Crohn’s disease is a chronic inflammatory disease of your intestinal tract. The majority of patients with Crohn’s disease are diagnosed in the second or third decade of life. The process of inflammation in Crohn’s disease can involve any part of the intestinal tract, from the mouth to anus. Your intestinal tract is made of different layers just like layers of onion. Unlike ulcerative colitis, which involves only the inner most layer also known as mucosa, Crohn’s disease can affect all the different layers of your intestine. To date, we don’t have a cure for this inflammation, and the goal of our therapy is to suppress and keep the inflammation down and prevent the complications of the disease. If left untreated, most patients will have intermittent periods of worsening of disease called flares followed by period of feeling better called remission. Some patients can go in remission for a long time after their first flare. It is hard to determine which patients will follow that pattern. However, without treatment most patients will have repeated attacks of mild to severe symptoms with ongoing damage to the lining of the GI tract. This ongoing process of inflammation can lead to scar formation that may cause abnormal narrowing of the intestine called a stricture or abnormal communications between different parts of intestinal tract called fistulas. Fistulas may also form between the intestinal tract and other organs as the vagina and urinary bladder or to the skin. All of these lead to an increased need of surgery with recurrence afterwards. Long-term difficulty to absorb nutrition in untreated CD can also lead to severe malnutrition, anemia, dehydration, weight loss, and lack of immunity to fight infections. All these complications can be debilitating and even life threatening if not recognized and treated in timely fashion. The risk of complicated disease increases if you are diagnosed at an early age or smoke cigarettes. Different types of immunosuppressive medications are prescribed not only to bring inflammation down but also keep it suppressed with the goal to keep the symptoms away; prevent flares, hospitalization, and surgical and nutritional complications; and improve the quality of life.

Crohn’s disease is a chronic, transmural immune-mediated inflammatory disease of the gastrointestinal tract that also can have extraintestinal manifestations. The current prevalence of Crohn’s disease in North America is 144 ± 198 cases per 100,000 persons [1, 2]. The goal of therapy is not only to control the symptoms but to also prevent structural bowel damage and disability. We now recognize mucosal healing, prevention of relapse, and prevention of hospitalization and surgery, offering cost-effective therapy and improving quality of life as evolving goals of managing our IBD patients. Most, if not all, patients will progress toward complicated course of the disease without medical therapy. Population-based studies have shown that majority of patients who initially have inflammatory disease phenotype at the time of diagnosis will progress to penetrating or fibrostenotic disease over the course of 10–20 years. Young patients, particularly those with perianal disease at the onset, are more likely to need surgery and several courses of steroids to control their disease. Delayed or inadequate therapy to control inflammation can lead more complicated course such as permanent ostomy or even short bowel syndrome.