Disclaimer:This article is reviewed by Dr. Titus and is intended for general informational purposes only. It does not constitute medical advice. If you have ongoing changes to your bowel habits, please see your GP or a qualified health professional.
Key Takeaways
Crohn’s Disease
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Crohn’s is an autoimmune disease of the gut. The immune system attacks the digestive tract, which is why treatment works by suppressing the immune system.
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Infection is ruled out first. A stool test comes before any IBD treatment, because you don’t want to suppress the immune system of someone fighting an infection.
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Treatment follows a ladder. Steroids calm flares short term, conventional immunosuppressants are the long-term base, biologics come in if those fail, and surgery is the last resort.
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There’s no cure yet, but long-term remission is very achievable. Some patients do well on simple medication, while others need to try several biologics before one works.
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Stem cells, FMT and hyperbaric oxygen aren’t proven Crohn’s treatments. The evidence is limited, and many sites promoting HBOT for IBD are selling it.
Search for Crohn’s disease treatments online and you’ll quickly find stem cells, hyperbaric oxygen and faecal transplants described as breakthroughs. Some sites make it sound as though a cure is one clinic visit away.
The reality is less dramatic, and more reassuring. We spoke with Dr. Titus, a hospital-based doctor about what Crohn’s treatment actually looks like, step by step, and which of the claims online hold up.
What Is Crohn’s Disease?
Crohn’s disease belongs to a group of conditions called inflammatory bowel disease (IBD). The other main form is ulcerative colitis. “Essentially it’s an autoimmune disease of the gastrointestinal tract,” Dr. Titus explains. In other words, the immune system attacks the lining of the gut.
That one fact explains almost everything about how Crohn’s is treated. Because the problem is an overactive immune system, the medications used to control it work by suppressing the immune system.
How Doctors Tell Crohn’s Apart From IBS or a Stomach Bug
Diarrhoea has many causes, so the first job is working out which one it is. Irritable bowel syndrome (IBS) usually shows up as bloating and abdominal discomfort rather than blood in the stool, and symptoms tend to settle with diet changes such as a low-FODMAP diet.
An infection is harder to separate from IBD on symptoms alone. Doctors look for clues such as recent travel, or others who ate the same meal falling sick. Infections also usually clear up with supportive care, sometimes with antibiotics. IBD does not.
“At their first presentation, they would usually have had about a month of bloody mucusy diarrhoea and some weight loss,” Dr. Titus says. Less commonly, IBD can also show up outside the gut as skin rashes or arthritis.
That is why a stool test usually comes first. “IBD treatment involves immunosuppression,” he explains. “As you can imagine, you do not want to suppress someone’s immune system if they are having an infection.”
When You Shouldn’t Wait to See a Doctor
How quickly people seek help varies. Someone with a family history of IBD often recognises the signs and comes in early. Someone who has never heard of the condition may assume they have a long, nasty stomach bug and wait much longer.
Dr. Titus gives a practical threshold: “If you are going to the toilet a lot more frequently than you normally do, roughly more than three to five times a day depending on your usual frequency, you should seek medical attention.”
The same applies if you notice weight loss, poor appetite, fevers, chills or trouble sleeping. Even when it turns out not to be IBD, “severe diarrhoea can also lead to electrolyte imbalances that can be dangerous if untreated.”
Frequent diarrhoea drains fluid and electrolytes quickly. Our guide on how to stay hydrated without drinking water covers how soups, foods and other drinks help replace both.
Is Crohn’s Becoming More Common in Singapore?
Dr. Titus points to a 2022 review by Low and colleagues, published in Intestinal Research, showing a clear rise in IBD in Singapore.
New IBD diagnoses at Singapore General Hospital doubled between 2007 and 2017, and the number of IBD patients treated at National University Hospital increased eightfold between 2013 and 2018.
Known risk factors include a family history of IBD and age, with most people diagnosed in their 20s and 30s and a smaller group in their 50s and 60s. Smoking raises the risk of Crohn’s specifically.
Curiously, it has been linked to a lower risk of ulcerative colitis, but Dr. Titus is clear that this is no reason to smoke, given “the increased risk of developing many other more severe medical conditions.”
Getting Diagnosed: From GP to Colonoscopy
If your GP suspects IBD, the first steps are usually blood tests (a basic blood panel, a full blood count and an inflammation marker called CRP) and a stool sample to check for infection. Some gastroenterologists also request a faecal calprotectin test, which picks up inflammation in the bowel.
These tests point in the right direction, but they don’t confirm the diagnosis. “Ultimately the diagnosis of IBD can only be confirmed with a colonoscopy, which is performed by a gastroenterologist,” Dr. Titus says. Suspected IBD therefore means a referral to a specialist.
Before a colonoscopy you’ll be asked to do bowel preparation. The details vary between clinicians, but generally you drink only clear fluids the day before and take a laxative several times. This clears out the bowel so the gastroenterologist can see the bowel wall properly and take biopsies if needed.
If you’ve had these blood tests and want to understand what markers like CRP actually mean, our guide to understanding abnormal blood test results explains them in plain language.
The Treatment Ladder: How Crohn’s Is Actually Treated
Crohn’s treatment follows a stepped approach, starting with the simplest effective option and moving up only when needed.
Step 1: Steroids
Steroids calm a flare quickly, but they are not a long-term solution because of the harmful side effects of prolonged use. Instead, Dr. Titus explains, they act “as a bridge whilst waiting for the immunosuppressant to kick into effect.”
Step 2: Conventional immunosuppressants
These form the long-term foundation of treatment. Your specialist will usually start one at the same time as the steroids, so that by the time the steroids are tapered off, the immunosuppressant is doing the work.
Step 3: Biologics
“Biologic medication is a special type of immunosuppression that targets specific components of your immune system,” Dr. Titus says.
They are usually reserved for Crohn’s that doesn’t respond to conventional immunosuppressants, and can also be used as rescue therapy for a severe flare that isn’t improving with steroids.
Biologics can be costly, so it’s worth understanding how healthcare costs in Singapore work, including subsidies and MediSave, before starting treatment.
Step 4: Surgery
Surgery is reserved for when all other treatments have failed. It involves removing the affected section of bowel and often means the patient needs a stoma. Depending on the type of surgery, the stoma may be reversed later once things have settled.
Can Crohn’s Be Cured?
Not yet. “Crohn’s, as with most autoimmune diseases, does not have a definitive cure at present. Remission is the goal,” Dr. Titus says.
The encouraging part is that long-term remission is very achievable. “Personal anecdotal evidence is that long-term remission is very possible for many patients with Crohn’s,” he says.
What differs is the route there: “Some patients do well on simple immunosuppressants, whilst others require trying, and failing, many different biologic agents before finding the one that helps them in the end.”
It’s a different story for ulcerative colitis, which affects only the large intestine. Because of that, it can technically be cured by surgically removing the entire colon, though Dr. Titus notes this is “usually only reserved for difficult to control disease that has failed every other option.”
Stem Cells, FMT and Hyperbaric Oxygen: Evidence or Hype?
These are the treatments most people come across online, so it’s worth looking at each one honestly.
Faecal microbiota transplant (FMT) does appear in current European IBD guidelines, but Dr. Titus explains the context: it was for treating recurrent C. difficile infections in people who have IBD, “rather than managing the IBD itself.”
Research into FMT for gut conditions is active, but “at present the evidence is still too limited for clinicians to be recommending them in the everyday setting.”
For stem cell therapy, the evidence is even thinner. Crohn’s and Colitis Australia specifically warns against signing up for stem cell trials overseas in the hope of a cure, because many don’t meet usual health and safety standards.
Hyperbaric oxygen therapy (HBOT) has very limited evidence and doesn’t appear in standard treatment guidelines.
Dr. Titus adds an observation worth keeping in mind: “If you search for the use of HBOT in the management of IBD, most of the websites suggesting that it works have a conflict of interest because they are actively selling HBOT as a viable solution.”
None of this means research should stop. It means that, for now, the proven treatments are the ones on the ladder above.
What to Do During a Flare
Your first step should be the plan your gastroenterologist has given you. “The gastro department at my hospital provides IBD patients with an emergency contact number,” Dr. Titus says.
Depending on how severe the symptoms are, patients may be directed to an urgent IBD clinic or told to go straight to the emergency department.
The number of bowel motions a day is a useful guide to how serious a flare is. Symptoms outside the gut, such as joint pain, eye inflammation (uveitis), rashes or fever, suggest more severe disease that needs urgent attention.
Living With Crohn’s: Pregnancy, Work and the GP’s Role
For women with Crohn’s who are planning a pregnancy, the priority is keeping the disease well controlled to reduce the risk of complications, while making sure the medications used are safe for the baby.
Dr. Titus notes that azathioprine, sulfasalazine and prednisolone are considered safe in pregnancy. Among biologics, certolizumab has the strongest safety data, although there are many reports of infliximab and adalimumab being used in pregnancy without issue.
The effect on work, as with most aspects of daily life, depends on how well controlled the disease is.
Once a specialist is managing Crohn’s, the GP still plays an important role. “The GP’s role in general is to coordinate the patient’s care between multiple specialties,” Dr. Titus says. Many patients now have more than one chronic condition and see several specialists, so the GP connects those pieces while keeping on top of everyday care such as vaccinations.
If you’re a new mother with diarrhoea that won’t settle after birth, our guide to postpartum diarrhoea explains what’s normal and when to see a doctor.
The Bottom Line
Crohn’s disease can’t be cured yet, but it is very treatable. Treatment follows a clear ladder, from steroids to conventional immunosuppressants, then biologics, with surgery as a last resort. Long-term remission is a realistic goal for many patients, even if finding the right medication takes time.
The treatments promoted online as breakthroughs mostly don’t have the evidence behind them yet. If your bowel habits have changed and aren’t settling, especially with weight loss or blood in the stool, the most useful step is to see a doctor early.
Crohn’s Disease
Frequently Asked Questions
What are the main treatments for Crohn’s disease?
Treatment follows a stepped approach. Steroids are used short term to calm a flare, while a conventional immunosuppressant is started as the long-term treatment.
If that doesn’t work, biologics (which target specific parts of the immune system) are the next step. Surgery to remove the affected bowel is reserved for when all other treatments have failed.
Can Crohn’s disease be cured?
Not yet. Like most autoimmune diseases, Crohn’s has no definitive cure, so the goal of treatment is remission.
Long-term remission is very possible for many patients, although some need to try several medications before finding one that works.
How is Crohn’s different from IBS?
IBS usually causes bloating and abdominal discomfort without blood in the stool, and often improves with diet changes such as a low-FODMAP diet.
Crohn’s is an inflammatory disease that typically causes persistent diarrhoea and weight loss, and doesn’t improve without treatment that suppresses the immune system.
When should I see a doctor about diarrhoea?
See a doctor if you’re going to the toilet much more often than usual (roughly more than three to five times a day above your normal), or if you have weight loss, poor appetite, fevers, chills or trouble sleeping.
Severe diarrhoea can also cause dangerous electrolyte imbalances, even if it turns out not to be Crohn’s.
How is Crohn’s disease diagnosed?
A GP usually starts with blood tests and a stool sample to rule out infection, and sometimes a faecal calprotectin test for bowel inflammation.
The diagnosis can only be confirmed by a colonoscopy, which is done by a gastroenterologist after a referral.
Is Crohn’s disease becoming more common in Singapore?
Yes. A 2022 study found that new IBD diagnoses at Singapore General Hospital doubled between 2007 and 2017, and the number of IBD patients treated at National University Hospital rose eightfold between 2013 and 2018.
Do stem cell therapy, FMT or hyperbaric oxygen work for Crohn’s?
The evidence for all three is limited, and none are part of standard Crohn’s treatment.
FMT appears in European guidelines only for treating recurrent C. difficile infection in IBD patients, not for IBD itself. Crohn’s and Colitis Australia warns against overseas stem cell trials that don’t meet safety standards.
What should I do during a Crohn’s flare?
Follow the plan your gastroenterologist has given you. Many hospitals give IBD patients an emergency contact number.
A sharp rise in daily bowel motions, or symptoms such as joint pain, eye inflammation, rashes or fever, suggests a severe flare that needs urgent attention.
Is Crohn’s medication safe during pregnancy?
Azathioprine, sulfasalazine and prednisolone are considered safe in pregnancy. Among biologics, certolizumab has the strongest safety data, and there are many reports of infliximab and adalimumab being used without issue.
The priority is keeping Crohn’s well controlled throughout, so speak with your specialist before and during pregnancy.
References
Lau, 2022. Inflammatory bowel disease in Singapore. https://pmc.ncbi.nlm.nih.gov/articles/PMC9344246/
Crohn’s & Colitis Australia, 2023. Stem cell therapy and IBD. https://crohnsandcolitis.org.au/2023/07/06/stem-cell-therapy-and-ibd/
Medically Reviewed
About the Expert
Reviewer
Dr Titus Leong
BClinSc/MD — Physician, Flinders University Graduate
Dr Titus Leong is a doctor currently working in Australia with multiple years of clinical experience across both rural and metropolitan settings. A graduate of Flinders University, he works at a tertiary hospital servicing roughly 50,000 inpatients annually and is part of their Basic Physician Training programme.
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About the Writer
Writer
Timothy Leong
Writer, Content Editor & Marketing Specialist — MMC
Timothy Leong is the writer, content editor, and marketing specialist at MMC. With experience in writing and creating websites for local businesses, he makes sure that everything online runs smoothly.
Crohn’s Disease Treatments Doctor Interview – Dr Titus
1) What symptoms make you suspect Crohn’s rather than IBS or a stomach bug?
So Crohn’s falls under a group of conditions called Inflammatory Bowel Disease (IBD). Essentially it’s an autoimmune disease of the Gastrointestinal (GI) tract that most commonly manifests itself as bloody, mucusy diarrhoea. Affected patients can have multiple loose stools depending on the severity of disease.
IBS typically doesn’t present as bloody diarrhoea, and symptoms are usually more bloating and abdominal discomfort. Symptoms resolve with diet modification (see FODMAP diet for further details).
Infective causes can be harder to differentiate from IBD based on bowel motions alone. Typically, infection would be suspected if you have had recent travel history (to third world countries usually) or have had a meal with other people who have also fallen sick or eaten at a place with a known outbreak. Infection also usually resolves with supportive treatment (and sometimes with antibiotics), whereas IBD does not usually improve without any immunosuppression. At their first presentation, they would usually have had about a month of bloody mucusy diarrhoea and some weight loss as a result of their symptoms.
IBD can also (rarely) present with other symptoms such as skin rashes or arthritis, typically but not limited to the spine.
Realistically, if someone presents with diarrhoea, we would rule out and infection with a stool culture first before examining for IBD, because IBD treatment involves immunosuppression. As you can imagine, you do not want to suppress someone’s immune system if they are having an infection.
2) How long do patients usually wait before seeing a doctor, and what red flags mean they shouldn’t wait?
Usually varies from patient to patient. For example, a patient with a strong family history of IBD would know the symptoms better and understand that they have an increased risk, hence they are more likely to present earlier. Contrast this with someone who may not have even heard of IBD and might just think they have a really bad and long lasting infection; they would probably take a lot longer to present.
I think that if you are going to the toilet a lot more frequently than you normally do (rough threshold >3-5x in a day, depending on your usual frequency), you should seek medical attention. Even if it is not IBD, severe diarrhoea can also lead to electrolyte imbalances that can be dangerous if untreated. If you are having weight loss or other constitutional symptoms (poor appetite, fevers/chills, difficulty sleeping etc), you should also seek further medical attention.
3) Are you seeing more Crohn’s in Singapore than you used to? Who tends to get it?
I don’t think I have worked long enough to give a personal feel for an increase in cases.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9344246
This study by Lau (2022) suggests that there has been an increase in IBD prevalence in Singapore, with 2x more new cases diagnosed in SGH from 2007-2017, and NUH having an 8x increase in the number of IBD patients they were treating from 2013-2018.
Risk factors for developing IBD include family history (suggesting a genetic component), ethnicity (caucasians, ashkenazi jews), and age (typically 20s-30s, with the other age group at risk being 50s-60s although less common). Smoking increases the risk of developing Crohn’s specifically, but has been shown to be protective against Ulcerative Colitis (the other IBD condition). I would still advise against smoking due to the increased risk of developing many other more severe medical conditions however.
4. What tests can a GP do first, and when do you refer to a gastroenterologist?
Usually a GP (or hospital ED) would do a basic blood panel called a MBA20, a Full Blood Count, and a CRP. A stool sample would normally be collected to investigate for any infective causes for symptoms, and some gastroenterologists recommend sending off a faecal calprotectin level as well.
Ultimately the diagnosis of IBD can only be confirmed with a colonoscopy, which is performed by a gastroenterologist. If your GP suspects you have IBD, they will refer you to a gastroenterologist.
5. What should patients expect from a colonoscopy, and roughly what does the referral pathway look like here (polyclinic vs private, subsidies)?
But in general before a colonoscopy you would be asked to do ‘bowel prep’. The details differ between clinicians, but the general idea is that you would drink only clear fluids the day before your colonoscopy, and be given a laxative to take a few times the day before your procedure. This is to clean out the bowel before the colonoscopy, so that the gastroenterologist is able to visualize the wall of the bowel and take biopsies as required.
6. In plain terms, what are the main treatment steps today: steroids, immunosuppressants, biologics, surgery?
As mentioned earlier, IBD is an autoimmune disease so the medications to manage it are immunosuppressants. Steroids are used in an acute setting, but are usually not used long term because of the many harmful side effects from long term steroid use. Your specialist would typically look at commencing you on a conventional immunosuppressant with the steroid acts as a bridge whilst waiting for the immunosuppressant to kick into effect.
Biologic medication is a special type of immunosuppression that targets specific components of your immune system. They are usually reserved for IBD that is refractory to conventional immunosuppressants, and in acute cases can also be used as a rescue therapy for acute severe IBD that is not improving with steroids.
Surgery is an invasive treatment that is reserved for when all other treatments do not work. It involves removal of the affected bowel, and as a result usually results in patients requiring a stoma. Depending on the type of surgery done, surgeons may look at reversing the stoma later on when things are more settled.
7. What do patients most misunderstand about biologics (cost, injections, infection risk)?
I’m not sure about common misconceptions of biologic therapy, most patients seem to understand them quite well due to the vast amount of information provided to them when discussing their commencement.
8. What’s your view on FMT, stem cells, HBOT and other treatments patients read about online? What’s evidence-based and what’s hype?
8. The 2026 European Crohn’s and Colitis Organization (ECCO) IBD guidelines mentions FMT, however the context for this study is that it was used to manage recurrent C Diff infections in patients with IBD, rather than managing the IBD itself. There is a lot of research looking at the use of FMT in gastrointestinal conditions as a whole, but at present the evidence is still too limited for clinicians to be recommending them in the everyday setting.
With stem cell therapy, the evidence for its use in IBD is even more limited. Crohn’s and Colitis Australia warns against signing up for stem cell therapy trials overseas for hope of a cure because they do not meet usual health and safety standards.
https://crohnsandcolitis.org.au/2023/07/06/stem-cell-therapy-and-ibd/
The evidence for HBOT in the management of IBD is extremely limited, and is not mentioned in standard treatment guidelines. Interestingly, if you search for the use of HBOT in the management of IBD, most of the websites suggesting that it works have a conflict of interest because they are actively selling HBOT as a viable solution to managing IBD. 🤔
9. Can Crohn’s be cured, or is remission the goal? How realistic is long-term remission?
Crohn’s, as with most autoimmune diseases, does not have a definitive cure at present. Remission is the goal. Personal anecdotal evidence is that long-term remission is very possible for many patients with Crohn’s, although the differing factor between patients is what is required to achieve long-term remission. Some patients do well on simple immunosuppressants, whilst others require trying (and failing) many different biologic agents before finding the one that helps them in the end.
Note that I mentioned Crohn’s only and not IBD in general. Ulcerative Colitis (UC), the other IBD disease, affects only the colon. This means that it can actually be cured definitively with surgical removal of the entire large intestine. But that’s usually only reserved for difficult to control disease that has failed every other option.
10. What do you tell patients about diet? Are there local foods that commonly trigger symptoms?
I don’t typically have diet recommendations for patients when they are in remission, typically most of it happens in hospital when they have an acute flare.
11. What should someone do during a flare, and when is it an emergency?
What a patient should do if they have a flare greatly depends on the escalation pathway provided by their gastroenterologist. The gastro department at my hospital provides IBD patients with an emergency contact number that patients can contact if they are having a flare. Depending on the severity of symptoms, patients might be directed to either an emergency IBD clinic for further assessment or be asked to present to ED immediately for hospital admission.
Typically with an IBD flare, the number of daily bowel motions gives a hint as to how severe the condition is. Other extra-intestinal symptoms like athritis, uveitis, rashes or fevers are also more suggestive of severe disease that requires urgent attention.
12. What’s the GP’s role once a specialist is managing it (vaccines, monitoring, medication side effects, mental health)?
The GP’s role in general is to coordinate the patient’s care between multiple specialties. It is becoming increasingly common nowadays where a patient would have more than just one chronic condition, and as a result need to see multiple different specialists for their respective comorbidities. The GP’s role then is to be able to liaise with the different specialists regarding patient care whilst also looking after and advocating for the usual bread and butter stuff that would apply to all patients regardless of whether you have IBD or not, like keeping on top of vaccinations.
13. Does Crohn’s affect life expectancy, pregnancy or work?
With pregnancy, the most important priority of the physician is to ensure good control of Crohn’s during pregnancy to reduce the risk of complications, and to also ensure that the immunosuppressants being used to manage the Crohn’s do not affect the viability of the fetus. The usual agents such as azathioprine, sulfasalazine and prednisolone are considered safe for use in pregnancy. With regards to biologic agents, the only agent with proven safety data in pregnancy is certolizumab, although there have been many case reports of the other agents like infliximab and adalimumab being used in pregnancy without issue.
With impact on work, again this would depend on the level of disease control one has with Crohn’s.
14. Is there an anonymised patient story or a common scenario you see in clinic?
Hmm not really, most of the cases I see in hospital are the severe cases where patients have poorly controlled disease. So won’t be a common scenario but more a picture of what happens in poorly controlled IBD.
