Crohn's Disease

Issue

Vol. 2 No. 2 (2025)

Date Log

Submitted
October 22, 2024
Published
April 6, 2025

Crohn’s Disease | Causes, Diagnosis & Treatment

https://doi.org/10.69512/ajphi.v2i2.77
Prabha Bhandari, MD
Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
https://orcid.org/0000-0002-1601-5579
Dipendra Kandel, MD
Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
Gauri Adhikari, MD
Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal
https://orcid.org/0000-0002-4250-9839
Preeti Kharel
Nepal Medical College, Kathmandu, Nepal
https://orcid.org/0009-0002-7744-3160

Corresponding Author(s) : Prabha Bhandari, MD

bhandariprabha991@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 2 (2025)

Abstract


  • Crohn’s disease is an inflammatory bowel disease that can affect any part of the digestive tract, with the small intestine and colon being the most commonly affected areas.

  • Crohn’s disease persists throughout life and follows a pattern of relapses and periods of improvement. 

  • While the exact cause of inflammatory bowel disease remains unclear, evidence suggests it stems from an abnormal immune response in the gut triggered by environmental factors like drugs, toxins, infections, or gut microbes in individuals with certain genetic susceptibilities. 

  • Smokers have a higher risk of developing Crohn's disease than nonsmokers.

  • To better manage Crohn's disease, try increasing fluid intake, eating smaller, more frequent meals, and maintaining a food diary to identify possible triggers.

Keywords

Chronic Diarrhea Crohn’s disease Inflammatory bowel disease (IBD) Malabsorption Strictures and Fistula
Bhandari, MD, P., Kandel, MD, D., Adhikari, MD, G., & Kharel, P. (2025). Crohn’s Disease | Causes, Diagnosis & Treatment . The American Journal of Patient Health Info, 2(2). https://doi.org/10.69512/ajphi.v2i2.77
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References
  1. Lewis JD, Parlett LE, Funk MLJ, Brensinger C, Pate V, Wu Q, et al. Incidence, prevalence, and racial and ethnic distribution of inflammatory bowel disease in the United States. Gastroenterology [Internet]. 2023 Jul 20;165(5):1197-1205.e2. Available from: https://doi.org/10.1053/j.gastro.2023.07.003
  2. Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-Induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients [Internet]. 2012 Aug 21;4(8):1095–119. Available from: https://doi.org/10.3390/nu4081095
  3. Crohn’s Disease - American College of Gastroenterology [Internet]. American College of Gastroenterology. 2024. Available from: https://gi.org/topics/crohns-disease/
  4. Borren NZ, Conway G, Garber JJ, Khalili H, Budree S, Mallick H, et al. Differences in clinical course, genetics, and the microbiome between familial and sporadic inflammatory bowel diseases. Journal of Crohn S and Colitis [Internet]. 2017 Nov 13;12(5):525–31. Available from: https://doi.org/10.1093/ecco-jcc/jjx154
  5. Ko Y, Butcher R, Leong RW. Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases. World Journal of Gastroenterology [Internet]. 2014 Jan 1;20(5):1238. Available from: https://doi.org/10.3748/wjg.v20.i5.1238
  6. Włodarczyk M, Makaro A, Prusisz M, Włodarczyk J, Nowocień M, Maryńczak K, et al. The Role of Chronic Fatigue in Patients with Crohn’s Disease. Life [Internet]. 2023 Aug 5;13(8):1692. Available from: https://doi.org/10.3390/life13081692
  7. Matsuoka K, Kobayashi T, Ueno F, Matsui T, Hirai F, Inoue N, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. Journal of Gastroenterology [Internet]. 2018 Feb 10;53(3):305–53. Available from: https://doi.org/10.1007/s00535-018-1439-1
  8. Mitsuyama K. Antibody markers in the diagnosis of inflammatory bowel disease. World Journal of Gastroenterology [Internet]. 2016 Jan 1;22(3):1304. Available from: https://doi.org/10.3748/wjg.v22.i3.1304
  9. Spiceland CM, Lodhia N. Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment. World Journal of Gastroenterology [Internet]. 2018 Sep 19;24(35):4014–20. Available from: https://doi.org/10.3748/wjg.v24.i35.4014
  10. Ahmad R, Ajlan AM, Eskander AA, Alhazmi TA, Khashoggi K, Wazzan MA, et al. Magnetic resonance imaging in the management of Crohn’s disease: a systematic review and meta-analysis. Insights Into Imaging [Internet]. 2021 Aug 18;12(1). Available from: https://doi.org/10.1186/s13244-021-01064-9
  11. Honap S, Sharma E, Samaan MA. 5-ASAs in Crohn’s Disease: Time to stop the salicylate? Digestive Diseases and Sciences [Internet]. 2021 Nov 19;67(7):2699–700. Available from: https://doi.org/10.1007/s10620-021-07304-8
  12. Farraj KL, Pellegrini JR, Munshi RF, Russe‐Russe J, Kaliounji A, Tiwana MS, et al. Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease. JGH Open [Internet]. 2022 Nov 10;6(12):910–4. Available from: https://doi.org/10.1002/jgh3.12841
  13. Rodríguez-Lago I, Gisbert JP. The role of immunomodulators and biologics in the medical management of stricturing Crohn’s disease. Journal of Crohn S and Colitis [Internet]. 2019 Sep 10;14(4):557–66. Available from: https://doi.org/10.1093/ecco-jcc/jjz158
  14. U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn’s Disease in Adults [Internet]. AbbVie News Center. 2023. Available from: https://news.abbvie.com/2023-05-18-U-S-FDA-Approves-RINVOQ-R-upadacitinib-as-a-Once-Daily-Pill-for-Moderately-to-Severely-Active-Crohns-Disease-in-Adults
  15. 15.Bernstein CN, Eliakim A, Fedail S, Fried M, Gearry R, Goh KL, et al. World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease. Journal of Clinical Gastroenterology [Internet]. 2016 Oct 12;50(10):803–18. Available from: https://doi.org/10.1097/mcg.0000000000000660
  16. Peyrin-Biroulet L, Harmsen SW, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV. Surgery in a Population-Based Cohort of Crohn’s Disease from Olmsted County, Minnesota (1970–2004). The American Journal of Gastroenterology [Internet]. 2012 Sep 4;107(11):1693–701. Available from: https://doi.org/10.1038/ajg.2012.298
  17. Ranasinghe IR, Tian C, Hsu R. Crohn Disease [Internet]. StatPearls - NCBI Bookshelf. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436021/
  18. Caio G, Lungaro L, Caputo F, Zoli E, Giancola F, Chiarioni G, et al. Nutritional treatment in Crohn’s Disease. Nutrients [Internet]. 2021 May 12;13(5):1628. Available from: https://doi.org/10.3390/nu13051628
  19. Papadimitriou K, Georgia-Eirini Deligiannidou, Gavriela Voulgaridou, Constantinos Giaginis, Papadopoulou SK. Nutritional Habits in Crohn’s Disease Onset and Management. Nutrients. 2025 Jan 31;17(3):559–9. Available from: https://pubmed.ncbi.nlm.nih.gov/39940417
  20. Rotem Sigall Boneh, Park S, Arcucci MS, Herrador-López M, Chen Sarbagili-Shabat, Nitzan Kolonimos, et al. Cultural Perspectives on the Efficacy and Adoption of the Crohn’s Disease Exclusion Diet across Diverse Ethnicities: A Case-Based Overview. Nutrients [Internet]. 2024 Sep 20 [cited 2024 Dec 9];16(18):3184–4. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11434781/
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Prabha Bhandaria, Dipendra Kandelb, Gauri Adhikaric, Preeti Khareld

a Kathmandu University School of Medical Sciences, Dhulikhel, Nepal

b Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal

c Nepalese Army Institute of Health Sciences-College of Medicine, Kathmandu, Nepal

d Nepal Medical College, Kathmandu, Nepal

Background

Crohn's disease is an inflammatory bowel disease (IBD) in which the gastrointestinal tract is inflamed. It is a chronic inflammatory condition that can affect any part of the gastrointestinal tract from the mouth to the anus. In Crohn’s disease, inflammation affects the entire bowel wall, from the inner mucosa to the outer serosa layer. This inflammation in various parts of the bowel and the disease's systemic impact can cause a range of clinical presentations and long-term risks.

In the United States, approximately 721 out of every 100,000 people live with IBD, which includes Crohn's disease and ulcerative colitis. [1]

Risk Factors of Crohn’s Disease

The exact cause of Crohn's disease remains uncertain, but here are some factors that might be involved:

Figure 1.

  • Immune System: Your immune system might mistakenly attack healthy cells when certain gut bacteria trigger a response, causing inflammation. This imbalance in gut bacteria weakens the gut's immune system. [2]
  • Genes: Crohn’s disease sometimes runs in families, so if you have a close relative with it, you might be more likely to get it, too.
  • Age: Crohn's disease can affect people of any age. However, it is most commonly diagnosed in young adults. Most cases are identified in individuals between the ages of 15 and 35.
  • Family History: If one of your parents has Crohn’s disease, your chances of developing it are around 7 to 10 percent. However, if both of your parents have the condition, your risk increases significantly to about 35 percent. [3]
  • Race and Ethnicity: Ashkenazi Jews are about four times more likely to get Crohn’s disease compared to non-Jews in the same area. While most people with IBD worldwide are not Jewish, the Jewish community is significantly more affected by these conditions. [4]
  • Other Factors: Smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, birth control pills, and high-fat diets may slightly increase risk. [5]

Symptoms of Crohn’s Disease

Patients often go through a cycle of active symptoms, known as flares, followed by remission, when symptoms lessen or disappear. These fluctuating symptoms can go on from weeks to years and range from mild to severe. The five most common symptoms are:

Figure 2.

  • Chronic Diarrhea: During an IBD flare, the intestine lining swells up, making it hard to absorb all the liquid. This can lead to loose, watery, or even completely liquid stools. This is sometimes accompanied by the urgency to pass stool when the bowels are empty. Sometimes, you might notice blood, mucus, pus, and loose stool.
  • Abdominal Pain: Pain and cramping are frequent symptoms of Crohn’s disease. Many patients feel abdominal pain on the lower right side or around their navel, usually about 1 to 2 hours after eating. The pain tends to worsen during a flare-up. While pain in the small intestine is common, cramps can occur regardless of which part of the digestive tract is affected, including the colon, stomach, or rectum, depending on the location and severity of the disease.
  • Weight Loss: Inflammation makes it harder to absorb nutrients, leaving you malnourished. Furthermore, dehydration and a reduced appetite caused by diarrhea and cramps may prevent the body from getting enough energy and essential nutrients it needs and cause unintentional weight loss.
  • Fatigue: Fatigue is a common experience for people with Crohn's and Colitis, affecting around 72% of individuals during a flare-up and about 30% during remission. In a study, individuals described their fatigue as "brain fog," feeling completely wiped out, or being “very, very weary.” This fatigue doesn’t improve with rest. [6]
  • Blood in Stool: Some people with Crohn's disease might not have any bleeding. Unlike ulcerative colitis, bleeding is less common in Crohn's. But if the lower colon and rectum are affected, you might see blood in your stool during flare-ups. [7]

Diagnosis of Crohn’s Disease

There is no single test for Crohn's disease. Diagnosis typically involves:

Figure 3.

1. Lab Tests

  • Blood Test: Different blood tests are performed to diagnose Crohn’s disease. A complete blood cell count can show changes in your red and white blood cells. Fewer or smaller red blood cells may indicate anemia, while a higher white blood cell count could mean inflammation or infection. Your doctors look for the specific type of immune protein, like Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (pANCA), Anti-Saccharomyces Cerevisiae Antibodies (ASCA), and Outer Membrane Porin C (Omp C) to help diagnose Crohn's disease. [8]
  • Stool Test: A stool test helps rule out other causes of digestive diseases, including tests like fecal calprotectin, which detect inflammation in the intestines. It helps distinguish between IBD and Irritable Bowel Syndrome.

2. Intestinal Endoscopy

Intestinal endoscopy is the best way to diagnose Crohn’s disease and check for other issues. It shows how your digestive tract looks and checks for any fissures, ulcers, or changes caused by inflammation. [9]

  • Colonoscopy: This procedure uses a thin tube with a camera to visualize the rectum and colon. If Crohn's disease is suspected, biopsies or tissue samples might be taken.
  • Upper GI endoscopy: During an upper GI endoscopy, your doctor guides the endoscope down your throat to see inside your stomach and duodenum.
  • Enteroscopy: Your small intestine is checked using a longer scope, which might involve different techniques, such as push enteroscopy or capsule endoscopy.

3. Upper GI Series

An upper GI series involves your doctor using X-rays, fluoroscopy, and a chalky liquid called barium to examine your upper digestive system.

4. Computed Tomography (CT) Scan

This imaging mode helps to see a super detailed picture of your insides, including your digestive tract.  CT scans help determine if you have Crohn’s disease and spot any problems it might be causing in your body, like inflammation, abnormal connections (fistula), or narrowing (strictures) in your intestines.

5. Magnetic Resonance Imaging (MRI) Scan

An MRI scanner obtains a detailed picture of your organs and tissues using the help of a magnetic field and radio waves. Doctors use MRI to check for fistulas near your anus (called pelvic MRI) or in your small intestine (MR enterography). They may also use MRI to monitor Crohn’s disease without exposing younger people to radiation. [10]

Treatment of Crohn’s Disease

There is no cure for Crohn's disease, and treatments aren't one-size-fits-all, either. Treatment goals are to lessen inflammation, prevent symptoms from worsening, and keep the disease under control. The American Gastroenterological Association (AGA) emphasizes the importance of early and effective inflammation control to prevent complications. Crohn’s disease can be controlled with medications, periods of bowel rest, and, in some cases, surgery.

Figure 4.

1. Medications

Different medications for Crohn’s disease are chosen depending on the location and severity of the symptoms.

  • Aminosalicylates: Aminosalicylates contain 5-aminosalicylic acid (5-ASA), which helps manage inflammation. They're often prescribed for people with newly diagnosed Crohn’s disease and with mild symptoms, though contradictory findings have been shown regarding its efficacy in remission. [11] Examples include balsalazide, mesalamine, olsalazine, and sulfasalazine. When you’re under this medication, you might experience side effects such as diarrhea, headaches, heartburn, nausea, vomiting, and abdominal pain.
  • Corticosteroids: Corticosteroids provide quick relief from inflammation and symptoms. However, long-term use is not advisable because of potential side effects like acne, bone loss, high blood glucose, high blood pressure, increased infection risk, mood swings, and weight gain. Examples include budesonide, hydrocortisone, methylprednisolone, and prednisone. [12]
  • Immunomodulators: Immunomodulators reduce the activity of your immune system, which decreases inflammation in your digestive tract. Immunomodulators, such as 6-mercaptopurine (6-MP), azathioprine, cyclosporine, and methotrexate, help you go into remission if you don't respond to other treatments. However, they may have side effects such as low white blood cell count, fatigue, nausea, vomiting, and pancreatitis. [13]
  • Biologic Therapies: Biologic therapies target your immune system protein to reduce inflammation in the intestines and achieve remission, especially if other medications haven't been effective. Examples include anti-tumor necrosis factor-alpha therapies like adalimumab, certolizumab, and infliximab, as well as anti-integrin therapies like natalizumab and vedolizumab and anti-interleukin-12 and interleukin-23 therapy such as ustekinumab. However, one might have a toxic reaction to the medication and an increased risk of infections, particularly tuberculosis. [13] For people with moderate to severe Crohn’s disease who have not responded well to one or more anti-tumor necrosis factor-alpha therapies, your doctor might prescribe new medication like Upadacitinib, recently approved by the US FDA (U.S. Food and Drug Administration). [14]
  • Other Medications: Doctors may prescribe acetaminophen for mild pain relief, antibiotics for infection-related complications like abscesses and fistulas, and loperamide to alleviate severe diarrhea, though its use is usually short-term due to the risk of megacolon. Metronidazole doesn’t work in Crohn’s disease. [15]

2. Bowel Rest

For severe cases, doctors may recommend bowel rest, during which you will consume only liquid nutrients or receive intravenous nutrition to allow the intestines to heal. You might need to stay in the hospital, but sometimes you can do this at home. Most people's intestines get better during bowel rest.

3. Surgery

Some people with Crohn’s disease may require surgery where a part of the small bowel, large bowel, or rectum may be removed, depending on the location, along with the surgery to help you pass stool through a pouch whenever necessary. However, advancements in medical treatment have reduced the need for surgical intervention. Studies have shown that while surgery can be necessary for certain complications, not everyone with Crohn’s will require it. When surgery is needed, it can effectively manage complications like fistulas, life-threatening bleeding, and intestinal blockages that can significantly improve quality of life, allowing many patients to regain control of their health. [16]

Complications of Crohn’s Disease

Crohn's disease is a systemic condition with various complications affecting the intestines and other parts of the body. Some complications associated with Crohn's disease include:

Figure 5.

  • Strictures in the intestines.
  • Formation of fistulas and abscesses.
  • Increased risk of colorectal carcinoma.
  • Ankylosing spondylitis causing joint pain.
  • Eye conditions like episcleritis and iritis cause eye redness or blurry vision.
  • Skin changes like painful red bumps (erythema nodosum) and open sores. (pyoderma gangrenosum)
  • Anemia due to chronic inflammation.
  • Weakening of bones leading to osteoporosis. [17]

Living with Crohn’s Disease

If you have Crohn’s disease, it's important to take care of yourself to feel your best. Here are some things you can do:

  • Daily physical Activity: Even a short walk, can help you feel better and reduce stress linked with Crohn’s disease.
  • Quit Smoking: If you smoke, stopping can help you manage your Crohn’s better and reduce the chances of complications.
  • Stress Management: Stress management techniques, such as mindfulness and relaxation exercises, are important to prevent symptom flare-ups. Social and emotional support from family, friends, and support groups can provide significant relief and encouragement.

Nutrition in Crohn’s Disease

Nutrition is crucial in managing Crohn's disease, as it can help reduce symptoms and promote overall health. Individuals with Crohn's disease often experience difficulty absorbing nutrients due to inflammation in the digestive tract, making it essential to focus on a nutrient-dense diet. This includes eating foods like fruits, vegetables, lean proteins, and whole grains while avoiding foods that can trigger flare-ups, such as high-fat, high-fiber, or spicy foods. Regular meals and adequate hydration are recommended to ease digestion and maintain energy levels. Keeping a food diary can help you identify and eliminate specific dietary triggers. Supplements may be necessary to address deficiencies in vitamins and minerals such as vitamin D, calcium, iron, and B12. [18]

Crohn's Disease Exclusion Diet (CDED)

The CDED is a special eating plan designed to help people with mild to moderate Crohn’s disease go into remission. It works by cutting out certain foods that might harm the gut and digestive system. The diet is done in three phases, each lasting six weeks, and is usually combined with partial enteral nutrition (PEN), which involves liquid nutrition to support your body. This combination helps the diet work better and makes it easier to follow, giving your gut the best chance to heal. [19]

Diet is heavily influenced by one's culture. Changing the diet to fit one's culture can be challenging, but it is important as it helps. This behaviour can affect something called food-related quality of life. Avoiding food that causes flare-ups and eating food that helps with prevention can have a positive impact, and the opposite can have a negative impact and reduce the quality of life. [20]

Questions To Ask Your Doctor

  1. Is there a possibility that my child will develop Crohn's disease?
  2. Will I require lifelong therapy?
  3. Are there ways to prevent Crohn's disease?
  4. How could being diagnosed with IBD impact my ability to conceive?
  5. Will Crohn's disease affect my whole life?

Conflict of Interest

PB and DK are unpaid research assistants at ehealthyinfo, and GA and PK are paid research assistants at ehealthyinfo. No other conflicts of interest were declared.

Peer Reviewed By

Dr. Bibek Karki, MD, MPH

Hurley Medical Center, Michigan

References

  1. Lewis JD, Parlett LE, Funk MLJ, Brensinger C, Pate V, Wu Q, et al. Incidence, prevalence, and racial and ethnic distribution of inflammatory bowel disease in the United States. Gastroenterology [Internet]. 2023 Jul 20;165(5):1197-1205.e2. Available from: https://doi.org/10.1053/j.gastro.2023.07.003
  2. Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-Induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients [Internet]. 2012 Aug 21;4(8):1095–119. Available from: https://doi.org/10.3390/nu4081095
  3. Crohn’s Disease - American College of Gastroenterology [Internet]. American College of Gastroenterology. 2024. Available from: https://gi.org/topics/crohns-disease/
  4. Borren NZ, Conway G, Garber JJ, Khalili H, Budree S, Mallick H, et al. Differences in clinical course, genetics, and the microbiome between familial and sporadic inflammatory bowel diseases. Journal of Crohn S and Colitis [Internet]. 2017 Nov 13;12(5):525–31. Available from: https://doi.org/10.1093/ecco-jcc/jjx154
  5. Ko Y, Butcher R, Leong RW. Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases. World Journal of Gastroenterology [Internet]. 2014 Jan 1;20(5):1238. Available from: https://doi.org/10.3748/wjg.v20.i5.1238
  6. Włodarczyk M, Makaro A, Prusisz M, Włodarczyk J, Nowocień M, Maryńczak K, et al. The Role of Chronic Fatigue in Patients with Crohn’s Disease. Life [Internet]. 2023 Aug 5;13(8):1692. Available from: https://doi.org/10.3390/life13081692
  7. Matsuoka K, Kobayashi T, Ueno F, Matsui T, Hirai F, Inoue N, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. Journal of Gastroenterology [Internet]. 2018 Feb 10;53(3):305–53. Available from: https://doi.org/10.1007/s00535-018-1439-1
  8. Mitsuyama K. Antibody markers in the diagnosis of inflammatory bowel disease. World Journal of Gastroenterology [Internet]. 2016 Jan 1;22(3):1304. Available from: https://doi.org/10.3748/wjg.v22.i3.1304
  9. Spiceland CM, Lodhia N. Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment. World Journal of Gastroenterology [Internet]. 2018 Sep 19;24(35):4014–20. Available from: https://doi.org/10.3748/wjg.v24.i35.4014
  10. Ahmad R, Ajlan AM, Eskander AA, Alhazmi TA, Khashoggi K, Wazzan MA, et al. Magnetic resonance imaging in the management of Crohn’s disease: a systematic review and meta-analysis. Insights Into Imaging [Internet]. 2021 Aug 18;12(1). Available from: https://doi.org/10.1186/s13244-021-01064-9
  11. Honap S, Sharma E, Samaan MA. 5-ASAs in Crohn’s Disease: Time to stop the salicylate? Digestive Diseases and Sciences [Internet]. 2021 Nov 19;67(7):2699–700. Available from: https://doi.org/10.1007/s10620-021-07304-8
  12. Farraj KL, Pellegrini JR, Munshi RF, Russe‐Russe J, Kaliounji A, Tiwana MS, et al. Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease. JGH Open [Internet]. 2022 Nov 10;6(12):910–4. Available from: https://doi.org/10.1002/jgh3.12841
  13. Rodríguez-Lago I, Gisbert JP. The role of immunomodulators and biologics in the medical management of stricturing Crohn’s disease. Journal of Crohn S and Colitis [Internet]. 2019 Sep 10;14(4):557–66. Available from: https://doi.org/10.1093/ecco-jcc/jjz158
  14. U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn’s Disease in Adults [Internet]. AbbVie News Center. 2023. Available from: https://news.abbvie.com/2023-05-18-U-S-FDA-Approves-RINVOQ-R-upadacitinib-as-a-Once-Daily-Pill-for-Moderately-to-Severely-Active-Crohns-Disease-in-Adults
  15. Bernstein CN, Eliakim A, Fedail S, Fried M, Gearry R, Goh KL, et al. World Gastroenterology Organisation Global Guidelines Inflammatory Bowel Disease. Journal of Clinical Gastroenterology [Internet]. 2016 Oct 12;50(10):803–18. Available from: https://doi.org/10.1097/mcg.0000000000000660
  16. Peyrin-Biroulet L, Harmsen SW, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV. Surgery in a Population-Based Cohort of Crohn’s Disease from Olmsted County, Minnesota (1970–2004). The American Journal of Gastroenterology [Internet]. 2012 Sep 4;107(11):1693–701. Available from: https://doi.org/10.1038/ajg.2012.298
  17. Ranasinghe IR, Tian C, Hsu R. Crohn Disease [Internet]. StatPearls - NCBI Bookshelf. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436021/
  18. Caio G, Lungaro L, Caputo F, Zoli E, Giancola F, Chiarioni G, et al. Nutritional treatment in Crohn’s Disease. Nutrients [Internet]. 2021 May 12;13(5):1628. Available from: https://doi.org/10.3390/nu13051628
  19. Papadimitriou K, Georgia-Eirini Deligiannidou, Gavriela Voulgaridou, Constantinos Giaginis, Papadopoulou SK. Nutritional Habits in Crohn’s Disease Onset and Management. Nutrients. 2025 Jan 31;17(3):559–9. Available from: https://doi.org/10.1093/ecco-jcc/jjz158
  20. Rotem Sigall Boneh, Park S, Arcucci MS, Herrador-López M, Chen Sarbagili-Shabat, Nitzan Kolonimos, et al. Cultural Perspectives on the Efficacy and Adoption of the Crohn’s Disease Exclusion Diet across Diverse Ethnicities: A Case-Based Overview. Nutrients [Internet]. 2024 Sep 20 [cited 2024 Dec 9];16(18):3184–4. Available from: https://news.abbvie.com/2023-05-18-U-S-FDA-Approves-RINVOQ-R-upadacitinib-as-a-Once-Daily-Pill-for-Moderately-to-Severely-Active-Crohns-Disease-in-Adults

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