Crohn’s disease

How do we monitor it?

• We monitor symptoms, blood tests and fecal calprotectin (a marker of inflammation), and may need endoscopy or imaging. Improved symptoms do not prove inflammation has gone. We review nutrition, iron and vitamin B12 according to your needs.
• Agree a written flare plan and a schedule for tests and endoscopy with your team. You may need regular colonoscopies for bowel cancer surveillance if colonic inflammation has lasted a long time; your doctor sets the timing according to your risk factors.

Treating flares and maintaining remission

• Corticosteroids settle a flare for a limited period and are not used for long-term maintenance of remission in Crohn’s. Follow the tapering plan and do not stop suddenly.
• Immunomodulators such as azathioprine or methotrexate may be used in specific circumstances and require blood-test monitoring. Methotrexate is taken weekly, not daily, and is unsuitable during pregnancy. Mesalazine is not a usual effective treatment for Crohn’s; do not change your prescription yourself.

Biologic and targeted treatments

• Biologics target specific parts of the inflammatory process and are given by intravenous infusion or injection under the skin. Examples include infliximab, adalimumab, vedolizumab, ustekinumab and risankizumab. We may choose them early for moderate or severe disease; they are not necessarily a last resort.
• Targeted tablets are also available for some patients, with particular precautions concerning infection, blood clots and pregnancy depending on the medicine. Your team chooses treatment after reviewing your condition, tests and vaccinations.

Using treatment safely

• Continue maintenance treatment even when you improve. If you have a fever or infection, contact your team before the next dose, and do not double a missed dose. Injection, storage and monitoring instructions differ between medicines; open your medicine card in the related guides below.

Fistulas in Crohn’s: what are they?

• A fistula is an abnormal tunnel-like channel connecting the bowel to the skin or another organ. It can form because Crohn’s inflammation extends deep into the bowel wall. Fistulas around the anus are most common, but they may also connect parts of the bowel to each other, or the bowel to the bladder or vagina.
• A fistula differs from an anal fissure, which is a small tear in the lining of the anal opening. It also differs from an abscess, a collection of pus, although a fistula and an abscess may occur together. A fistula does not mean poor hygiene, and not every fistula is caused by Crohn’s.

What symptoms should I report?

• A fistula around the anus may appear as an opening that drains pus, fluid or blood, with skin irritation or recurring swelling and pain. Depending on the connection, there may be gas in the urine, recurrent urinary infections, or gas or stool passing through the vagina. Tell your team if these occur.
• Increasing pain or a tender swelling around the anus, especially with fever, chills or marked tiredness, may indicate an abscess and needs urgent assessment. Do not wait for a clinic appointment or squeeze the swelling. A deep abscess can occur without a visible opening or fever.

How are fistulas investigated and treated?

• An examination, pelvic MRI or examination under anesthesia may be needed to map the tract and rule out an abscess. The gastroenterologist and colorectal surgeon usually coordinate care, protecting the muscles that control bowel movements.
• An abscess may need drainage; antibiotics alone are usually insufficient. A flexible drainage thread called a seton may be placed through the fistula tract to keep it draining and reduce pus buildup. It is part of treatment; do not pull it out or cut it yourself.
• Biologic treatment may be used to control Crohn’s inflammation and help the fistula heal after treating any infection or abscess. Some cases need further surgery. Drainage stopping or the skin opening closing does not by itself prove that the internal tract has healed; follow-up matters.

Food and everyday life

• No single diet cures Crohn’s. Eat a varied diet with enough protein, and seek dietitian support if you lose weight or find eating difficult.
• If you have a narrowing, your team may temporarily recommend soft foods low in coarse fiber. Do not begin a high-fiber diet without advice if you have a stricture.
• Avoid painkillers such as ibuprofen and diclofenac without medical advice.

Smoking affects the course of Crohn’s itself

• Smoking increases the likelihood of Crohn’s flares, surgery and recurrence after surgery. Quitting is therefore an important part of treatment, not simply general health advice, and can help at any stage of the disease.
• Complete cessation is best; even light smoking is not considered safe in Crohn’s. If you cannot stop immediately, make cutting down a step within a quit plan, and agree a date and suitable support with your doctor. Quitting does not replace prescribed treatment.
• Ask for a referral to a smoking cessation clinic and discuss behavioral support, stop-smoking medicines or nicotine replacement as appropriate for you. If you resumed smoking after a previous attempt, try again with your team and adjust the plan.

Care between flares

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