the endoscopic diagnosis of IBD, producing an accurate diagnosis of either Crohn’s disease or ulcerative colitis in up to 90% of cases [9].
- Flexible sigmoidoscopy: a far less common procedure, flexible sigmoidoscopy is used in cases when doctors believe a full colonoscopy is dangerous, such as when the colon is very inflamed. It is very similar to a colonoscopy, except that only the last section of the colon is observed [10, 11].
- Upper endoscopy: this procedure observes the upper section of the digestive tract, usually the esophagus, stomach, and even parts of the small intestine. This is not a common procedure in IBD, but may be recommended for certain cases [10, 12].
- Capsule endoscopy: for this procedure, the patient swallows a capsule that contains a tiny camera. For the next 8-12 hours (until the battery runs out), the camera sends 2-6 images per second to a gastroenterologist, who reviews the images [13, 14].
- Balloon-assisted enteroscopy: this procedure uses tiny balloons to compress the walls of the intestine so that a camera can reach and treat less accessible portions of the digestive tract [13, 15].
Imaging
Non-invasive imaging techniques may sometimes be used in place of (or in addition to) endoscopy. These include X-rays, CT scans, or MRIs [16, 17].
Challenges
Crohn’s disease can develop anywhere along the digestive tract and in any layer of the gut lining, so it can be challenging to locate, image, and assess. Researchers are hard at work developing techniques to reliably identify Crohn’s as well as therapies to treat it [18].
How is IBD Treated?
IBD (as either ulcerative colitis or Crohn’s disease) is a significantly more serious condition than IBS. Although your doctor will likely recommend holistic strategies to manage IBD symptoms, more often than not you will be prescribed special diets immediately after diagnosis. Be sure to follow any and all prescriptions and recommendations from your doctor, which may or may not include therapies and strategies described here. Never use any of the following strategies in place of what your doctor recommends or prescribes.
Dietary Interventions
Low FODMAP Diet (Possibly Effective)
Some nutritionists recommend a low FODMAP diet to help control the symptoms of Crohn’s disease. FODMAPs are a group of carbohydrates which, in the last decade or so, have been identified as some of the prime irritants behind IBD. FODMAPs is a catchy acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols [19, 20, 21].
The major FODMAPs include [22, 23]:
- Fructose
- Lactose
- Fructans and galactans
- Galacto-oligosaccharides
- Polyols (sugar alcohols, or any sweetener that ends with -ol)
The low FODMAP diet isn’t appropriate for everyone, and its effectiveness in Crohn’s disease is contested. Talk to your doctor to determine whether an elimination diet could be right for you [19, 24].
For more about the low FODMAP diet, check out this post on how it works and this post on which foods are included.
Potassium-Rich Foods
A prospective study of almost 200,000 women found that those whose diets were richer in potassium were less likely to develop Crohn’s disease. The authors of the study suggested that dietary potassium could affect the development of Tregs and the TH17 pathway, thereby helping control the immune response and prevent autoimmune reactions [25].
Crohn’s disease can also increase potassium secretion into the colon. If this isn’t counterbalanced by potassium absorption, it can lead to deficiency [26].
If you have Crohn’s disease, you may want to ask your doctor about your risk of potassium deficiency and whether your daily potassium requirement might be higher than normal. Potassium-rich foods to help prevent deficiency include stone fruit (especially apricots and prunes), legumes, and squash [26].
Specific Carbohydrate Diet
The specific carbohydrate diet (SCD) is a type of elimination diet that completely removes most types of carbs in an attempt to slow the growth of harmful bacteria that may be causing inflammation and damage in the gut [27].
The SCD is considered a relatively extreme elimination diet. It should only be attempted under the careful supervision of a trained nutritionist or dietitian [28, 27].
Other Elimination Diets
A great deal of research indicates that diet is a factor in the development and severity of ulcerative colitis. A meta-analysis identified several potentially problematic foods, including processed meat and alcohol [29].
Your doctor may or may not advise you to cut certain foods out of your diet to see if your symptoms improve. You may want to work with a specialized nutrition or dietitian to find the best diet to manage your condition.
Enteral Nutrition & Elemental Diets
In severe cases, people with IBD may require special nutritional interventions. Up to 75% of people with Crohn’s disease may be at risk of malnutrition; they may require an elemental diet (liquid nutrients) enteral feeding (elemental diet through a tube), or parenteral nutrition (injection of nutrients directly into the bloodstream) to allow damaged intestinal tissue to rest and heal [30, 31].
Lifestyle Changes
In order to control the symptoms of IBS and improve your quality of life, your doctor may recommend a few lifestyle changes. If your doctor has prescribed medication, however, these strategies should never be used in place of those prescriptions.
Exercise
Moderate exercise (and improved physical fitness) is among the best remedies for gut inflammation and overall health. According to many studies, physical activity actually changes the composition of the gut flora, resulting in an increase of beneficial species [32].
People with IBD may or may not be advised to adjust their physical activity to help manage inflammation and symptoms. Broadly speaking, exercise may have a mild protective effect on the development of IBD; that is, people who are already physically active are somewhat less likely to develop Crohn’s than those who are sedentary [33].
Some people with severe IBD may not be able to exercise as strenuously as healthy peers. However, if the intensity of exercise is limited, then physical activity is believed to be beneficial for IBD patients. Physically fit people have less inflammation, a healthier immune response, lower weight, better mental health, and stronger bones [33, 34, 35].
If you have IBD, we recommend talking to your doctor about how much physical activity would be beneficial in your case.
Stress Management
Many people with IBD develop anxiety and depression associated with their debilitating gastrointestinal symptoms. Furthermore, psychological stress is broadly believed to worsen symptoms of IBD. Because of this potential feedback loop, many doctors emphasize the importance of managing the mental health of IBD patients [36, 37, 38, 39].
If you have clinical symptoms of anxiety or depression, your doctor may refer you to a psychologist for further evaluation and treatment. Regardless, you may want to try other stress-busting activities like yoga or meditation, provided that they don’t interfere with your doctor’s treatment plan.
Acupuncture & Moxibustion
Two unusual stress management strategies that have seen some interesting experimental results in IBD are acupuncture and its offshoot, moxibustion.
Moxibustion is a traditional Chinese therapy that involves burning dried mugwort on acupuncture points, stimulating them with heat. Several studies have found that either acupuncture or moxibustion by a licensed professional improved the symptoms of Crohn’s disease [40, 41].
However, acupuncture and moxibustion are difficult to study because it is difficult to create “placebo” groups. Additional research is required to determine exactly how effective acupuncture and moxibustion may be in reducing the symptoms of IBD.
Meditation
Researchers are increasingly finding that meditation interventions focusing on relaxation, breathing, and movement improved both psychological and physical symptoms of IBD. While meditation should never be used to replace anything your doctor recommends or prescribes, it is a safe and potentially useful complementary strategy for IBD patients with psychological symptoms [42, 43].
Supplements for IBD
The FDA has not approved any natural substances for medical use in IBD, and supplements generally lack solid clinical research. Speak with your doctor before using any of these substances, and never use them in place of something your doctor recommends or prescribes.
To Prevent Deficiency
IBD has been linked with poor nutrient absorption, leading to a number of nutrient deficiencies and subsequent health complications. As such, your doctor may recommend certain supplements. It’s important not only to follow your doctor’s instructions and take any recommended supplements, but to discuss how these might interact with anything else you are doing to manage your condition.
Iron
Chronic internal bleeding may lead to iron deficiency anemia; according to some estimates, between 60-80% of IBD patients become deficient in iron and as many as 74% become anemic. As such, iron is one of the most common supplements recommended or prescribed to people with IBD [44, 45].
However, caution is recommended when taking iron supplements; oral iron may actually worsen colitis and further damage the microbiome. We strongly recommend against taking iron supplements unless your doctor has recommended them [46].
Calcium & Vitamin D
Crohn’s disease (and the steroids used to treat it) have been linked to calcium and vitamin D deficiencies and subsequent osteoporosis. Your doctor will monitor your vulnerability to these deficiencies, and if appropriate, prescribe supplements [47, 48, 49].
Possibly Effective
1) Omega-3 Fatty Acids
Omega-3 fatty acid intake, including from fish, has been inversely linked to the development of Crohn’s disease; that is, people who eat more fish (and omega-3s) appear less likely to get Crohn’s [29].
It is unclear whether omega-3 supplementation can help Crohn’s disease that has already developed and progressed. However, multiple studies have suggested that omega-3s may help keep Crohn’s disease in remission [29, 50].
Talk to your doctor about whether increasing your intake of fish or taking omega-3 supplements might be useful in your case.
2) Curcumin
Curcumin is a natural anti-inflammatory compound extracted from turmeric. Multiple clinical trials have produced promising results for curcumin in IBD (including Crohn’s), and further research is currently underway. Remember to never combine supplements with medications without first discussing these combinations with your doctor [51, 52, 29].
3) Thunder God Vine
Thunder god vine (Tripterygium wilfordii), known as Lei Gong Teng in Chinese, is a woody plant that grows wild in the mountainous regions of southern China, Korea, Japan, and Taiwan [53].
In a clinical trial on 16 people with Crohn’s disease, thunder god vine improved ulcers and reduced inflammation. 60 mg/day was used for 12 weeks [54].
In 3 other studies on over 250 people, it was better than two anti-inflammatory drugs (mesalazine and sulfasalazine) at preventing Crohn’s worsening. In another trial on 47 people, it worked as well as the typical drug (azathioprine) during the first weeks, but its effects were weaker in the long term [55, 56, 57, 58, 59].
Insufficient Evidence For
The following substances have shown promise against Crohn’s disease in limited, low-quality clinical studies; there is currently insufficient evidence to support their use in this context, and they should never replace what your doctor prescribes. Remember to talk to your doctor before starting any new supplement or making significant changes to your diet.
4) Mastic Gum
In a clinical trial of 60 IBD patients, 2.8 g/day of mastic gum improved the quality of life and IBD markers (lysozyme, lactoferrin, and calprotectin levels). However, it did not change CRP levels in this study. CRP is a commonly used marker of IBD, and mastic gum did influence its levels in people with Crohn’s disease specifically [60].
Supplementation with mastic gum (2.2 g/day) reduced symptoms of Crohn’s disease and improved general well-being in a clinical trial of 18 people over 4 weeks. Aside from reducing the frequency of liquid stools, stomach pain and cramps, and antidiarrheal drug use, it also significantly decreased key markers that trigger and worsen inflammation (IL-6 and CRP) [61].
Other Medical Procedures
Medications
If you are diagnosed with IBD, your doctor is likely to prescribe medication to help improve your quality of life. We strongly recommend against taking any of these medications without a doctor’s prescription.
Medications that may be prescribed to treat IBD include [62]:
- Anti-inflammatory drugs (corticosteroids and aminosalicylates)
- Immunomodulators
- Antibiotics
- Anti-diarrheal medication
- Pain relievers
- Biologic therapies
Biologics
Biologics are prescription drugs which are made or extracted from a living organism. Several biologics are available to treat Crohn’s disease, including the anti-TNF antibodies infliximab and adalimumab [63].
Biologics are an emerging class of drugs for IBD; the best ways to use them and the appropriate cases to prescribe are still topics of debate [63].
Surgery
Unfortunately, IBD can be a very serious diagnosis, and many people with IBD will require surgery over the course of their lifetimes: according to some data, as many as 20% of people with ulcerative colitis and 80% of people with Crohn’s have at least one operation [64].
Surgery is considerably more common in Crohn’s disease than in ulcerative colitis; furthermore, there is no available surgery that can cure Crohn’s. Instead, surgeons remove damaged portions of the gut, reconnect healthy sections, drain abscesses, and close up fistulas. After surgery, there is temporary relief, but additional damage is likely to build up, and multiple procedures may be required over a person’s lifetime [65, 66].
Fecal Transplant
Fecal transplants are a relatively new procedure for the treatment of intestinal disorders and diseases. In brief, the bacteria from a healthy person’s gut are introduced into the colon of a person with intestinal disease. This is typically done with a direct transplant of carefully-screened feces from the healthy donor into the recipient [67, 68].
Fecal transplants are not common practice to treat Crohn’s disease, and there is a lack of data available about its efficacy and safety in this particular condition. However, the research continues to advance, and some researchers are confident that fecal transplantation could become quite common in Crohn’s in the next few years [69].
Takeaway
Crohn’s disease is one of the two types of inflammatory bowel disease (IBD). It differs from ulcerative colitis in that it can produce chronic inflammation and damage anywhere in the digestive tract, where ulcerative colitis is centered in the colon.
Crohn’s disease is typically diagnosed using blood tests, endoscopic procedures (most commonly colonoscopy), and occasionally non-invasive imaging techniques (like CT scan or MRI). After the diagnosis is made, a doctor will prescribe medication and recommend dietary and lifestyle changes to manage symptoms and improve quality of life. Dietary changes typically include some form of elimination diet, which aims to remove any foods that trigger worse symptoms in the individual patient. In severe cases of malnutrition, enteral or parenteral nutrition may be required.
Crohn’s patients may benefit from moderate exercise and stress management therapies like yoga, meditation, acupuncture, and moxibustion. Some supplements have also been the focus of research in Crohn’s patients; these include omega-3 fatty acids, curcumin, thunder god vine, and mastic gum.
Doctors also commonly prescribe medication to Crohn’s patients, and surgery may be required for severe cases.
