An estimated 1 million people in the U.S. live with Crohn’s disease, an inflammatory, lifelong condition that affects your digestive tract. Although there’s no cure, treatment can keep the condition in remission.
In a WebMD Reddit AMA about Crohn’s disease, gastroenterologist Reezwana Chowdhury, MD, discussed a variety of topics, from the Mediterranean diet and nutrition options to GLP-1s for symptom management.
Chowdhury, a doctor at Johns Hopkins Endoscopy and Surgery Center in Columbia, Maryland, researches and treats inflammatory bowel disease (IBD), including Crohn’s.
Here are Chowdhury’s answers to some of the questions asked during the Reddit AMA.
In recent years, has there been any promising research into the root cause of Crohn’s disease?
Chowdhury: There are ongoing studies trying to understand what causes Crohn’s disease and ulcerative colitis, including early exposure to antibiotics, childbirth, and changes in microbiome and environmental triggers. There’s also a genetic component.
For someone newly diagnosed, what’s the one thing they should know that most doctors don’t say in the first appointment?
Chowdhury: They should understand that Crohn’s is a lifelong disease. But that doesn’t mean they have to have symptoms their entire lives and not be able to live a normal life.
Is there any reason certain cases of Crohn’s are so resistant to treatment?
Chowdhury: Unfortunately, we don’t know why some folks respond well to some treatments and others have to “cycle” through treatments. There are different phenotypes of Crohn’s and some are more difficult to treat than others, including those with perianal fistulas or isolated small intestinal disease or fistulas and strictures.
What kind of diet should people with Crohn’s follow?
Chowdhury: Crohn’s patients should follow a Mediterranean diet, including fruits and vegetables, proteins such as fish and chicken, and avoid processed and ultraprocessed foods.
What are some of the most promising Crohn’s treatments on the horizon?
Chowdhury: There are many medications and great treatments on the horizon. The treatments are appropriate for various conditions, including those who may have dermatological or rheumatological manifestations as well. There are newer classes of medications on the horizon, and there are many ongoing clinical trials investigating these further.
There are many treatment options for Crohn’s disease these days, and there’s lots of hope for patients to live a normal life in both clinical and endoscopic remission. It’s important to build a good relationship with your GI and always advocate for yourself.
What have you seen regarding the use of GLP-1s for Crohn’s management?
Chowdhury: GLP-1s alone are not a treatment for Crohn’s, but the treatment of obesity and underlying metabolic abnormalities is overall helpful for inflammation.
What’s the small molecule therapeutics space currently like for Crohn’s, and what’s limiting it compared to biologics?
Chowdhury: Current small molecules approved for Crohn’s disease include janus kinase inhibitors such as upadacitinib. There’s a risk of infection — including shingles — with this medication. I would use caution in older individuals or those with a history of heart disease or blood clots.
In your experience, does stress actually make Crohn’s flare-ups worse or is that overstated?
Chowdhury: Yes, I do think stress, lack of sleep, and a lack of a healthy diet can precipitate a flare.
What’s the rule of thumb with Crohn’s remission and taking ibuprofen?
Chowdhury: Use of NSAIDs like ibuprofen in small quantities intermittently may be OK, but these medications can cause ulcerations anywhere in the GI tract.
What’s your advice for dealing with Crohn’s, which can be more difficult because of the way society treats invisible illnesses?
Chowdhury: That’s a great question and it’s unfortunate that patients and folks with chronic illnesses are made to feel that way. I would recommend continuing to advocate and educate folks that symptoms are not only GI-related but that patients can have extraintestinal manifestations. As physicians, we should also do a better job educating.
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SOURCES:
Reezwana Chowdhury, MD, gastroenterologist, Johns Hopkins Endoscopy and Surgery Center, Columbia, Maryland.
National Institute of Diabetes and Digestive and Kidney Diseases: “Definition & Facts for Crohn’s Disease.”
