If you’ve been living with pain and diarrhea from Crohn’s disease, you may wonder what it would take to be free of symptoms. This can happen -- it’s called remission, and it’s the goal of all the treatments you take.
What Is Crohn’s Remission?
Remission is a stage of Crohn’s when your disease is no longer active. That means inflammation stops causing painful damage to your bowel and colon because your immune system is working like it should.
If your disease is in remission, you’ll likely notice these signs:
- No more symptoms like pain, diarrhea, or fatigue.
- Blood tests will show normal inflammation levels.
- Your Crohn’s disease activity index (CDAI) score may be below 150 -- more on this below.
- Lesions in your bowel or colon start to heal.
- You feel normal and have a good quality of life.
Is Remission the Same as a Cure?
No. Most people with Crohn’s go through cycles of remission and relapses. When the disease is active, you’ll have symptoms of inflammation. When it goes into remission, you won’t. The pattern varies. Flares could last for weeks or months, and you might have mild diarrhea or cramps. About 10%-20% of people have long-term remission after the first flare. Treatment makes it more likely that you’ll go into remission and stay there.
Are There Different Types of Remission?
Yes. You can be in:
- Clinical remission: You have no symptoms. It can result from medications, but sometimes it happens on its own. If you’re taking corticosteroids to keep the disease at bay, you aren’t considered to be in remission.
- Deep healing, endoscopic remission, mucosal healing: These are all different ways to say that the doctor finds no signs of disease when they check your colon with an endoscope, a tiny camera on the end of a long, flexible tube that helps the doctor see inside your digestive tract.
- Histologic remission: Cells from your colon look normal under a microscope. This category is not yet well defined since there are 18 different scoring systems for Crohn’s.
- Surgical remission: A lack of disease activity after a surgery, particularly an ileocolonic resection. This is the most common surgery for Crohn’s disease. It involves removal of the terminal ileum, where the small intestine meets the large intestine.
- Biochemical remission: Your blood and poop don't contain certain substances that are signs of inflammation.
How Do You Get to Remission?
Treatment is usually the way to get your Crohn’s into remission. The condition usually doesn’t get better on its own or go into remission without treatment. In fact, it will probably get worse and lead to serious complications. To get you to remission, your doctor will try:
Medications. Your treatment plan will depend on how the disease affects your body. Most people need one or more drugs to ease their inflammation, reduce symptoms like pain or diarrhea, and help damaged intestines heal. These include:
- Steroids like prednisone (Deltasone)
- Aminosalicylates like mesalamine (Asacol HD, Delzicol) and sulfasalazine (Azulfidine) that curb inflammation in your gut
- Drugs to slow down your immune system, like azathioprine (Azasan and Imuran), cyclosporine (Gengraf, Neoral, Restasis, and Sandimmune), mercaptopurine (Purinethol and Purixan), or methotrexate (Rasuvo and Trexall)
- TNF inhibitors like adalimumab (Humira), certolizumab pegol (Cimzia), or infliximab (Remicade) and the many biosimilars now available
- Newer biologics like natalizumab (Tysabri), risankizumab-rzaa (Skyrizi), ustekinumab (Stelara), or vedolizumab( Entyvio)
- Antibiotics like ciprofloxacin (Cipro, Cetraxal, Ciloxan, and Proquin) or metronidazole (Flagyl)
You may start with mild drugs, then step up to stronger ones if you need them to get to remission. Or if your disease is severe, you could try strong drugs first, then move down to milder ones.
Surgery. In addition to meds, up to half the people with Crohn’s also need surgery. Your doctor will take out parts of your intestines where there’s damage and reconnect the healthy areas.
You may need to get foods in liquid form through a feeding tube or injected into your vein to help your bowels rest and heal. Your doctor will probably suggest a low-fiber diet to help you pass smaller stools and avoid a bowel blockage.
After about a month, you should start to see signs that your treatments are working. But it could take up to 4 months to really get results.
How Do You Know You’re in Remission?
The Crohn's disease activity index (CDAI) is one way to check. It measures 18 symptoms, including pain and diarrhea, and gives you a score. But this test isn't always accurate. Even though symptoms go away and you feel fine, you might still have inflammation that can cause a flare.
Newer tests may work better to show if you’re in remission:
- Scopes and scans: A colonoscopy, endoscopy, CT scan, or MRI will show the inside of your digestive tract so your doctor can see if damage has healed.
- Blood tests: Your doctor uses them to check for signs of active disease and inflammation.
How Long Will Remission Last?
There is no standard. Crohn’s affects different parts of the gastrointestinal tract and is usually active when you get diagnosed. In general, if you’re in remission, your odds of relapse at the following milestones are:
- 1 year -- 20%
- 2 years -- 40%
- 5 years -- 67%
- 10 years -- 76%
How to Stay in Remission
Once you get there, you want to keep it going. Here’s how:
Follow your treatment plan. Don’t stop taking your Crohn’s drugs unless your doctor says to stop. That can cause your disease to flare up again.
You may be able to stop using one of your drugs or slowly taper your dose of others. This is called maintenance therapy.
Your treatment plan depends on what type of damage you have in your intestines, where it’s located, and what symptoms you have. You’ll probably keep taking a mix of meds to slow down your immune system or block inflammation.
Steroids can cause severe side effects, like bone loss, if you use them too long. Your doctor will probably slowly cut down and stop them as you start other treatments.
Avoid trigger foods and drinks. Your doctor might call this an elimination diet. It can help you figure out how certain foods affect you. Some common ones to consider include:
- Corn oil
- Fast food
- Processed foods
- Processed meats
- Red meat (beef, pork, lamb)
- Soft drinks
- Sugary drinks
- Safflower oil
No single food affects everyone the same.
Eat healthy foods. Add these to your diet:
- Dairy products
- Healthy fats (olive oil, non-hydrogenated nut/seed butters)
- Insoluble fiber (brown rice, whole wheat bread and pasta)
- Nuts and seeds
- Soluble fiber (oats, psyllium, pulses)
- Whole foods
What Else Can You Do?
Take these steps to help lower your risk of a Crohn’s flare-up:
- Don’t smoke, or get help to quit.
- Don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin for minor aches and pains. They can cause bleeding or ulcers in your gut.
- Don’t take an antibiotic for an infection unless your gastroenterologist says it’s OK.
- Keep up with doctor’s appointments to make sure you have no signs of Crohn’s coming back. Stay up to date with vaccinations or health screenings that your doctor suggests. If your insurance changes and you can’t afford your maintenance drugs, let your doctor know right away.
How to Deal With Crohn’s Relapses
Doctors don’t always know why a relapse happens. But they do know it’s more common among women than men, and among people who are diagnosed with Crohn’s before age 25.
It can be tough to deal with diarrhea, belly pain, and fatigue again -- especially if you haven’t had symptoms for a while.
- Work with your doctor. Let them know what’s going on. It may be time to adjust your treatment plan.
- Give yourself time to recover. Take breaks and rest when you feel extra tired. You may want to see if you can make changes at work, school, or home to get some breathing room. You may need to talk with your supervisor, teacher, or family members about what changes would help as you get back to feeling better.
- Tend to your emotions. If you feel overwhelmed, anxious, or down, see a psychologist or therapist. There’s help, including learning new ways to handle the stress Crohn’s can cause.
- Plan for outings. You might worry that you’ll have a problem when you’re out and about. Or you might hesitate to go out to eat with friends and family if you’re not sure the food will be friendly to your diet. You can scope out bathrooms and menus in advance to feel more confident, so you can still join in.
- Lean in. Turn to friends, family members, and other people around you for help. Join a support group for people with Crohn's disease. You'll meet people who know what you’re dealing with and who can offer advice.
- Keep a diary of your symptoms. Note what makes them worse. Try to avoid anything that seems to set them off. Or if those things aren’t avoidable, look for new ways to manage them.
- Tame stress. Out-of-control stress is a well-known trigger for flare-ups. Cut down on it as much as possible, and then learn to handle the stress you can’t get rid of. Practice yoga, tai chi, or meditation. Breathe deeply. Go for a walk. It may help cut down on flares.