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Part 1 · Understanding your illness · 1/22

Crohn's: what we know now

The discoveries of recent years that are changing the way we see and treat the disease.

ileummouthanus inflamed areas

Identity card

  • Where?Anywhere from the mouth to the anus. Most often at the end of the small intestine (ileum).
  • How?In patches, with healthy areas in between.
  • How deep?Through the whole thickness of the bowel wall. Hence strictures and fistulas.

The bowel cut in a slice, like a tube seen end-on

inside(food)The inflammation goes throughthe whole thickness of the tubeIt can break through outside:that is a fistulaAs it heals, the tubenarrows: that is a stricture

What has changed

1

BEFOREThe disease starts with the first symptoms.

NOWIt starts silently. In research, a blood test picks up signs up to 16 years before diagnosis (not yet a routine test).

Gastroenterology 2025; Nature Communications 2025

2

BEFOREYou start gently and step up if it isn't enough.

NOWTreating early and hard changes the future: 79% lasting remission versus 15%, and far fewer emergency operations.

PROFILE trial, 2024

3

BEFOREIf I have no more symptoms, I've won.

NOWThe aim is a healed bowel wall. Calprotectin (stool test) and bowel ultrasound make it possible to check without a colonoscopy every time.

STRIDE international recommendations

4

BEFOREHaving surgery means failure.

NOWWhen Crohn's affects only a short segment at the end of the ileum, early surgery is a real option, just as valid as medicines.

LIR!C trial and its long-term follow-up

5

BEFOREA stricture can only be treated with surgery or dilation.

NOWThe first anti-scarring medicines are being tested in humans, including a large trial of 320 patients since October 2026.

Ontunisertib, NOV-ERA trial

6

BEFORECrohn's is a single disease.

NOWMore than 200 regions of the genome are involved, and Crohn's of the ileum differs from Crohn's of the colon. We are moving towards tailor-made treatments.

International genetic studies

7

BEFOREDiet doesn't really matter.

NOWIn children, 100% liquid nutrition calms flares as well as cortisone does. Ultra-processed foods are linked to a higher risk.

ECCO/ESPGHAN recommendations; large cohorts

8

BEFOREOne treatment at a time.

NOWCombinations of two biologics are being tested, with more healed lining than with just one.

ABBV-466, DUET programme