Crohn’s Disease

Crohn’s disease is a lifelong inflammatory bowel disease that can affect any part of the gut, from mouth to anus, most often the end of the small bowel. It comes in flares and quiet spells. Modern treatments keep most people well, and stopping smoking is one of the most powerful things you can do.

Symptoms

• Tummy pain (often lower right), diarrhoea, sometimes with blood or mucus
• Weight loss, tiredness, fevers, low iron or B12
• Around the anus: fissures, abscesses or fistulas (abnormal tunnels)
• Mouth ulcers, joint pain, red eyes or skin rashes
• Usually starts between 15 and 40, but any age

See your GP soon for any of these: weight loss you can’t explain, vomiting that won’t settle, trouble swallowing, black or bloody stools, low iron or anaemia, a family history of bowel or stomach cancer, or new symptoms after 60.

How it’s diagnosed

• Bloods (inflammation, iron, B12) and a faecal calprotectin stool test for gut inflammation
• Colonoscopy with biopsies, plus MRI or ultrasound of the small bowel
• Stool tests to exclude infection

Crohn’s vs ulcerative colitis

• Crohn’s: anywhere in the gut, patchy, through the full bowel wall; strictures and fistulas can form
• UC: only the large bowel, continuous from the rectum, the inner lining only
• Smoking makes Crohn’s worse; it oddly seems to protect against UC, but is never worth it

Treatment

Usually led by a gastroenterologist, with your GP. The aim is healing the bowel, not just easing symptoms.

1. Step 1 · LifestyleStop smokingThe single most important change for Crohn’s.

   Works

   Quitting lowers flares and the need for surgery; ex-smokers do about as well as people who never smoked

   Cost

   Free help: Quitline 13 7848

   How long

   Ongoing

   Watch for

   Smoking and Crohn’s: worst double act in gastroenterology.

2. Step 2 · FlaresSteroids (budesonide or prednisolone), or exclusive liquid nutrition in childrenTo settle a flare, not for long-term use.

   Works

   Induce remission in most

   Cost

   Low cost

   How long

   Weeks

   Watch for

   Steroid side effects: mood, sleep, sugar, bones.

3. Step 3 · MaintenanceImmunomodulators: azathioprine, mercaptopurine or methotrexateKeep the disease quiet.

   Works

   Maintain remission in many

   Cost

   $25 PBS script

   How long

   Long term

   Watch for

   Blood test monitoring; TPMT test before azathioprine.

4. Step 4 · SpecialistBiologics and newer tablets: infliximab, adalimumab, vedolizumab, ustekinumab, risankizumab, upadacitinibFor moderate to severe disease.

   Works

   Many people reach remission and avoid surgery

   Cost

   PBS-subsidised for eligible people

   How long

   Long term

   Watch for

   Infection risk; screening for TB and hepatitis first.

5. Step 5 · SurgeryRemoving a narrowed or damaged section, or treating fistulasFor strictures, abscesses, fistulas or disease that won’t respond.

   Works

   Often gives years of relief; treatment continues afterwards

   Cost

   Medicare or public hospital

   How long

   One-off

   Watch for

   Disease can return at the join.

Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.

Living with Crohn’s

• Vaccines before starting immune-lowering medicines; avoid live vaccines on some treatments
• Bone health, iron, B12 and vitamin D checks
• Bowel cancer surveillance colonoscopies if the large bowel is involved
• Mental health support: anxiety and low mood are common, and treatable

Helpful resources

• Crohn’s & Colitis AustraliaInformation, support and helpline. Free.
• Quitline 13 7848Free help to quit smoking.

Evidence and more information

• Crohn’s & Colitis Australia: About IBD
• Torres J et al. ECCO guidelines on therapeutics in Crohn’s disease (2020)

Updated 14 November 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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