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Crohn's disease

Morbus Crohn · Crohnova choroba

What it is

Patchy full-thickness inflammation anywhere from mouth to anus.

Symptoms & signs

  • Crampy pain
  • chronic diarrhoea
  • weight loss
  • fatigue
  • mouth ulcers
  • perianal fistulas
  • fever

🚩 Get help if…

  • call 112 / 911 now Severe belly pain with a swollen belly and vomiting
  • call 112 / 911 now Heavy bleeding from the back passage or fainting
  • see a doctor soon Fever with a painful lump near the anus or in the belly
  • see a doctor soon More than 6 loose stools a day, or dehydration

Where it strikes

Medical treatment

  • Anti-TNF (infliximab, adalimumab)
  • ustekinumab, vedolizumab, risankizumab
  • azathioprine
  • exclusive enteral nutrition
  • resection for strictures
  • JAK inhibitor upadacitinib — approved 2023 (FDA, EMA), with warnings on clots, infection and heart events

Natural & lifestyle

  • Exclusive enteral nutrition (as effective as steroids in children)
  • Crohn's exclusion diet
  • stop smoking (crucial)
  • iron, B12, vitamin D repletion

Emerging & experimental

  • Stem-cell therapy for fistulas (darvadstrocel — failed its confirmatory trial)
  • microbiome consortia
  • anti-fibrotic agents

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Low-dose naltrexone — small trials induced a response early / small studies
  • Cannabis — better symptoms and quality of life in small trials, no fall in inflammation mixed evidence
  • Wormwood (Artemisia absinthium) — two small trials allowed steroids to be reduced early / small studies
  • Helminth (pig whipworm) therapy — early trials were positive; a larger trial failed not confirmed in trials
  • Anti-MAP antibiotics (mycobacterium theory, RHB-104) — a phase 3 trial reported more remission; still debated mixed evidence
  • Specific carbohydrate or carnivore diets — patients report remission; in the DINE-CD trial a specific carbohydrate diet did no better than a Mediterranean one mixed evidence

ICD codes