Description

Crohn's disease is a type of inflammatory bowel disease (IBD) that causes swelling and irritation of the tissues, called inflammation in the digestive tract. This can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.

The inflammation caused by Crohn's disease can affect different areas of the digestive tract in different people. Crohn's disease most commonly affects the end of the small intestine and the beginning of the large intestine. The inflammation often spreads to the deeper layers of the intestine.

Crohn's disease can be painful and debilitating. Sometimes, it can lead to serious or life-threatening complications.

There is no known cure for Crohn's disease, but therapies can significantly reduce your symptoms and even bring about long-term remission and healing of the inflammation. With treatment, many people with Crohn's may work well.

Symptoms

The symptoms of Crohn's disease include:

  • The diarrhea.
  • Fever.
  • Fatigue.
  • Abdominal pain and cramping.
  • Blood in the stool.
  • Sores in the mouth.
  • Decreased appetite and weight loss.
  • Pain or drainage near or around the anus due to inflammation of a tunnel in the skin, called a fistula.

Crohn's disease can affect any part of the small intestine or the large intestine. May involve several segments, or can be continuous. The most common is the last part of the small intestine. In some people, the disease is only in the colon or the large intestine.

The symptoms of Crohn's disease can vary from mild to severe. They usually develop gradually, but sometimes it can come suddenly, without prior notice. Someone with Crohn's disease may also have periods of time without symptoms. This is known as remission.

Other symptoms

People with severe Crohn's disease may also experience symptoms outside of the intestinal tract, including:

  • Inflammation of the skin, eyes and joints.
  • Inflammation of the liver or bile ducts.
  • Stones in the kidney.
  • Iron deficiency is called anemia.
  • Delayed growth or sexual development in children.

When to see a doctor

Consult a health care professional if you have ongoing changes in your bowel habits or if you have any of the symptoms of Crohn's disease, such as:

  • Belly pain.
  • Blood in the stool.
  • Nausea and vomiting.
  • Diarrhea that lasts more than two weeks.
  • Losing weight without trying.
  • The fever, in addition to the symptoms listed above.

Causes

The exact cause of Crohn's disease is unknown. Previously, diet and stress were suspected, but now the health professionals know that these factors may aggravate but don't cause Crohn's disease. Several factors that could play a role in its development.

  • Genes. More than 200 genes have been associated with Crohn's disease. However, researchers are not sure exactly what role they play in the condition. Have one or more of these genes may make someone more likely to get Crohn's disease.
  • Immune system. It is possible that bacteria, viruses, or other environmental factors may trigger Crohn's disease. For example, certain bacteria in the gut microbiome are suspected to be associated with Crohn's disease, but it is unknown whether these bacteria cause Crohn's disease. When the immune system tries to fight off an invading microorganism or environmental triggers, an atypical immune response causes the immune system to attack the cells in the digestive tract, too.

Risk factors

Risk factors for Crohn's disease may include:

  • The history of the family. People with a first-degree relative, like a father, brother or son, are at greater risk of having the disease. 1 out of every 5 people with Crohn's disease has a family member with the disease.
  • Age. Crohn's disease can occur at any age, but is more likely to develop the condition when you are young. The majority of people who develop Crohn's disease are diagnosed before they are around 30 years of age.
  • The ethnic origin. Although Crohn's disease can affect any ethnic group, whites have the highest risk, especially people of eastern european (Ashkenazi) Jewish descent. However, the incidence of Crohn's disease is increasing among Black people living in North America and the United Kingdom. Crohn's disease is also increasingly seen in the East Half of the population, and among migrants to the united States.
  • Smoking cigarettes. Cigarette smoking is the most important controllable risk factor for the development of Crohn's disease. Smoking also leads to more severe disease and a higher risk of having the surgery. If you smoke, it is important to stop.
  • Nonsteroidal anti-inflammatory drugs. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and other. While that does not cause Crohn's disease, which can lead to inflammation of the intestines that causes Crohn's disease worse.

Complications

Crohn's disease can lead to one or more of the following complications:

  • Intestinal obstruction or blockage. Crohn's disease can affect the entire thickness of the intestinal wall. Over time, parts of the bowel may scar and narrow, which can block the flow of digestive contents, often known as a stricture. Surgery to widen the stricture, or to remove the diseased part of the bowel may be necessary.
  • The ulcers. Ongoing inflammation can cause open sores called ulcers anywhere in the digestive tract. This may include the mouth, the anus and the genital area.
  • Fistulas.Sometimes ulcers can extend completely through the intestinal wall, creating a connection between the different parts of the body that should not be there. This is known as a fistula. Fistulas can develop between the bowel and the skin or between the intestine and another organ. Fistulas near or around the anal area are the most common type. When fistulas develop inside the abdomen, which can lead to infections and collections of pus are called abscesses. This can be fatal if not treated. Fistulas can form between loops of bowel, bladder, or vagina, or through the skin, causing a continuous drainage of the contents of the gut to the skin.
  • The Anal fissure. This is a small tear in the tissue that lines the anus, or in the skin around the anus, where infections can occur. It is often associated with pain and stool can lead to a fistula.
  • Malnutrition. Diarrhea, abdominal pain and cramps, can make it difficult to eat or for the intestine to absorb enough nutrients. It is also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
  • The Colon cancer.Have Crohn's disease that affects the colon increases the risk of colon cancer. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy at least every 10 years starting at 45 years of age. In people with Crohn's disease that affects a large part of the colon, colonoscopy to detect colon cancer is recommended about eight years after the onset of the disease and is usually done every 1 to 2 years later. Ask a health professional if you need to make this test before, and with more frequency.
  • Disorders of the skin. Many people with Crohn's disease may also develop a condition called hidradenitis suppurativa. This disorder of the skin that involves a deep nodules, tunnels, and abscesses in the armpits, groin, under the breasts, and in the genital or perianal regions. Some of Crohn's disease treatments also increase the risk of cancers of the skin, so that a routine skin examination is recommended.
  • Other health problems. Crohn's disease can also cause problems in other parts of the body. Among these problems are low iron, called anemia, osteoporosis, arthritis, kidney stones, eye problems, and of the gallbladder or the liver.
  • The medicine of risks.Certain Crohn's disease drugs that block the functions of the immune system are associated with a lower risk of developing cancer such as lymphoma and skin cancer. It also increases the risk of infections. Corticosteroids may be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure, among other conditions. Work with a health professional to determine the risks and benefits of medicines.
  • The blood clots. Crohn's disease increases the risk of blood clots in veins and arteries.

Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a connection between the different parts of the body that should not be there. This is known as a fistula. Fistulas can develop between the bowel and the skin or between the intestine and another organ. Fistulas near or around the anal area are the most common type.

When fistulas develop inside the abdomen, which can lead to infections and collections of pus are called abscesses. This can be fatal if not treated. Fistulas can form between loops of bowel, bladder, or vagina, or through the skin, causing a continuous drainage of the contents of the gut to the skin.

The Colon cancer. Have Crohn's disease that affects the colon increases the risk of colon cancer. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy at least every 10 years starting at 45 years of age.

In people with Crohn's disease that affects a large part of the colon, colonoscopy to detect colon cancer is recommended about eight years after the onset of the disease and is usually done every 1 to 2 years later. Ask a health professional if you need to make this test before, and with more frequency.

The medicine of risks. Certain Crohn's disease drugs that block the functions of the immune system are associated with a lower risk of developing cancer such as lymphoma and skin cancer. It also increases the risk of infections.

Corticosteroids may be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure, among other conditions. Work with a health professional to determine the risks and benefits of medicines.

Diagnosis

A health professional is likely diagnose Crohn's disease only after ruling out other possible causes of symptoms. There is No single test to diagnose Crohn's disease.

A combination of tests may be used to help confirm a diagnosis of Crohn's disease, including:

Laboratory tests

  • Blood tests.The blood test can determine if there are signs of infection or anemia, a condition in which not enough red blood cells to carry enough oxygen to the tissues. These tests can also be used to check the levels of the inflammation, the function of the liver or the presence of inactive infections, such as tuberculosis. The blood can also be tested to detect the presence of immunity against infections.
  • Stool studies. A stool sample may be used for the testing of blood or of organisms, such as bacteria that cause the infection or, rarely, parasites in the stool, to look for the causes of the diarrhea and the symptoms. Sometimes looking for the feces of the markers of inflammation, such as calprotectin, it can be useful.

Blood tests. The blood test can determine if there are signs of infection or anemia, a condition in which not enough red blood cells to carry enough oxygen to the tissues.

These tests can also be used to check the levels of the inflammation, the function of the liver or the presence of inactive infections, such as tuberculosis. The blood can also be tested to detect the presence of immunity against infections.

Procedures

  • Colonoscopy. A colonoscopy uses a tiny camera on the end of a flexible tube to visually inspect the entire colon and the end of the ileum. During the procedure, small samples of tissue, called a biopsy, may be taken for laboratory analysis. This can help make a diagnosis. Groups of inflammatory cells called granulomas may suggest a diagnosis of Crohn's disease.
  • Computed tomography.A ct scan is a special X-ray technique that provides more detail than a standard X-ray. This test is seen throughout the intestine, as well as in tissues outside the gut. CT enterography is a special type of computed tomography which consists in taking a contrast agent oral and getting intravenous contrast of the images of the intestines. This test provides better images of the small intestine and has been replaced by a barium X-rays in many medical centers.
  • The magnetic resonance imaging.An mri uses a magnetic field and radio waves to create detailed images of organs and tissues. Magnetic resonance imaging was used with a contrast fluid, called the mr enterography, is particularly useful for the evaluation of a fistula around the anal area or the small intestine. Sometimes the mr enterography can be performed to check the status of the disease or the progression. This test can be used in place of CT enterography to reduce the risk of radiation, especially in the very young.
  • The capsule endoscopy.This test involves swallowing a capsule with a camera in it. The camera takes pictures of the small intestine and sent to a tape recorder carried on a belt. The images are then downloaded to a computer, displayed on a monitor and checked for signs of Crohn's disease. The camera exits the body without pain in the stool. Endoscopy with biopsy may be necessary to confirm a diagnosis of Crohn's disease. Those with Crohn's disease of the small intestine may be at a higher risk of the capsule to be stuck in the intestines, especially if there is a history of narrowing or surgery of the small intestine. Capsule endoscopy should not be done if there is a suspected stenosis or obstruction, also called a bowel obstruction.

Computed tomography. A ct scan is a special X-ray technique that provides more detail than a standard X-ray. This test is seen throughout the intestine, as well as in tissues outside the gut.

CT enterography is a special type of computed tomography which consists in taking a contrast agent oral and getting intravenous contrast of the images of the intestines. This test provides better images of the small intestine and has been replaced by a barium X-rays in many medical centers.

The magnetic resonance imaging. An mri uses a magnetic field and radio waves to create detailed images of organs and tissues. Magnetic resonance imaging was used with a contrast fluid, called the mr enterography, is particularly useful for the evaluation of a fistula around the anal area or the small intestine.

Sometimes the mr enterography can be performed to check the status of the disease or the progression. This test can be used in place of CT enterography to reduce the risk of radiation, especially in the very young.

The capsule endoscopy. This test involves swallowing a capsule with a camera in it. The camera takes pictures of the small intestine and sent to a tape recorder carried on a belt. The images are then downloaded to a computer, displayed on a monitor and checked for signs of Crohn's disease. The camera exits the body without pain in the stool.

Endoscopy with biopsy may be necessary to confirm a diagnosis of Crohn's disease. Those with Crohn's disease of the small intestine may be at a higher risk of the capsule to be stuck in the intestines, especially if there is a history of narrowing or surgery of the small intestine. Capsule endoscopy should not be done if there is a suspected stenosis or obstruction, also called a bowel obstruction.

Treatment

There is currently no cure for Crohn's disease, and there is not a single treatment that works for everyone. However, there are several medications that have been approved for the treatment of Crohn's disease. One of the goals of medical treatment to reduce the inflammation that causes the symptoms. Another goal is to improve the long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.

Anti-inflammatory drugs

Anti-inflammatory medications are often the first step in the treatment of inflammatory bowel disease. They include:

  • Corticosteroids.Corticosteroids such as prednisone and budesonide (Entocort EC) can help to reduce inflammation in the body, but they do not work for everyone with Crohn's disease. Sometimes, intravenous steroids are used at the hospital for a short duration. Corticosteroids may be used for short-term (3 to 4 months) improvement of the symptoms and to induce remission. Corticosteroids can also be used in combination with an immune system suppressor to induce the benefit of other medications. They are then finally dissipated.
  • Oral 5-aminosalicylates. These medications are sometimes used for mild to moderate cases of Crohn's disease. They include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Delzicol, Pentasa, other). Oral 5-aminosalicylates work best for Crohn's disease in the colon, but it doesn't work so well if the disease is in the small intestine.

Corticosteroids. Corticosteroids such as prednisone and budesonide (Entocort EC) can help to reduce inflammation in the body, but they do not work for everyone with Crohn's disease. Sometimes, intravenous steroids are used at the hospital for a short duration.

Corticosteroids may be used for short-term (3 to 4 months) improvement of the symptoms and to induce remission. Corticosteroids can also be used in combination with an immune system suppressor to induce the benefit of other medications. They are then finally dissipated.

Immune system suppressors

These drugs also reduce inflammation, but they go to their immune system, which produces substances that cause inflammation. For some people, a combination of these drugs works better than one of the drugs separately.

The suppressors of the immune system include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for the treatment of inflammatory bowel disease. Taking requires that you follow very closely with a health care professional and have your blood checked regularly. This is to look for side effects, such as a decreased resistance to infection and inflammation of the liver. These medications can also cause nausea and vomiting.
  • Methotrexate (Trexall). This medicine is sometimes used for people with Crohn's disease who do not respond well to other medications. You will need to be closely followed by the side effects.

Biological products

This class of therapies objectives of proteins produced by the immune system. Types of biological products for the treatment of Crohn's disease include:

  • Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Also known as TNF inhibitors, these drugs work by the neutralization of an immune system protein known as tumor necrosis factor (TNF).
  • Ustekinumab (Stelara). This is the Crohn's disease by interfering with the action of an interleukin, which is a protein involved in inflammation.
  • Vedolizumab (Entyvio). This is a type of drug known as a monoclonal antibody. It works by preventing certain cells in the immune molecules of the integrin — binding to other cells in the intestinal lining. Vedolizumab the intestine-specific agent and is approved for Crohn's disease.
  • Risankizumab (Skyrizi). Risankizumab is also a monoclonal antibody. This medicine works against a molecule known as interleukin-23. Risankizumab was recently approved for the treatment of moderate-to-severe Crohn's disease.

Synthetic versions of biological products, called biosimilars, are available to treat Crohn's disease. These drugs function as the original versions of biological products, and that may cost less.

Janus kinase (JAK) inhibitors

Inhibitors of JAK, are a type of medicine known as small molecules. These new drugs may help to reduce inflammation by targeting the parts of the immune system that causes inflammation in the intestines. It is taken by mouth. Inhibitors of JAK may be recommended for Crohn's disease that has not responded to other therapies. The Food and Drug Administration has approved the inhibitor of JAK upadacitinib for treating Crohn's disease. Inhibitors of JAK is not recommended for use in pregnancy.

Antibiotics

Antibiotics can reduce the amount of drainage of fistulas and abscesses, and sometimes heal in people with Crohn's disease. Some researchers also believe that antibiotics can help to reduce the harmful bacteria that may be causing the inflammation in the intestine. Commonly prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Other medications

In addition to the control of inflammation, some medications may help to relieve the symptoms. But talk with a healthcare professional before taking any medicines you can buy without a prescription. Depending on the severity of Crohn's disease, a health professional may recommend one or more of the following:

  • Anti-diarrheals.A fiber supplement, such as psyllium husk (Metamucil) or methylcellulose (Citrucel), may help relieve mild to moderate diarrhea by adding bulk to the stool. For more severe diarrhea, loperamide (Imodium a-D) can be effective. These medications may be ineffective or even harmful in some people with stenosis, or certain infections. Please consult a health professional before taking these medicines.
  • Pain relievers. For mild pain, a health professional may recommend acetaminophen (Tylenol, others)— but not to other common pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These medications can make symptoms worse and can make the illness worse.
  • Vitamins and supplements. If you're not absorbing enough nutrients, your health care professional may recommend vitamins and nutritional supplements.

Anti-diarrheals. A fiber supplement, such as psyllium husk (Metamucil) or methylcellulose (Citrucel), may help relieve mild to moderate diarrhea by adding bulk to the stool. For more severe diarrhea, loperamide (Imodium a-D) can be effective.

These medications may be ineffective or even harmful in some people with stenosis, or certain infections. Please consult a health professional before taking these medicines.

Nutrition therapy

A health professional may recommend a special diet given by the mouth or a feeding tube, called the enteral nutrition. The nutrients can also be delivered into a vein, it is called parenteral nutrition. This can improve the overall health and allow the bowel to rest. The rest of the small intestine can reduce inflammation in the short term.

Your health care professional may use the nutrition therapy to short-term and combined with medication, such as suppressors of the immune system. Enteral and parenteral nutrition is usually used to make people healthy before the surgery or when other medications fail to control symptoms.

Your health care professional may also recommend a low residue or low-fiber diet to reduce the risk of intestinal obstruction if you have a narrowing of the bowel, called a stricture. A low-residue diet is designed to reduce the size and number of stools.

Surgery

If diet and lifestyle changes, medications or other treatments do not relieve symptoms, a healthcare provider may recommend surgery. Nearly half of people with Crohn's disease may require at least one surgery. However, the surgery does not cure Crohn's disease.

During the surgery, the surgeon removes a damaged portion of your digestive tract, and then reconnects the healthy sections. The surgery can also be used to close fistulas and drainage of abscesses.

The benefits of surgery for Crohn's disease are usually temporary. The disease often recurs, often close to the reconnected tissue. The best approach is to follow the surgery with a medication to reduce the risk of recurrence.

Lifestyle and home remedies

Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet

There is No firm evidence that what you eat causes of inflammatory bowel disease. But certain foods and drinks can aggravate your symptoms, especially during a crisis.

It can be helpful to keep a food journal to track what you are eating, as well as how you feel. If you find that certain foods are causing your symptoms to flare up, you can try to remove them.

Here are some dietary suggestions that may help control your condition:

  • Limit dairy products. Many people with inflammatory bowel disease, problems such as diarrhea, abdominal pain and gas to improve by the limitation or elimination of dairy products. You may be lactose intolerant, that is to say, your body can't digest the milk sugar, called lactose in dairy products. The use of an enzyme product, such as Lactaid can help.
  • Eat small meals. You can feel better eating five or six small meals a day instead of two or three larger ones.
  • Drink plenty of fluids. Try to drink plenty of water daily. The water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
  • Consider the possibility of multi-vitamins. Because Crohn's disease can affect your ability to absorb nutrients and due to that your diet may be limited, and multivitamin and mineral supplements are often helpful. Consult with a healthcare professional before taking any type of vitamins or supplements.
  • Talk with a dietitian. If you begin to lose weight or your diet has become very limited, talk with a registered dietitian.

Smoking

Smoking increases your risk of developing Crohn's disease. And once you have Crohn's disease, smoking can make it worse. People with Crohn's disease who smoke are more likely to have relapses and the need for medication and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.

Stress

Although stress does not cause Crohn's disease, can make your symptoms worse and may trigger outbreaks. Although it is not always possible to avoid stress, you can learn ways to help manage, such as:

  • Exercise. Even moderate exercise can help to reduce stress, relieve depression and regulate bowel function. Talk with a health care provider about an exercise plan that is right for you.
  • Biofeedback. This stress-reduction technique may help to reduce muscle tension and decrease the heart rate with the help of a biofeedback machine. The goal is to help you enter a relaxed state so that you can deal more easily with stress.
  • Relaxation and breathing exercises. A way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. Many useful books and online videos are available to help with relaxation and meditation.

Alternative medicine

Many people with Crohn's disease have used some form of complementary and alternative medicine for the treatment of your condition. However, there are few well-designed studies of the safety and efficacy of these treatments.

Coping and support

Crohn's disease not only affects you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life can turn around a constant need to run to the bathroom. Even if your symptoms are mild, gas and abdominal pain can make it difficult to be in a public place. All of these factors can alter your life, and can lead to depression. Here are some things you can do:

  • Be informed. One of the best ways of being more in control is to find out as much as possible about Crohn's disease. To search for information in the Crohn's & Colitis Foundation.
  • Join a support group. Although support groups aren't for everyone, they can provide valuable information about your condition, as well as emotional support. Group members often know about the latest medical treatments, or integrative therapies. You can also find it reassuring to be among others with Crohn's disease.
  • Talk with a therapist. Some people find it helpful to consult a mental health professional who is familiar with the inflammatory bowel disease and the emotional difficulties it can cause.

Despite living with Crohn's disease can be daunting, the research is in progress and the prognosis is improving.

Preparing for your appointment

The symptoms of Crohn's disease may first be asked to visit your primary healthcare professional. Your health care professional may recommend that you see a specialist who treats diseases of the digestive system, called a gastroenterologist.

Because appointments can be brief, and there is often a lot of information to discuss, it is a good idea to be well prepared. Here's some information to help you prepare, and what to expect from your visit.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking.
  • Ask a family member or friend to come with you to your appointment. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

Prepare a list of questions before you go can help you get the most out of your visit. A list of questions from most important to least important in case time runs out. For Crohn's disease, some basic questions to ask include:

  • What is the cause of these symptoms?
  • There are other possible causes of the symptoms?
  • What kinds of tests do I need? Do these tests require any special preparation?
  • Is this condition temporary or long-term?
  • What treatments are available, and which do you recommend?
  • There are medications should I avoid?
  • What types of side effects can I expect from treatment?
  • Are there alternatives to the approach that you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • You should follow the dietary restrictions?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • If I have Crohn's disease, what is the risk that my child is going to develop?
  • What type of follow-up tests I need to in the future?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment.

What to expect from your doctor

It is likely that he will ask a series of questions, including:

  • When did you first begin experiencing symptoms?
  • The symptoms been continuous or intermittent?
  • How severe are the symptoms?
  • Do your symptoms affect your ability to work or do other activities?
  • Nothing seems to improve the symptoms?
  • Is there anything that you've noticed that it makes your symptoms worse?
  • Do you smoke?
  • Do you take any over the counter or prescription nonsteroidal anti-inflammatory drugs (Nsaids) — for example, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or diclofenac sodium?
Symptoms and treatment of Crohn's disease