Crohns Disease Causes

Mild to moderate cases are usually treated with oral medications called aminosalicylates that can relieve inflammation and keep Crohns in remission.More serious cases are treated with corticosteroids such as Prednisone, and medications such as Remicade and Humira that can reduce inflammation and heal fistulas.

Due to the potential side effects of these medications, many people opt for natural anti inflammatories such as fish oil. It has been proven to be beneficial in intestinal health, and can be as effective as prescription drugs as a Crohns treatment.

If you have Crohn’s disease, you will usually be seen regularly by a specialist team. Treatment will aim to increase your quality of life as much as possible, but there is no cure. If you have Crohn’s disease it’s important that you eat a healthy, balanced diet with a high fibre content, unless you are prone to blockages.

This is especially true when your symptoms flare up, as you will need to replace lost nutrients, although you may not feel like it. If you can eat a normal diet, you should continue to do so. However, you may find that certain foods disagree with you or that you need to eat more of particular types of food such as starchy carbohydrates (eg potatoes, bread and pasta).

When your Crohn’s disease is active, your doctor may recommend that you have a liquid diet, made up of simple forms of protein, carbohydrates and fats. This is called an elemental diet and is commonly used to treat children.

Many people with Crohn’s disease find that treatment with medicines is effective. Medicines used to treat Crohn’s disease include:
•    corticosteroids (eg prednisolone) to reduce inflammation
•    medicines to suppress your immune system (eg methotrexate or azathioprine)
•    a medicine called infliximab – your doctor may recommend this if you have severe Crohn’s disease that hasn’t responded to other medicines

During flare-ups you may consider taking painkillers, but your GP may advise you not to take certain medicines such as ibuprofen (eg Nurofen) as they can make Crohn’s disease worse. It’s usually fine to take paracetamol as a painkiller, but check with your GP first. It’s not a good idea to take antidiarrhoeal medicines all the time as they may cover up signs that your disease has become more severe. Speak to your GP if diarrhoea is a problem.

Crohn’s disease is a chronic inflammatory condition involving the small intestine, most often the lower part called the ileum. However, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix or anus. Crohn’s disease is also called ileitis or enteritis.

Crohn’s disease affects a half million Americans, many aged 15 to 35 years.

Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration < or = 15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration.

Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn’s disease.

The long-term significance of vitamin D deficiency for this population is unknown at present and merits additional study. A 42-year-old blond Caucasian woman taking azathioprine for 8 years developed an intra-epidermal carcinoma of the shin. She regularly used a sun bed to maintain a tan. Although the increased risk of non-melanoma skin cancer in immunosuppressed transplant recipients is well recognized, patients with Crohn’s disease are not currently warned of the risk of exposure to ultraviolet light.

Individuals with inflammatory bowel disease who take azathioprine, especially those with a fair complexion, should be informed of the potential dangers of sun bathing and should be advised to limit sun exposure. Spleen Deficiency – may be due to constitutional deficiency or overeating cold and raw food.

Patients with Crohn’s disease usually have spleen deficiency characterized by a compromised ability of the spleen to transform and transport food. Symptoms include frequent and severe diarrhea, watery stool with undigested food, dull abdominal pain, poor appetite, poor digestion, gastric discomfort after food intake, pale facial complexion, fatigue and lethargy due to chronic malabsorption and malnutrition.

Diagnostic criteria for this type of ulcerative colitis includes loose bowels made worse by poor lifestyle habits or consumption of greasy foods, undigested foods in the stools, lack of appetite, distention, fatigue and sallow complexion. On examination, the tongue is pale and covered by white fur; the pulse is weak and thready. Diagnostic criteria for this type include diarrhea with mucus or darkish blood, straining for defecation, fixed stabbing pain, distention, belching and a darkish complexion. On examination, the tongue is purple with bleeding spots; the pulse is taut and hesitant.

Thirty-two years ago Ginger Gray walked into her doctor’s office complaining of abdominal pain, diarrhea, severe weight loss, and overwhelming joint pain. At 19, she hadn’t grown an inch since the sixth grade. But her doctor said there was nothing physically wrong with her, and even suggested she seek psychiatric counseling.

Fortunately for Gray, she sought another physician’s opinion.

Based on tests he conducted, the doctor recommended the 4-foot-11-inch Pennsylvania resident begin full-time treatment for Crohn’s disease.”Crohn’s disease robbed me of my stamina,” Gray says. “It took two years for me to fully regain my strength and weight so that I could begin working again.”Until now, treatment for Crohn’s has relied on surgery and anti-inflammatory and other drugs also used to treat other conditions.

In August 1998, the Food and Drug Administration licensed the first treatment specifically for Crohn’s disease, an incurable and sometimes debilitating inflammation of the bowel.Remicade (infliximab) is a genetically engineered antibody that blocks inflammation caused by a protein called tumor necrosis factor. After clinical trials showed benefit from Remicade treatment within a two-to-four week period following a single dose, FDA approved the drug for patients with moderate to severe Crohn’s disease who have not found relief with other treatments.

“We recognized that [Remicade] had such a dramatic effect on patients,” says Barbara Matthews, M.D., a medical officer in FDA’s Center for Biologics Evaluation and Research, “that it was given accelerated approval.”Remicade, which is taken intravenously, can decrease the amount of inflammation along the lining of the intestine.

Clinical trials also show that Remicade is effective in closing fistulas (abnormal passages or sores between the bowel and skin). Although not a cure, the drug reduces the symptoms in patients who have not responded well to traditional treatments.”This is an exciting development for two reasons,” says R. Balfour Sartor, M.D., professor of medicine, microbiology and immunology at the University of North Carolina, and chairman of the National Scientific Advisory Committee for the Crohn’s & Colitis Foundation of America (CCFA). “It is the first therapy for Crohn’s disease derived by molecular techniques, and it has the possibility of improving the quality of life for [Crohn's] patients.”

But Sartor also cautions that the long-term toxic effects of Remicade are unknown and that the drug is not needed by every Crohn’s disease patient. “Two-thirds of the people will have near immediate results,” he says, “but only those patients who do not respond to other therapies” are eligible to take the drug. The next step is to maintain a patient’s remission after the drug’s initial effect has worn off.

Currently, studies are being done to better define the risks and longer-term benefits of Remicade because drug reactions and potential adverse effects from suppressing tumor necrosis factor require further clarification. Crohn’s disease is one of two major types of inflammatory bowel diseases (IBD)–the general term for diseases that cause inflammation in the intestines–and has no cure and a high rate of recurrence following treatment.

It usually occurs in the lowest portion of the small intestine (ileum), and the large intestine (colon or bowel), but it can occur in other parts of the digestive tract. Crohn’s usually involves all layers of the intestinal wall.

The disease can be difficult to diagnose because its symptoms, which include chronic diarrhea, crampy abdominal pain, loss of appetite, and weight loss, often mimic those of the other IBD type–ulcerative colitis–which affects only the colon. (See “Is It Crohn’s Disease?”)

Researchers have not yet identified the cause of Crohn’s disease, so it is described as an “idiopathic” disease. It is known that inflammation is part of the body’s immune response, and an immune response is usually triggered by something. But to date no specific “trigger” has been found to cause the inflammatory response seen in Crohn’s disease.

There is some evidence that Crohn’s disease has a genetic component. While there is no simple correlation from parent(s) to offspring, the disease tends to “run” in families. As many as 20 to 25 percent of patients with Crohn’s disease have a relative with CD or ulcerative colitis.

There is also a higher incidence among certain ethnic groups.In addition, some possible environmental factors have been linked to initial episodes or relapses. Crohn’s disease appears to be a disease that primarily affects those living in Western, industrialized societies. Whether this is due to some condition of the environment in which people live or their diet has not been determined.

The Role Of Heredity
Physicians classify Crohn’s disease as one of the “familial” or “complex” genetic diseases, as opposed to a “simple” genetic disease. In simple genetic diseases, such as sickle cell disease or cystic fibrosis, a person who inherits a copy of the defective gene from each parent is certain to get the disease. In Crohn’s disease, this is not the case. In fact, 75 to 80 percent of people with Crohn’s disease have no relative with either Crohn’s disease or ulcerative colitis.

But because there are fewer than 500,000 Americans with Crohn’s disease, the level of multiple incidence in families (20 to 25 percent of Crohn’s patients) means that the risk of being diagnosed with the disease is statistically somewhat higher in individuals who have a family member with either Crohn’s disease or ulcerative colitis.

Other evidence that suggests a genetic basis for Crohn’s disease is the fact that populations who have intermarried closely within their communities for many generations, such as Eastern European Jews, have a higher incidence of inflammatory bowel disease than do other groups.

Weakened Immune Response
In the healthy intestine, certain types of bacteria (enteric microflora) are present and necessary. In fact, between one billion and one trillion normal intestinal bacteria exist in every gram of intestinal content. These “normal” bacteria contribute to the process of digestion and keep abnormal bacteria, which can enter the GI tract in food, water, etc., from surviving and causing illness. If abnormal bacteria do survive and multiply, the body recognizes them as invading organisms, or “antigens.”

To a certain extent, these antigens are ignored in the GI tract – the immune system has a certain level of tolerance for them. But immunologic evidence shows that in the intestines of those with inflammatory bowel disease, some of this tolerance for bacteria is lost.

The TH1 cells, which are responsible for activating the immune response against invading organisms, do their job. But the TH2 cells, which are responsible for deactivating the immunologic response after invading organisms are destroyed, fail to perform theirs. The result is an inflammatory overreaction, resulting in pain, fever, and, sometimes, tissue damage.Some evidence also suggests that flare-ups of Crohn’s disease or ulcerative colitis are a heightened response to seasonal allergies, upper-respiratory infections, or other transient illnesses.

Colitis or Crohn’s Disease, NACC has produced a range of different benefit guides relating to incapacity benefit and disability living allowance. Crohn’s disease (CD) frequently presents during early adulthood, a peak time of work productivity. There are limited data from the United States on work disability from CD. We performed this study to identify clinical factors associated with permanent work disability in a CD tertiary referral cohort.

Methods: Cases were identified as patients who received permanent work disability compensation from the social security administration (SSA) related to CD. Four control patients who were not receiving work disability were selected for each case. Multivariate logistic regression was performed to identify characteristics that were independently associated with work disability.

Results: A total of 737 patients with CD were seen in our center, and 185 CD patients were included in our study (37 disability cases, 148 controls). On multivariate analysis, an SIBDQ score ≤50 (OR 12.44, 95% CI 4.45-34.79), undergoing two or more GI surgeries (OR 7.09, 95% CI 2.63-19.11), and two or more medical hospitalizations (OR 2.76, 95% CI 1.03-7.37) were significantly associated with work disability in CD. Disease location (small bowel vs colon), type (inflammatory, stricturing, or fistulizing), or specific treatment strategies were not associated with work disability in our analysis.

Conclusion: Permanent work disability administered through social security was encountered in 5.3% of the Crohn’s patients followed in our cohort. Patients who consistently report low quality of life, or have frequent flares requiring surgical intervention or hospitalization for medical management, may be at risk for CD-related work disability.
The statistics of the German social security system were used to analyse the epidemiology of inflammatory bowel disease (IBD) in Germany and to assess its impact on disability.

Patients granted disability pension for IBD were compared with a control group of patients disabled from other causes. Crohn’s disease and ulcerative colitis led to disability in significantly younger patients than other diseases. Disability from Crohn’s disease was 2.0-fold more common in women than men (95% confidence interval: 1.8-2.3), while disability from ulcerative colitis was similar in both sexes.

White collar employees were affected by both diseases more frequently than blue collar employees, the ratio being 1.3 (1.2-1.5) in Crohn’s disease and 1.6 (1.4-1.8) in ulcerative colitis. Although IBD is relatively rare, it has severe socioeconomic implications, because compared with other diseases, predominantly young age groups become disabled

Women with Crohn’s disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children. Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohn’s disease.

Even so, women with Crohn’s disease should discuss the matter with their doctors before pregnancy. Most children born to women with Crohn’s disease are unaffected. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases. Women with ulcerative colitis have normal fertility.

In Crohn’s disease, fertility may be reduced when the disease is active. Sulphasalazine can cause men to become less fertile. Fertility usually returns to normal when the drug is stopped. If possible, women should try to get pregnant when the disease is in remission. Flare-ups can occur during pregnancy but they are usually mild and will respond to medical treatment. Clinical experience has shown that the risk from steroids and sulphasalazine to the baby is extremely low.

Some doctors advise women to avoid pregnancy while on azathioprine because of theoretical risks, though many successful pregnancies have been recorded while taking the drug. Some doctors would suggest that a woman with inactive Crohn’s disease should stop taking her medication(s) during pregnancy, resuming an appropriate regimen only if a flare-up occurs.

Others might have different advice. Any woman who has Crohn’s disease and wants to become pregnant should discuss the issue of treatment during pregnancy with her health-care providers, where her personal medical history and treatment requirements can be taken into account. Women with Crohn’s disease whose disease is in remission at the time they conceive may experience increased symptoms during their third trimester, if they have symptoms at all. Many women suffer flare-ups immediately after giving birth. Doctors believe this is due to the hormonal changes of the pregnancy and postpartum period. “If Crohn’s disease flares up during pregnancy, sulphasalazine and steroids are permitted. Azathioprine and metronidazole should be avoided unless advised by a specialist.

However, note that there is no convincing proof that azathioprine has been responsible for foetal abnormalities and many inflammatory bowel disease specialists now recommend continuing the drug for those patients in whom relapse would be a major problem.There is no predicatable pattern to inflammatory bowel disease in pregnancy. Patients with inflammatory bowel disease often seem to be healthier during pregnancy, but at a risk of a flare-up in the postpartum period. The chance of a flare-up is not increased by pregnancy however it is advised to wait until disease is inactive before conception.

If patients conceive during a flare of Crohn’s disease:
- about 1/3 get better, 1/3 get worse and 1/3 stay the same

Women with Crohn’s disease tend to have more preterm births and babies with lower birth weights ”

An intestinal obstruction is a partial or complete blockage of the small or large intestine. Surgery is sometimes necessary to relieve the obstruction. The small intestine is composed of three major sections: the duodenum just below the stomach; the jejunum, or middle portion; and the ileum, which empties into the large intestine.

The large intestine is composed of the colon, where stool is formed; and the rectum, which empties to the outside of the body through the anal canal. A blockage that occurs in the small intestine is called a small bowel obstruction, and one that occurs in the colon is a colonic obstruction.There are numerous conditions that may lead to an intestinal obstruction. The three most common causes of small bowel obstruction are adhesions, which are bands of scar tissue that form in the abdomen following injury or surgery; hernias, which develop when a portion of the intestine protrudes through a weak spot in the abdominal wall; and cancerous tumors.

Adhesions account for approximately 50% of all small bowel obstructions, hernias for 15%, and tumors for 15%. Other causes include volvulus, or formation of kinks or knots in the bowel; the presence of foreign bodies in the digestive tract; intussusception, which occurs when a portion of the intestine telescopes or pulls over another portion; infection; and congenital defects.

While most small bowel blockages can be treated with the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube, surgical intervention is necessary in approximately 25% of patients with a partial obstruction, and 50%–65% of patients with a complete obstruction.An obstruction of the large intestine is less common than blockages of the small intestine.

Blockages of the large bowel are usually caused by colon cancer; volvulus; diverticulitis (inflammation of sac-like structures called diverticula that form in the intestines); ischemic colitis (inflammation of the colon resulting from insufficient blood flow); Crohn’s disease (a disease that causes chronic inflammation of the intestines); inflammation due to radiation therapy; and the presence of foreign bodies. As in the case of small bowel obstruction, most patients with a blockage of the large intestine can be treated with IV fluids and bowel decompression. To cut is not to cure. Every clinician involved in caring for patients with Crohn’s disease is facing this dilemma.

Although resection of stenotic or perforated intestinal segments is often unavoidable, surgical remission is only temporary in patients with Crohn’s disease. More than 70% of patients will have new lesions detected by endoscopy within a year, and 40% will be symptomatic within 4 years.1 Repeated bowel resections can result in short-bowel syndrome, and the quest for bowel-conserving strategies has introduced both endoscopic and surgical strictureplasty to clinical practice over the last 25 years.

Material and methods : We prospectively evaluated 128 patients with Crohn’s disease at the moment of diagnosis. We predicted the evolution of their disease using the mathematical model Z = -9.49 + 2.2643 (AD) – 0.0066 (DD) + 2.5282 (AM) + 1.3433 (OS). The cut-off value (reveiver operating characteristics curve) obtained in the training set of patients was P = 0.45. A value higher than this cut off discriminated patients who developed a stricturing pattern. The actual behaviour of the patients’ Crohn’s disease was observed after a median of 19 months from diagnosis. Of the 128 patients, 80 were classified into one of the two known patterns. Thirty-nine patients (48.8%) developed a stricturing pattern while 41 (51.2%) had a penetrating form of Crohn’s disease. Results : The sensitivity of the model for predicting a stricturing type was 100% and the specificity was 31.7%. A P value of < 0.45 proved to be highly reliable in predicting the evolution to a penetrating pattern (positive predictive value was 100% and negative predictive value was 58%). No statistical differences were found between stricturing-type or penetrating-type groups in terms of anal disease, abdominal mass, duration of disease or onset of symptoms.

Compared to patients with the penetrating form, initial ileal location was significantly more frequent than colonic location in patients with the stricturing type of Crohn’s disease.Conclusions : We have validated a simple mathematical model that is able to predict the behaviour of Crohn’s disease in patients based on clinical variables collected at their initial evaluation.

This model can be considered a useful tool for patient management. The anatomical location of the disease is related to the evolutive pattern.

It is also known as regional enteritis is a chronic, episodic, inflammatory bowel disease (IBD) that affects any part of the entire wall of the bowel or intestines. Crohn’s disease can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn’s disease vary among afflicted individuals.

The disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody, though this may not be visible to the naked eye), constipation, vomiting, weight loss or weight gain. Crohn’s disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.

The disease was independently described in 1904 by Polish surgeon Antoni Lesniowski and in 1932 by American gastroenterologist Burrill Bernard Crohn, for whom the disease was named. Crohn, along with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness.

Crohn’s disease affects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age. Although the cause of Crohn’s disease is not known, it is believed to be an autoimmune disease that is genetically linked. The highest relative risk occurs in siblings, affecting males and females equally. Smokers are three times more likely to get Crohn’s disease.

Unlike the other major types of IBD, there is no known drug based or surgical cure for Crohn’s disease. Treatment options are restricted to controlling symptoms, putting and keeping the disease in remission and preventing relapse. Crohn’s disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932.

It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis. Crohn’s disease tends to be more common in relatives of patients with Crohn’s disease. It also is more common among relatives of patients with ulcerative colitis. Crohn’s disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis.

Together, Crohn’s disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn’s disease have no medical cure.

Although diet cannot cause or cure Crohn’s disease, some studies suggest that people who eat foods high in saturated fat and sugar or who eat processed foods may be more likely to develop the disease. Certain foods may also reduce symptoms and make recurrences of the disease less likely.

•    Eating fruits and vegetables, lowering fat, and eliminating sugar may reduce the risk of developing Crohn’s disease. Although a low-fiber diet is one of the risk factors for developing Crohn’s disease, some people with Crohn’s disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables rather than eating them raw, and avoid high fiber fruits such as apples.

•    Certain foods may aggravate symptoms of Crohn’s disease – most often, dairy products, fats, and spicy foods. People with Crohn’s disease may want to avoid these foods.

•    Eat five or six small meals a day.

•    If symptoms are severe, an elemental diet may be recommended. Elemental formulas are liquid diets that contain only the basic building blocks of food and need not be broken down into smaller substances along the digestive tract.

Some people find it difficult to stick to an elemental diet, but after a period of time, often other foods can be reintroduced. One study suggests that adding omega-3 fatty acids to an elemental diet may boost its nutritional content and make it more likely that people with Crohn’s disease will adhere to it.

Because of decreased appetite, malabsorption, chronic diarrhea, side effects of medication, and surgical removal of parts of the digestive tract, many people with Crohn’s disease have vitamin and mineral deficiencies. In particular, people with Crohn’s disease may lack adequate vitamin D, B12, and K, plus folic acid, calcium, and zinc. Your doctor may recommend that you take a multivitamin daily.  Zinc (25 mg), folic acid (800 mcg), vitamin B12 (800 mcg) — These vitamins are used by the body to repair cells in the intestine.

In addition, drugs such as sulfasalazine and methotrexate may case levels of folic acid in the body to drop, requiring supplementation. Vitamin D (1,000 IU per day) — is necessary to maintain strong bones. People with Crohn’s disease, especially those who take corticosteroids, often have low levels of vitamin D and are at risk for osteoporosis.  Fish oil (2.7 g per day) — Omega-3 fatty acids found in fish oil may help fight inflammation and reduce the chances of recurrence, but studies have been mixed. The study with the most positive results used a special type of fish oil – “enteric-coated free-fatty-acid form” – that is not sold commercially.

Some researchers suggest that measuring the blood levels of different types of fatty acids may help determine if fish oil would be useful. Do not take high doses of a fish oil supplement if you take blood-thinning medication.

Crohn’s disease is a life-long illness. The severity of the disease can vary, and a patient can experience periods of time when the disease is not active and he or she is symptom free. However, the complications and risks of Crohn’s disease tend to increase over time. Well over 60% of all patients with Crohn’s disease will require surgery, and about half of these patients will require more than one operation over time. About 5-10% of all Crohn’s patients will die of their disease, primarily due to massive infection.

Endoscope
A medical instrument that can be passed into an area of the body (the bladder or intestine, for example) to allow examination of that area. The endoscope usually has a fiber-optic camera that allows a greatly magnified image to be shown on a television screen viewed by the operator. Many endoscopes also allow the operator to retrieve a small sample (biopsy) of the area being examined, to more closely view the tissue under a microscope.

Fistule
An abnormal channel that creates an open passageway between two structures that do not normally connect.

Gastrointestinal tract
The entire length of the digestive system, running from the stomach, through the small intestine, large intestine, and out the rectum and anus.

Immune system
The body system responsible for producing various cells and chemicals that fight infection by viruses, bacteria, fungi, and other foreign invaders. In autoimmune disease, these cells and chemicals turn against the body itself.

Inflammation
The result of the body’s attempts to fight off and wall off an area that is infected. Inflammation results in the classic signs of redness, heat, swelling, and loss of function.

Obstruction
A blockage.

Ulceration
A pitted area or break in the continuity of a surface such as skin or mucous membrane.

Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.)

People with Crohn’s disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn’s disease are able to hold jobs, raise families, and function successfully at home and in society.