In this article
Crohn’s disease is a chronic inflammatory bowel disease (IBD) in which the immune system attacks the digestive tract, most often the end of the small intestine, with inflammation that runs through the full thickness of the bowel wall. About 500,000 Americans live with it, and because it relapses and remits, treatment aims for long, sustained remission and healed bowel lining rather than a one-time fix.
- Crohn’s disease (CD) can affect any part of the gastrointestinal tract from mouth to anus, most often the terminal ileum, and is usually diagnosed between ages 15 and 35.
- Colonoscopy with biopsies is the reference test for diagnosis, supported by MR enterography, CT enterography, CRP and fecal calprotectin.
- Biologic drugs (anti-TNF, anti-integrin, IL-12/23 and IL-23 blockers) and oral JAK inhibitors are the backbone of moderate to severe disease care, with mucosal healing as the treatment target.
- In a 2011 randomized trial by Jill Smith and colleagues in Digestive Diseases and Sciences, 4.5 mg naltrexone daily produced endoscopic remission in 33% of adults with active Crohn’s versus 8% on placebo after 12 weeks.
- The European Medicines Agency withdrew the stem cell product darvadstrocel (Alofisel) in December 2024 after its confirmatory ADMIRE-CD II trial missed its primary endpoint, so stem cell therapy for Crohn’s remains investigational.
- Diet has randomized trial support: the Crohn’s Disease Exclusion Diet with partial enteral nutrition (Levine et al., 2019) and the DINE-CD trial of the Specific Carbohydrate and Mediterranean diets (Lewis et al., 2021).
At a Glance
- Type: Chronic inflammatory bowel disease (IBD) that can affect any part of the GI tract, from mouth to anus
- Prevalence: About 500,000 Americans live with Crohn’s disease, with rising rates worldwide
- Pattern: Characterized by “skip lesions” (patches of inflammation separated by healthy tissue) and transmural involvement (inflammation through the full bowel wall)
- Age of onset: Most commonly diagnosed between ages 15 and 35
- Key challenge: Crohn’s is relapsing-remitting, and current treatments aim for sustained remission and mucosal healing rather than a permanent end to the disease
- Who treats it: A gastroenterologist, ideally an IBD specialist, leads care, with colorectal surgeons, registered dietitians and, for some patients, integrative physicians alongside
What Is Crohn’s Disease?
Crohn’s disease is a form of inflammatory bowel disease in which the immune system launches a chronic attack on the gastrointestinal tract. Unlike ulcerative colitis, which stays in the colon and affects only the surface lining, Crohn’s can strike anywhere along the digestive tract and penetrates through all layers of the bowel wall. This transmural inflammation is what makes Crohn’s particularly prone to complications like strictures (narrowing), fistulas (abnormal tunnels between organs), and abscesses.
You may also see Crohn’s called regional enteritis, ileitis or ileocolitis (when it involves the ileum and colon), or granulomatous colitis (when it is limited to the colon). Clinicians abbreviate it as CD and group it with ulcerative colitis (UC) under the umbrella of IBD. Our Crohn’s disease condition overview lists the treatments clinics in the directory offer for it.
The exact cause remains unclear, but the current model combines four factors: genetic susceptibility (over 200 risk genes have been identified, with NOD2 being the most well-known), an altered gut microbiome, environmental triggers, and a dysregulated immune response. In people with Crohn’s, the immune system overreacts to normal gut bacteria, setting off a cycle of inflammation that damages the intestinal lining.
What makes Crohn’s so frustrating for patients is its unpredictability. Flares can appear seemingly out of nowhere, and the disease can progress silently even when symptoms are minimal. This is why objective monitoring with lab work, imaging, and sometimes endoscopy is so important, even when you feel well.
How is Crohn’s disease different from ulcerative colitis?
| Feature | Crohn’s disease | Ulcerative colitis |
|---|---|---|
| Location | Anywhere from mouth to anus, most often the terminal ileum | Colon and rectum only |
| Depth of inflammation | Full thickness of the bowel wall (transmural) | Inner lining (mucosa) only |
| Pattern | Skip lesions with healthy tissue between | Continuous, starting at the rectum |
| Fistulas and strictures | Common | Rare |
| Effect of surgery | Disease often returns at the join (anastomosis) | Removing the colon removes the disease site |
Symptoms to Watch For
Crohn’s symptoms vary depending on which part of the GI tract is involved. The most common location is the terminal ileum (the last section of the small intestine), but Crohn’s can affect the colon, stomach, esophagus, and even the mouth.
- Abdominal pain and cramping: Often in the right lower quadrant, especially with ileal disease
- Chronic diarrhea: Sometimes bloody, though less commonly than in ulcerative colitis
- Weight loss and malnutrition: The inflamed small bowel cannot absorb nutrients properly
- Fatigue: From chronic inflammation, anemia, and nutritional deficiencies
- Fever: Low-grade fevers are common during flares; high fevers may signal an abscess
- Perianal disease: Fistulas, fissures, and abscesses around the anus occur in about one-third of Crohn’s patients
Beyond the Gut: Crohn’s is a systemic disease. Extra-intestinal manifestations include joint pain (affecting up to 30% of patients), skin conditions (erythema nodosum, pyoderma gangrenosum), eye inflammation (uveitis), liver involvement (primary sclerosing cholangitis), and kidney stones. If you have Crohn’s and develop symptoms outside the GI tract, let your doctor know.
Which symptoms need same-day medical care?
Severe abdominal pain with vomiting and no passage of stool or gas can mean a bowel obstruction from a stricture. A high fever, a painful swelling near the anus, heavy rectal bleeding or signs of dehydration also need prompt assessment by a doctor or an emergency department, not a wait for the next routine visit.
Can Crohn’s look like IBS?
Crohn’s and irritable bowel syndrome share pain, bloating and changed bowel habits, but IBS does not cause visible inflammation, bleeding, weight loss or a raised fecal calprotectin. Night-time symptoms, blood in the stool and unexplained weight loss point toward IBD and are a reason to ask for testing.
Diagnosis
Diagnosing Crohn’s requires a combination of clinical evaluation, lab work, imaging, and endoscopy. There is no single definitive test.
- Colonoscopy with biopsies: The gold standard. Allows direct visualization of the bowel lining and tissue sampling to confirm the characteristic granulomatous inflammation
- MR enterography (MRE): A specialized MRI that evaluates the small bowel for wall thickening, strictures, and fistulas without radiation exposure
- CT enterography: Similar to MRE but uses CT; preferred in emergencies for its speed
- Lab markers: CRP and ESR measure inflammation levels; fecal calprotectin is a stool test that correlates well with intestinal inflammation and is useful for monitoring disease activity
- Capsule endoscopy: A swallowed camera pill that photographs the small bowel, useful when standard endoscopy cannot reach the affected area
Which doctors diagnose and treat Crohn’s disease?
A gastroenterologist makes the diagnosis and leads treatment, and many large health systems run dedicated IBD centers with gastroenterologists who focus on Crohn’s and ulcerative colitis. Colorectal surgeons manage strictures, fistulas and abscesses, radiologists read enterography scans, and a registered dietitian with IBD experience guides nutrition. Integrative and functional medicine physicians, naturopathic doctors and hyperbaric physicians usually work alongside this team rather than replacing it.
Conventional Treatment
Treatment for Crohn’s disease follows a step-up (or increasingly, a top-down) approach depending on disease severity and location. Patients at high risk of complications, such as those with deep ulcers, perianal disease or a young age at diagnosis, are now more often started on a biologic early instead of working up through weaker drugs first.
Medications
5-ASA drugs (mesalamine) have limited benefit in Crohn’s compared to ulcerative colitis but are sometimes used for mild colonic Crohn’s.
Corticosteroids (prednisone, budesonide) are effective for inducing remission during flares but are not suitable for long-term use due to serious side effects including bone loss, diabetes, and adrenal suppression.
Immunomodulators (azathioprine, 6-mercaptopurine, methotrexate) are used for maintenance therapy to keep the disease in remission.
Biologic therapies have transformed Crohn’s management. Anti-TNF agents (infliximab, adalimumab) remain the most widely used. Newer options include vedolizumab (gut-selective integrin blocker), ustekinumab (IL-12/23 blocker), and IL-23 blockers such as risankizumab, mirikizumab and guselkumab. These biologics can achieve mucosal healing, which is the gold standard treatment target.
Oral small molecules are the newest drug class. Upadacitinib, a Janus kinase (JAK) inhibitor taken as a daily tablet, was approved by the FDA for moderate to severe Crohn’s disease in 2023 for adults who have not responded well enough to an anti-TNF biologic.
What does treat to target mean?
Treat to target means adjusting therapy until objective measures of inflammation, not just symptoms, return to normal. The STRIDE-II consensus from the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD, 2021) sets clinical response first, then normal CRP and fecal calprotectin in an acceptable range, then endoscopic healing as the longer-term goal. Feeling better while calprotectin stays high is a reason to review the plan with your gastroenterologist.
Surgery
Up to 70% of Crohn’s patients will need at least one surgery in their lifetime, typically for strictures, fistulas, or disease that does not respond to medications. Surgery does not end the disease (Crohn’s frequently recurs at the surgical site), but it can provide years of improved quality of life when medical therapy falls short. Common operations include resection of the diseased segment, strictureplasty to widen a narrowed section without removing bowel, and drainage or seton placement for perianal fistulas.
Regenerative and Integrative Approaches
Regenerative and integrative therapies are add-ons that some Crohn’s patients explore, particularly those who have not achieved adequate control with conventional therapies. The evidence ranges from randomized trials (low-dose naltrexone) to animal studies only (BPC-157 and KPV). Most of these options are off label for Crohn’s, many are cash pay, and the safest way to use them is with your gastroenterologist informed and your biologic or immunomodulator unchanged unless they advise otherwise.
Low-Dose Naltrexone (LDN)
Low-dose naltrexone has some of the strongest evidence of any integrative therapy for Crohn’s disease. In a double-blind randomized controlled trial of 40 adults with moderate to severe active Crohn’s, published by Smith and colleagues in Digestive Diseases and Sciences (2011), 4.5 mg naltrexone daily for 12 weeks produced endoscopic remission in 33% of patients versus 8% on placebo. Endoscopic response was 78% versus 28%, and 88% versus 40% had a meaningful drop in their Crohn’s Disease Activity Index (CDAI) score.
LDN works by transiently blocking opioid receptors, triggering an upregulation of endogenous opioids (endorphins, enkephalins) and the opioid growth factor receptor system. This is thought to promote mucosal healing and modulate the immune response. Side effects are usually mild, most often vivid dreams or sleep disturbance in the first few weeks.
The trial was small, and two of its investigators hold a patent on naltrexone for IBD, which they disclosed. LDN is prescribed off label, usually filled by a compounding pharmacy, and is not a substitute for a biologic in severe disease. Our LDN for Crohn’s disease article covers dosing and practical questions in more depth.
Peptide Therapy: BPC-157 and KPV
Peptide therapy is gaining traction in the Crohn’s community. Two peptides stand out:
BPC-157 (Body Protection Compound-157) is a pentadecapeptide originally isolated from gastric juice. Animal studies consistently show it accelerates healing of intestinal ulcers, reduces inflammation, and promotes angiogenesis (new blood vessel formation) in damaged gut tissue. It can be taken orally (which provides direct contact with the GI lining) or via subcutaneous injection for systemic effects. The BPC-157 treatment guide explains what is and is not known in people.
KPV is a tripeptide (Lys-Pro-Val) derived from alpha-melanocyte-stimulating hormone (alpha-MSH). It has anti-inflammatory effects mediated through inhibition of NF-kB, a master inflammatory signaling pathway. In preclinical IBD models, KPV delivered orally in nanoparticles reduced colitis severity comparable to standard medications. Its ability to target intestinal inflammation directly makes it a candidate worth studying for Crohn’s, and the KPV peptide guide summarizes the research so far.
Neither peptide is a component of any FDA-approved drug, and the evidence in Crohn’s comes from animal and laboratory studies. In its review of bulk substances for compounding, the FDA states that it has limited or no human safety data for BPC-157 and KPV, and its Pharmacy Compounding Advisory Committee reviewed both in July 2026. Clinics that offer them list under peptide therapy providers.
Stem Cell Therapy
Stem cell therapy for Crohn’s has been tested in people, with mixed results. The most notable product is darvadstrocel (Alofisel), derived from allogeneic (donor) adipose-tissue mesenchymal stem cells (MSCs). In 2018, it became the first stem cell therapy approved in Europe specifically for complex perianal fistulas in Crohn’s disease, after the Phase III ADMIRE-CD trial reported combined remission at 24 weeks in about 50% of patients treated with a single injection around the fistula tract.
The larger confirmatory trial, ADMIRE-CD II, enrolled 568 patients and did not show a meaningful difference from placebo at 24 weeks. According to the European Medicines Agency (December 2024), the manufacturer withdrew Alofisel from the EU market because its clinical benefit was no longer demonstrated. No stem cell product is FDA approved for Crohn’s disease in the United States.
Beyond fistula treatment, systemic MSC infusion is being studied for luminal Crohn’s disease. Early trials report improvements in disease activity scores and inflammatory markers with few serious adverse events, but they are small and mostly uncontrolled. Hematopoietic stem cell transplantation (HSCT) has also been explored for severe, refractory Crohn’s, with some patients achieving drug-free remission for years, though the procedure carries significant risks. Trials that are recruiting are listed on ClinicalTrials.gov.
If you are weighing a clinic offer, the stem cell therapy treatment guide explains cell sources and regulation, and the national list of stem cell therapy clinics shows who offers it. Ask whether the product is part of a registered trial, because outside a trial it is unproven and paid out of pocket.
Hyperbaric Oxygen Therapy (HBOT)
Hyperbaric oxygen therapy delivers 100% oxygen at increased atmospheric pressure, raising the amount of oxygen dissolved in blood plasma and reaching poorly perfused tissue. For Crohn’s patients, HBOT has drawn interest mainly for perianal disease and fistulas, where poor blood supply makes healing difficult.
Multiple case series and small trials report fistula closure rates of 50-75% with HBOT, often in patients who had failed surgical interventions. Laboratory and small clinical studies also suggest HBOT reduces intestinal inflammation and has antimicrobial effects. A typical protocol involves 20-40 sessions at 2.0-2.4 atmospheres.
Crohn’s disease is not on the Undersea and Hyperbaric Medical Society (UHMS) list of approved HBOT indications, so insurers usually treat it as off label and patients often pay cash. The hyperbaric oxygen therapy guide covers chamber types and safety, and the directory of HBOT clinics lets you compare providers who use medical-grade chambers.
Gut Healing Protocols
Addressing leaky gut (increased intestinal permeability) is foundational in any integrative approach to Crohn’s disease. While conventional gastroenterology focuses on immune suppression, integrative practitioners also work to restore the integrity of the intestinal barrier itself.
Key components of a gut healing protocol for Crohn’s include:
- Remove: Identify and eliminate dietary triggers, test for and treat SIBO, address Candida overgrowth
- Replace: Digestive enzymes if needed, especially for patients with ileal disease or prior resections
- Reinoculate: Specific probiotic strains with evidence in IBD (Saccharomyces boulardii, VSL#3/Visbiome, E. coli Nissle 1917)
- Repair: L-glutamine, zinc carnosine, butyrate, colostrum, and BPC-157 to restore mucosal integrity
The four-R framework is a clinical convention, not a tested protocol. Probiotic evidence is stronger in ulcerative colitis and pouchitis than in Crohn’s, so treat these steps as supportive. Small intestinal bacterial overgrowth is common after ileal resection, and the SIBO treatment overview explains how it is tested and treated.
Diet Strategies for Crohn’s
Diet plays a unique role in Crohn’s because it directly contacts the affected organ. Several dietary approaches have clinical evidence:
Evidence-Based Diets
| Diet | Approach | Evidence | Best For |
|---|---|---|---|
| Exclusive Enteral Nutrition (EEN) | Liquid formula diet replacing all food for 6-8 weeks | Strong: first-line for pediatric Crohn’s, remission rates equal to steroids | Active disease, especially in children/adolescents |
| Specific Carbohydrate Diet (SCD) | Removes complex carbohydrates, grains, most sugars | Moderate: observational studies show improvement in symptoms and inflammation; not superior to the Mediterranean diet in the DINE-CD trial | Maintenance, mild-moderate disease |
| Mediterranean Diet | Anti-inflammatory whole foods pattern | Moderate: the DINE-CD trial showed similar outcomes to SCD | General maintenance, sustainable long-term |
| Crohn’s Disease Exclusion Diet (CDED) | Partial enteral nutrition + whole food diet excluding specific triggers | Strong: a 2019 RCT in children found it better tolerated than EEN, with higher sustained remission at week 12 | Active mild-moderate Crohn’s in adults and children |
Two trials anchor this table. In the pediatric trial by Levine and colleagues in Gastroenterology (2019), 75.6% of children on CDED with partial enteral nutrition were in steroid-free remission at week 12, compared with 45.1% of those who started on EEN. In the adult DINE-CD trial reported by Lewis and colleagues (2021), symptomatic remission at week 6 was 46.5% on the Specific Carbohydrate Diet and 43.5% on the Mediterranean diet, a difference too small to favor the stricter diet.
Practical Tip: During a flare, reduce fiber and avoid raw vegetables, nuts, seeds, and popcorn, which can worsen symptoms and potentially cause obstructions in narrowed bowel segments. Once inflammation is controlled, gradually reintroduce fiber-rich foods to nourish beneficial gut bacteria.
Our Crohn’s disease diet article covers meal planning by disease stage, and a registered dietitian with IBD experience can help adapt any of these patterns if you have a stricture or have had part of your bowel removed.
Comparing Treatment Approaches
Biologics have the strongest evidence for moderate to severe Crohn’s, LDN and diet have randomized trial support as adjuncts, and peptides remain preclinical. The table below sets each option against its mechanism and evidence level.
| Therapy | Primary Mechanism | Evidence Strength | Best Candidates |
|---|---|---|---|
| Anti-TNF Biologics | Block TNF-alpha-mediated inflammation | Strong (Phase III RCTs) | Moderate-severe Crohn’s |
| LDN | Endorphin upregulation, mucosal healing | Moderate (RCTs, case series) | Mild-moderate, adjunct to biologics |
| BPC-157 | GI mucosal repair, anti-inflammatory | Preclinical (animal studies) | Adjunct for mucosal healing |
| Stem Cells (Alofisel) | Local immunomodulation, tissue repair | Mixed (positive ADMIRE-CD, negative ADMIRE-CD II; EU authorization withdrawn 2024) | Complex perianal fistulas, now within trials |
| HBOT | Tissue oxygenation, angiogenesis | Moderate (case series, small trials) | Perianal disease, refractory fistulas |
| Gut Healing Protocol | Barrier repair, microbiome restoration | Emerging (mechanistic + clinical) | All Crohn’s patients as foundation |
How to Find an Integrative Crohn’s Clinic
An integrative Crohn’s clinic works best as an addition to your gastroenterologist, not a replacement. Most clinics in the directory focus on one or two therapies, such as hyperbaric oxygen, peptides or IV nutrient therapy, so start from the therapy you want to explore and the Crohn’s treatment guide, which maps options by disease stage.
Listing order on Regenerated.com is not a paid ranking. Featured slots are clearly labeled and capped, a Verified badge means the clinic completed our credential checks rather than paid for placement, and the directory is free for patients to use. Inclusion in a list is not an endorsement, and the guide to Featured, Verified and organic listings explains each label.
What should I ask a clinic before starting?
- Who prescribes and supervises the therapy, and what is their license and specialty?
- Will the clinic share notes and lab results with my gastroenterologist?
- Which published studies support this therapy for Crohn’s, and in which patients?
- How will we measure whether it is working, for example with fecal calprotectin, CRP or imaging?
- What is the full cost, what does insurance cover, and what happens if I stop early?
Frequently Asked Questions
What causes Crohn’s disease?
Crohn’s disease results from a combination of genetic susceptibility, environmental triggers, gut microbiome changes and immune dysregulation, and no single cause has been identified. More than 200 risk genes are known, NOD2 being the best studied. In people with Crohn’s, the immune system overreacts to normal intestinal bacteria and creates chronic inflammation. Smoking, antibiotics, diet, stress and infections have all been implicated as triggers in genetically susceptible people.
Is Crohn’s disease the same as ulcerative colitis?
No. Both are forms of inflammatory bowel disease, but Crohn’s can affect any part of the GI tract and involves the full thickness of the bowel wall, while ulcerative colitis is limited to the colon and its inner lining. Crohn’s tends to have skip lesions and can cause fistulas and strictures, which are rare in UC. Surgery to remove the colon ends ulcerative colitis, whereas Crohn’s often returns after surgery.
Can Crohn’s disease go into remission permanently?
Crohn’s disease can stay in remission for years or even decades, but it is a lifelong condition that can relapse at any time. The goal of treatment is deep remission, meaning clinical, biochemical and endoscopic remission together, because it gives the best chance of staying well long term. Regular monitoring with fecal calprotectin and endoscopy, plus attention to diet, smoking and stress, supports keeping that remission once it is reached.
How effective is LDN for Crohn’s?
Low-dose naltrexone showed meaningful benefit in one small randomized trial. Smith and colleagues (2011) gave 4.5 mg daily to adults with active Crohn’s for 12 weeks: 33% reached endoscopic remission versus 8% on placebo, and 88% versus 40% improved their CDAI score by at least 70 points. LDN is off label, inexpensive and generally well tolerated, but it is an add-on rather than a replacement for biologics in moderate to severe disease.
What foods should I avoid with Crohn’s?
Triggers are individual, but common problem foods include alcohol, caffeine, high-fiber raw vegetables during flares, dairy if you are lactose intolerant, spicy foods, and ultra-processed foods with emulsifiers and artificial sweeteners. People with strictures should also avoid nuts, seeds and popcorn. A food diary and a dietitian experienced in IBD help identify personal triggers, and in remission a diverse, Mediterranean-style whole-foods diet supports microbiome health.
Are stem cells a proven treatment for Crohn’s?
No, stem cell therapy for Crohn’s remains investigational. Darvadstrocel (Alofisel) was approved in Europe in 2018 for complex perianal fistulas, but the larger ADMIRE-CD II trial did not beat placebo and the European Medicines Agency withdrew it in December 2024. No stem cell product is FDA approved for Crohn’s. Mesenchymal stem cell infusions and hematopoietic stem cell transplant are still being studied, so the safest route is a registered clinical trial.
