Crohn’s disease (CD) is a serious, chronic condition that can affect a person’s entire digestive tract, from the mouth to the anus. It causes inflammation and open sores (ulcers) that may result in diarrhea, bloody stool, abdominal pain and weight loss.    

Crohn’s disease can affect different parts of the digestive tract, and it can affect the tract in different ways (swelling, edema, abnormal passages, etc).  This accounts for the wide variety of symptoms seen in patients with CD. CD most commonly occurs in the last part of the small intestine and the first part of the large intestine. It can cause deep tissue inflammation and can lead to serious medical complications, such as obstruction or perforation of the intestines, which can require surgery.

The cause of CD is unknown, although it appears to have a genetic component. CD occurs primarily in North America and Europe. Young people between the ages of 15 and 35 are more likely to develop CD, as are whites and people of a Jewish ethnic background. Cigarette smokers also have an increased risk of developing CD.

When symptoms appear, an initial physical examination may include blood tests, stool tests and patient medical history. The most common imaging tests used to diagnose CD are barium x-rays and various forms of endoscopy, in which a flexible tube with a camera is inserted into the digestive tract.

Patients with CD may experience alternating periods of symptom activity and relief throughout their lives. Although there is no cure for CD, various medical and surgical treatment options exist. Medications are available to help reduce or eliminate the ulcers and inflammation caused by CD, as well as the symptoms of CD.

Surgery may be necessary when severe inflammation and ulcers cause parts of the intestines to narrow (stricture), food products are diverted from their normal digestive pathway (fistulae) or when food gets stuck in the intestines. Even after surgery, however, CD often reappears elsewhere in the digestive tract. Most patients require surgery at some point.

Crohn’s disease (CD) is an inflammatory bowel disease that causes chronic inflammation and ulceration within the digestive tract. Ulcers (open sores) in the intestinal lining and inflamed tissue may swell, redden and bleed, often leading to bloody diarrhea, abdominal pain and cramping.

Irritation caused by CD can run deep – into all layers of a person’s gastrointestinal lining. Inflammation may be confined to one location or it may occur in patches, with normal tissue located between inflamed areas.

About 500,000 Americans have CD, according to the Crohn’s & Colitis Foundation of America (CCFA). Another 500,000 have ulcerative colitis, the other major type of inflammatory bowel disease. CD most often occurs in young people between the ages of 15 and 35, but may also affect older or younger populations. According to the CCFA, approximately 100,000 of those diagnosed with CD are children under 18.

The cause of CD is unknown. However, recent research indicates that the disease may result from a missing gene or the mutation of a specific gene. 

CD appears to involve dysfunction of the immune system. Protective cells normally present in the gastrointestinal lining are triggered to attack when bacteria and viruses pass through the digestive tract. In patients with CD, this attack continues, even when harmful substances are no longer present – leading to chronic inflammation and irritation. It is not clear whether this immune dysfunction is a cause or result of CD.

CD may cause inflammation and ulceration anywhere in the digestive tract. As food is digested, it enters the mouth and travels through the esophagus, stomach, small intestine and large intestine, before being expelled as waste through the anus. CD most commonly occurs in the intestines – specifically, in the ileum (last part of the small intestine) and the cecum (first part of the large intestine).

Patients may experience a variety of medical complications as a result of Crohn’s disease (CD). These include:

• Obstruction. Created when scar tissue or swelling from the chronic inflammation of CD narrows gastrointestinal passageways. The intestines may become completely or partially obstructed. This may block digestion and require surgery to remove the diseased portion of the bowel. Obstruction is the most common complication in patients with CD.
  
  
• Fistulae. Abnormal tunnels that develop when ulcers break through intestinal walls, creating a tract that connects to nearby tissue (e.g., other parts of the intestines, the bladder, vagina or skin). These tunnels may become infected and abscesses (collection of pus) may develop, which require drainage. Fistulae often appear in areas around the rectum and anus. Medication is sometimes used to treat fistulae, although some cases require surgery. Fistulae occur in approximately 30 percent of patients with CD, according to the Crohn’s & Colitis Foundation of America (CCFA).
  

  

• Anal fissures. Tears in the lining of the anus where infections may occur. Patients with CD may develop fissures, which can cause pain, itching and bleeding, especially during bowel movements. Most fissures heal on their own and do not require treatment.
  

  

• Malnutrition. Insufficient amounts of calories, proteins and vitamins. Patients with CD may find it difficult to eat, or their intestines may fail to absorb enough nutrients (malabsorption), due to abdominal pain and diarrhea common in CD. Treatment involves the replacements of nutrients, either through injections or supplements in tablet or liquid form.
  
  
• Toxic megacolon. Occurs when the large intestine widens, losing muscle tone. This inflammation may cause the colon to rupture. Symptoms include abdominal distention, fever, pain and shock. This life-threatening condition requires immediate medical attention and usually surgery.
  
  
• Impaired development in children. Children 18 and under who have CD may experience stunted or delayed physical growth as well as delayed sexual development. The use of steroids to treat CD in children may also retard growth. Aggressive nutritional therapy with supplements (e.g., enteral and parenteral nutrition) can help normalize growth in children with CD.
  
  
• Osteoporosis. A decrease in bone mass that causes bones to be weak and easily fractured. Thirty to 60 percent of patients with inflammatory bowel disease have low bone density, according to the CCFA. Patients who have had CD for a long time, postmenopausal women and people using steroids have a greater risk of developing osteoporosis. Blood tests can identify vitamin deficiencies that may indicate osteoporosis and periodic bone density testing can identify early osteoporosis in patients with CD. Osteoporosis develops in many patients with CD at the age when bones are normally the densest (early 20s and 30s). Nutritional supplements (e.g., calcium and vitamin D) and weight-bearing exercises can help build bone strength.
  
  
• Liver and biliary function problems. Gallstones, kidney stones and other diseases of the liver and bile ducts may occur in patients with CD. Gallstones may require surgical removal. Kidney stones may be passed during urination or require urology consultation.

  

• Clotting problems. In some cases CD may cause problems with blood clotting (deep vein thrombosis).
  
  
• Short bowel syndrome. Patients who have surgery to remove large portions of the small intestine may be at risk for short bowel syndrome. It can cause serious problems in the ability to absorb nutrients, and requires treatment with parenteral nutrition.

Crohn’s disease (CD) may be classified into various types, depending on the location of symptoms. CD most commonly affects the small intestine (made up of the duodenum, jejunum and ileum) and the large intestine (cecum, colon and rectum). The various types of CD include:

• Ileocolitis. The most common form of CD, with symptoms occurring in both the small intestine’s ileum and the first part (cecum) of the large intestine. Symptoms include diarrhea, significant weight loss, and cramping or pain in the lower right or middle of the abdomen.
  
  
• Ileitis. When inflammation occurs in the ileum (also referred to as the “terminal ileum”). The symptoms are similar to those of ileocolitis, although fistulae and abscesses may also develop.
  
  
• Gastroduodenal Crohn’s disease. Affects the stomach and small intestine’s duodenum. Symptoms include loss of appetite, nausea, vomiting and weight loss. Vomiting may indicate an intestinal obstruction.
  
  
• Jejunoileitis. Inflammation of the jejunum, the largest part of the small intestine. Symptoms include diarrhea, abdominal pain and cramping. Malnutrition may occur, due to malabsorption by the jejunum, where most absorption of nutrients occurs. Fistulae may also develop.
  

The cause of Crohn’s disease (CD) is unknown. The disease seems to occur equally as often in men as it does in women. However, certain factors appear to be related to the potential for developing CD. These factors include:

• Heredity. CD appears to run in families. Approximately 20 percent of patients with CD have a blood relative with some form of inflammatory bowel disease, according to the National Institutes of Health.
  
  
• Age. Young people, especially those between the ages of 15 and 35, are more likely to develop CD, although CD may also occur in older or younger populations. According to the Crohn's & Colitis Foundation of America, an estimated 100,000 CD patients are children under the age of 18.
  
  
• Race and ethnicity. Whites have a higher risk of developing CD than non-whites. The risk of the disease is greater for people with a Jewish ethnic background (especially those of European descent) than other ethnic groups.
  
  
• Environment. CD appears to be a disease of the developed world, occurring primarily in North America and Europe. It is unclear whether lifestyle (e.g., diet) or possible toxic exposure (e.g., pollutants) in these areas of the world may be related to CD. The risk of CD also appears to increase for those living in urban areas and in northern climates.
  
  
• Cigarette smoking. People who smoke (especially female smokers) are more likely to develop CD than non-smokers. In addition, patients with CD who smoke are more likely to have an aggressive form of the disease. It has been suggested that smoking may be related to CD because it can decrease blood flow to the intestines and cause immune system changes.

Crohn’s disease (CD) is a condition that causes chronic inflammation within the digestive tract. Open sores (ulcers) may develop anywhere along this tract, from the mouth to the anus. Ulcers form most often in the intestines.

Patients with CD may experience the following:

• Chronic diarrhea
• Abdominal cramping
• Abdominal pain
• Blood in the stool
• Fever
• Elevated white blood cell count
• Loss of appetite
• Weight loss (unexplained)
• Foul-smelling stools

When abdominal pain occurs, it is frequently felt in the lower right-hand side of the abdomen. This is where the last portion of the small intestine (ileum) and the first portion of the large intestine (cecum) meet – the location of ileocolitis, the most common type of CD.  Abdominal pain associated with CD may range from mildly uncomfortable to severe. It may be confused with appendicitis, which involves pain that may occur in the same area. A physician should be consulted for an accurate diagnosis.

Diarrhea is often accompanied by a loss of control over bowel movements (fecal incontinence). This is because it is harder to keep loose or liquid stool in the rectum than hard stool, leading to the involuntary release of rectum contents. For patients with CD, this can mean numerous trips to the bathroom throughout the day, as well as potential soiling.

Additional signs of CD include dehydration and anemia. Chronic diarrhea can cause the loss of too much water and salt with stool, leading to dehydration. Bleeding caused by ulcers in the gastrointestinal lining can lead to the loss of too much blood, causing anemia.

Other areas of the body may be affected by CD, including:

• Eyes and vision. The eyes may become swollen or red, and vision may become blurred.
  
  
• Mouth. Sores in the mouth may appear.
  
  
• Joints. Joint pain can occur, with or without accompanying swelling and redness.
  
  
• Skin. Rashes or sores may appear on the skin, particularly in the lower legs (erythema nodosum).
  
  
• Liver and biliary system. Inflammation of the liver or bile ducts, and gallstones or kidney stones may also develop.
  

  

• Bones. Osteoporosis, a condition that causes weak, brittle bones, can occur in patients who have had CD for a long time.

The first step in diagnosing Crohn’s disease (CD) is a visit to a physician. The physician will compile a complete medical history and conduct a physical examination. Patients may be asked about the duration of their symptoms, any family history of CD, as well as their cigarette smoking habits. 

Blood tests and stool samples may also be required. Blood tests can identify low red blood cell counts (anemia), high white blood cell counts (which may indicate inflammation or infection) and nutrient levels. A stool sample analysis (fecal test) can rule out intestinal infections, which include symptoms similar to those of CD.

Because CD may involve any area of the digestive tract, there are a number of different imaging tests used to determine if a patient has the disease. In addition, these tests may be used to rule out evidence of infections or other diseases (e.g., colorectal cancer or diverticulitis) that may be causing the symptoms. These tests include:

• Barium x-ray. Organs are coated with a chalky substance (barium) that shows up on x-rays. Patients either drink the barium (for upper GI x-rays of the esophagus, stomach and/or small intestine) or have it administered via an enema (for lower GI x-rays of the large intestine). These x-rays allow physicians to identify any abnormalities within the digestive tract. Risks include low radiation exposure and possible perforation of the intestinal wall (which is very rare). Barium x-rays are not considered as reliable as an endoscopy for diagnosing CD because the x-rays may miss polyps and do not allow tissue samples to be taken.
  
  
• Conventional endoscopy. Examination using a small, flexible tube (with a light and camera) that is inserted through either the mouth or the anus and into the digestive tract. This procedure allows physicians to view the lining of the digestive tract and identify the severity and extent of any disease. In cases where the large intestine is being viewed, patients take a laxative prior to the procedure to cleanse the large intestine and are sedated during the procedure. A tissue sample (biopsy) may be taken for evaluation under a microscope. Color photographs may also be taken. Risks include perforation of the gastrointestinal wall and bleeding.
  
  Types of endoscopy used for patients with CD include:
  
  
• Colonoscopy. Used to view the entire large intestine.
  
  
• Sigmoidoscopy. Used to view the last two feet of the large intestine (the sigmoid colon) and the rectum.
  
  
• Esophagogastroduodenoscopy (EGD). Also called an upper endoscopy. An EGD is used to examine the esophagus, stomach and the first part of the small intestine (duodenum).
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP). Used to examine the bile ducts in the liver and the pancreatic duct.
  
  
• Endoscopic ultrasound. Tube includes an ultrasound probe that takes below-the-surface images of the gastrointestinal lining. This is used to detect fistulas that develop near the anus in patients with CD.
  
  
• Capsule endoscopy. A new instrument, called a capsule endoscope, allows physicians to look for abnormalities in the small intestine. Patients swallow a capsule that contains a tiny camera, which transmits images of the small intestine to a recorder for later viewing. The camera passes painlessly in the patient’s stool. This may be especially helpful for areas of the small intestine that are hard to reach during a conventional endoscopy. In cases of severe intestinal obstruction, there is a risk the camera may become stuck in the intestine and this method is not used.
  
  
• CAT scans. Simultaneous x-rays taken from different angles. CAT scans provide more detailed images than standard x-rays. This may be used to look for any sign of intestinal obstruction, fistulas or abscesses that can result from CD. Risks include increased radiation exposure.

Crohn’s disease (CD) is a lifelong condition. Once it appears, patients may experience symptoms of varying intensity for the rest of their lives, usually in alternating periods of activity and remission.

Treatment of CD attempts to reduce or eliminate the inflammation caused by the disease, as well as its symptoms (e.g., diarrhea, abdominal pain). Long-term treatment with medication is often recommended. Medical and surgical treatment may be necessary to correct any medical complications of CD, such as malnutrition, fistulae and intestinal obstruction.

Medications used to reduce inflammation include:

• Aminosalicylates. Reduces inflammation in the lining of the digestive tract. The active component of these drugs is the compound 5-aminosalicylic acid (5-ASA) – the most common treatment choice for inflammatory bowel disease. Aminosalicylates can be taken orally or rectally (in enema or suppository form).
  
  
• Corticosteroids. Used to control inflammation when 5-ASA drugs are not effective. This medication can be taken orally, rectally (e.g., suppository, enema) or intravenously. Long-term use of corticosteroids can increase a patient’s risk of serious side effects, including high blood pressure, osteoporosis and diabetes. Fluid retention and a rounded/swollen appearance of the face may also occur. The risk of side effects varies depending on the type of corticosteroid used and the length of treatment. A newer formulation of steroids (budesonide) has fewer side effects because of less blood absorption and may be useful with mild to moderate ileal inflammation.
  
  
• Immunosuppressants. Suppress the body’s ability to create the disease-fighting substances (antibodies) that are attacking the intestinal tissue lining in patients with CD, causing inflammation. This decreases immune system activity in patients with CD. Usually taken orally, these drugs may not have an impact for weeks or months. Possible side-effects include nausea, vomiting, diarrhea and an increased risk of infections. Immunosuppressants may be prescribed for long-term treatment of symptoms.
  
  In 1998, the Food and Drug Administration (FDA) licensed an immunosuppressant as the first treatment specifically for Crohn’s disease. It is only available as an intravenous preparation. Infliximab is used for patients with moderate to severe Crohn’s disease (CD) whose symptoms have not adequately responded to conventional therapies. In 2002, infliximab was approved by the FDA for maintaining remission of symptoms in patients with CD. In May of 2006 it was approved for use in children with CD who do not respond to conventional therapies.
  
  Infliximab is known as an anti-TNF medication that works by blocking the immune system’s production of a specific chemical (called tumor necrosis factor, or TNF) that intensifies inflammation.

Various medications can be used to treat the symptoms or complications of CD. These medications include:

• Antidiarrheals. Used to relieve the chronic diarrhea that is one of the most common symptoms of CD.
  
  
• Laxatives. Used in cases where a partial intestinal obstruction leads to constipation. Laxatives are not used to treat complete intestinal obstruction.
  
  
• Acetaminophen. Used to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen should not be used by patients with CD because they may intensify symptoms.
  
  
• Iron supplements. Used to restore iron loss and treat anemia, which can result from chronic intestinal bleeding.
  
  
• Vitamin B-12 injections. Used to help prevent anemia from malabsorption.
  
  
• Antibiotics. Sometimes used to treat infections in the small intestine caused by fistulas or as the result of surgery. 

Surgery may be required in cases of intestinal obstruction or perforation, or when medications fail to control the symptoms of CD. Up to 70 percent of patients with CD will require surgery at some point during the course of the disease, according to the American College of Gastroenterology (ACG). Many patients experience inflammation and ulcers that go deep into the intestinal tissue – increasing their risk of fistulas, abscesses and intestinal obstructions that can require surgery.

Surgery for patients with CD can include:

• Strictureplasty. Used to widen narrowed areas of the digestive tract.
  
  
• Bowel resection. Removal of the diseased portion of the intestine. This may involve a partial colectomy (part of the colon is removed). In some cases an ostomy may be necessary to allow stool to pass from the body. An ostomy may be required temporarily or permanently depending on how much bowel is removed.
  
  
• Correction of fistulae. Closes tunnels to keep food products from being improperly diverted from the normal digestive pathway.
  
  
• Draining of abscesses. Removes infectious material.

Surgery may be necessary to relieve symptoms that do not respond to medications or to correct complications of CD (e.g., obstruction, fistulae, abscesses). However, it is not a cure. The goals of surgery are to conserve as much of the intestines as possible and to relieve a patient’s symptoms. According to the ACG, the disease returns in 70 to 85 percent of patients with CD, even after surgery. The inflammation tends to recur close to the area removed by surgery.

After surgery, the symptoms of CD may remain in remission for years. However, when symptoms recur, many patients may require second or third operations. Recurrence is more likely for patients with severe CD and for patients in whom it occurs outside the colon. Following surgery with medications used to treat CD may help reduce the risk of recurrence.  

Hospitalization may be necessary to treat patients with CD when they are malnourished or have experienced severe diarrhea and blood loss. A special diet may be recommended, supplements may be added to the regular diet or intravenous feeding may be required (enteral and parenteral nutrition). Nutrition supplements may be necessary before a surgical procedure to help boost the immune system. They may also be used to add extra calories to the diet for patients who are losing a lot of weight or children who are not growing at a normal rate.

Nutrition and emotional support are important aspects of coping with CD and helping to reduce the severity of its symptoms. A healthy diet for patients with CD includes foods that will not aggravate the digestive tract, such as soft, bland foods that are low in fiber. Adequate amounts of proteins, calories and vitamins should be consumed. Products that stimulate the digestive system and aggravate the symptoms of CD should be avoided. These include: high-fiber foods (e.g., bran, beans, fresh fruits, vegetables), dairy products, caffeine and alcohol.

Research also indicates that relapse rates of CD may diminish following a pregnancy.

Although there is no cure for Crohn’s disease (CD), its symptoms may be reduced or eliminated in a variety of ways. Certain dietary changes, stress reduction and lifestyle choices can help. For example, cigarette smoking can increase the occurrence and severity of symptoms, so choosing not to smoke can help prevent the symptoms of CD.

Dietary changes that may help prevent the symptoms of CD include:

• Avoid foods high in fat. Patients with CD in the small intestine may have difficulty digesting or absorbing fatty foods. This can make stool soft and greasy, causing diarrhea. Foods that may be particularly hard to digest include fried foods, red meat, chocolate, butter, margarine, cream, peanut butter, nuts and mayonnaise.
  
  
• Experiment with fiber. Foods high in fiber (e.g., bran, beans, fresh fruits, vegetables) are usually an important part of a balanced diet. Since fiber can worsen symptoms of CD, patients should experiment with the levels of fiber in their diet. For example, some patients may be able to tolerate fresh fruits and vegetables when they are steamed, baked or stewed. High-fiber foods that may be especially problematic for patients with CD include those in the cabbage family (e.g., broccoli, cauliflower) and very crunchy foods (e.g., raw apples and carrots).
  
  
• Avoid problem foods. Any other foods that aggravate or cause a flare-up of symptoms in patients with CD should be avoided. This may include spicy foods and popcorn.
  
  
• Eat smaller meals. Eating smaller amounts of food throughout the day can aid digestion in patients with CD and help prevent its symptoms.
  
  
• Avoid caffeine, alcohol and carbonated drinks. Alcohol and beverages that contain caffeine (e.g., soda, coffee, tea) stimulate digestion, causing diarrhea. Carbonated beverages can produce gas, which can aggravate the symptoms of CD.
  
  
• Limit dairy products. Patients with CD may also be lactose intolerant, unable to digest the sugar (lactose) found in most dairy products. If so, avoiding these products can help prevent the symptoms of CD.
  
  
• Drink plenty of fluids. Drinking plenty of water throughout the day can help a patient with CD remain hydrated and may lessen the severity of CD symptoms.
  
  
• Use supplements. Multivitamins can help maintain a healthy nutritional balance for patients with CD who may suffer from diet restrictions and malabsorption problems. Omega 3 fatty acid supplements and probiotics (dietary supplements that contain potentially beneficial bacteria, such as that found in yogurt) are commonly used to help prevent symptoms of CD. Calcium and vitamin D supplements may be used to treat low bone density and osteoporosis.

Stress does not cause CD, but may aggravate its symptoms. Normal digestion is disrupted when a person is under stress. Stress may speed up or slow down the movement of stool through the digestive tract. It can also further irritate intestinal tissue, leading to a worsening of symptoms in patients with CD.

Activities that can help reduce stress and may prevent the symptoms of CD include:

• Regular exercise
• Yoga
• Tai chi
• Massage
• Meditation
• Deep breathing
• Hypnosis
• Biofeedback
• Music or art therapy

For many patients, coping with the symptoms of Crohn's disease (CD) can be difficult. Chronic diarrhea may include a loss of control (fecal incontinence), which can be embarrassing and limit outdoor activities. Patients with CD can be prepared for the sudden onset of symptoms by knowing the location of available restrooms when traveling, and by keeping extra toilet paper and clothing handy. In addition, dietary restrictions can make eating in social settings an uncomfortable experience for patients with CD. Gas and abdominal pain may make it difficult to be out in public.  

Research continues into additional medical treatments for CD. These include:

• Interleukin 10 (IL-10). A chemical that suppresses inflammation. The effectiveness of laboratory produced IL-10 in treating CD is being studied.
  
  
• Antibiotics. Currently used to treat infections that may occur in patients with CD. Some research suggests that antibiotics may be useful to treat CD itself.
  
  
• Methotrexate and cyclosporine. Two types of immunosuppressants that appear to work faster than traditional immunosuppressants.
  
  
• Natalizumab. An experimental drug being tested for treatment of CD. It works by keeping white blood cells in the bloodstream, preventing them from reaching and further irritating inflamed areas. However, research has been halted due to potentially serious side effects.
  
  
• Zinc. A mineral that removes free radicals (molecules produced during processes such as fat metabolism, stress, infection) from the blood. Free radicals are believed to contribute to inflammation. Research is under way to determine whether supplements of zinc may reduce inflammation.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to Crohn’s disease:

1. Am I at risk for Crohn’s disease?
   
   
2. At what point should I be concerned about my symptoms?
   
   
3. What kind of tests will you need to take to determine the cause of my symptoms? How should I prepare for these tests?
   
   
4. Could my symptoms be a sign of some other type of inflammatory bowel disease?
   
   
5. Where exactly is the inflammation in my body? How severe is the damage it may have caused to my digestive tract?
   
   
6. Is something I’m eating or drinking causing my Crohn’s disease, or aggravating its symptoms? What about smoking? Or stress?
   
   
7. What type of treatment do you recommend?
   
   
8. What medication is most appropriate for me? How long will I have to take it?
   
   
9. Are there over-the-counter medications I can also take that would help?
   
   
10. Are there over-the-counter medications that I need to avoid because they could worsen my symptoms or increase the risk of complications?
    
    
11. Will I need surgery?  What are the risks and benefits of surgery?
    
    
12. How will I need to change my lifestyle once diagnosed with Crohn’s disease?
    
    
13. Are there complementary treatments (e.g., nutritional supplements, acupuncture, meditation, etc.) you would recommend that may help prevent the symptoms of Crohn’s disease?
    
    
14. What symptoms or changes should I immediately be reporting to you?
    
    
15. If my symptoms subside for a period (remission) do you want to be informed when and if they resume?
    
    
16. Will I need regular follow-up visits or testing? How often?
    
    
17. Are my children at higher risk for Crohn’s or other inflammatory bowel diseases now that I have been diagnosed? Should they be evaluated for the condition?