It is estimated that Crohn’s disease affects around a million people in the United States, and evidence suggests it is only becoming more common. For many Crohn’s patients, the condition quietly progresses even as symptoms come and go seemingly at random. Without objective testing, it can be difficult to know whether the disease is truly under control or simply lying dormant between flares. The American College of Gastroenterology has recently updated their guidelines for treatment of Crohn’s disease, and these new guidelines emphasize a more proactive approach that aims to prevent progression rather than simply react to flares.1

What Is Crohn’s Disease?

Crohn’s disease is one of the two principal forms of inflammatory bowel disease (IBD), the other being ulcerative colitis. IBD refers to chronic conditions characterized by persistent inflammation of the digestive tract that causes tissue damage over time. While ulcerative colitis affects only the colon and rectum, Crohn’s disease can occur anywhere along the entire gastrointestinal tract, from the mouth to the anus. Most commonly, Crohn’s affects the end of the small intestine (the ileum) and the beginning of the colon, though the pattern and location vary significantly from patient to patient.

The inflammation in Crohn’s disease penetrates deep through multiple layers of the intestinal wall, not just the surface lining. This deep inflammation can lead to ulcers that tunnel through tissue, creating complications like strictures (narrowed sections of bowel that can cause blockages) or fistulas (abnormal connections between different parts of the intestine or between the intestine and other organs). The disease typically appears in patches, with areas of healthy tissue between inflamed sections. Over time, repeated cycles of inflammation and healing can cause scarring and permanent damage to the intestinal wall, which explains why early and aggressive treatment has become increasingly important in managing the condition.

Common symptoms of Crohn’s disease include persistent diarrhea, abdominal pain and cramping, blood in the stool, fatigue, weight loss, and reduced appetite. Some patients also experience fever, mouth sores, or inflammation in other parts of the body like joints or skin. It’s worth noting that Crohn’s disease (IBD) is frequently confused with irritable bowel syndrome (IBS), though they are fundamentally different conditions. IBS is a functional disorder where the digestive system doesn’t work properly but shows no visible tissue damage or inflammation. IBD like Crohn’s involves actual inflammation that can be seen on imaging and during colonoscopy, causing progressive damage if left untreated. This distinction matters because the treatment approaches differ significantly between these conditions.2

The New Treat-to-Target Approach

The 2025 ACG guidelines represent a shift away from how Crohn’s disease has traditionally been managed. For years, the standard approach focused primarily on controlling symptoms. If abdominal pain and diarrhea improved, both patients and doctors considered the treatment successful. However, research has revealed a problem with this symptom-focused strategy. Many patients feel relatively okay even while inflammation continues actively damaging their intestines. This silent progression can lead to complications like strictures or fistulas that eventually require surgery, even in patients who thought their disease was under control.

The new guidelines emphasize what’s called a treat-to-target approach. This means setting specific, measurable goals beyond just symptom relief and regularly checking whether you’re achieving them. Your gastroenterologist might aim for healing of intestinal ulcers visible during colonoscopy, normal inflammation markers in blood tests, or keeping you well without needing steroids. Progress gets monitored through scheduled appointments and testing rather than waiting for a flare to signal that something is wrong. If the targets aren’t being met, treatment gets adjusted before major problems develop.

Research comparing treat-to-target management to traditional symptom-based care shows that patients achieve sustained remission more often and face fewer hospitalizations or surgeries over time. The 2025 guidelines reflect this evidence by encouraging doctors to start effective therapies earlier for patients with moderate to severe disease or high-risk features, rather than taking a gradual approach that waits for progression. For patients, this shift might mean stronger medications from the outset, more frequent monitoring through labs and imaging, and greater emphasis on objective measures of disease activity rather than relying solely on how you feel from day to day.

Treatment Goals Under Treat-to-Target

So what exactly are doctors and patients aiming for with this approach? Treat-to-target relies on setting clear, specific goals that go beyond simply feeling better. These targets typically include both medical markers that doctors can measure objectively and quality-of-life improvements that matter to patients in their daily lives. Your gastroenterologist will work with you to establish which targets make sense for your specific situation and create a timeline for achieving them.

  • Clinical remission: This means minimal or no active symptoms in your day-to-day life. You should have formed stools without blood, little to no abdominal cramping, normal energy levels, and a healthy appetite and weight. This is the immediate relief every patient wants and the foundation of feeling well enough to work, travel, and maintain normal activities.
  • Endoscopic remission (mucosal healing): This target focuses on what doctors see during a colonoscopy.The goal is a healed intestinal lining with no visible ulcers, inflammation, or active disease. The 2025 ACG guidelines emphasize that mucosal healing remains a primary goal of therapy because it indicates the disease is truly under control at the tissue level, not just masked by symptom relief. Achieving this target strongly predicts long-term remission and reduced risk of complications.
  • Biomarker remission: Normal lab results indicating that inflammation is controlled. This includes blood tests like C-reactive protein (CRP) and stool tests like fecal calprotectin. The updated guidelines provide specific calprotectin cutoff values (around 50-100 µg/g) to help distinguish active inflammatory disease from other causes of symptoms. These objective markers help confirm that what you're feeling matches what’s happening inside your body.
  • Steroid-free remission: Staying well without relying on prednisone or other corticosteroids for long-term control. While steroids can quickly calm a flare, they’re not safe for extended use and don’t maintain remission once stopped. The 2025 guidelines strongly recommend limiting steroid courses to fewer than three months and transitioning to safer maintenance medications. Achieving remission without ongoing steroid use is considered a critical marker of successful treatment.
  • Quality of life improvements: Your personal wellbeing matters just as much as test results. Treatment goals should include being able to work or attend school without frequent absences, maintaining social activities and relationships, having energy for hobbies and exercise, and feeling confident about leaving home without bathroom anxiety. These life goals are harder to measure than lab values but are essential to what remission truly means for patients.

    Contact Cary Gastro for Crohn’s Treatment

    The updated guidelines for Crohn’s disease reflect important advances in understanding how to achieve and maintain long-term remission. Whether you’re newly diagnosed, have been managing Crohn’s for years, or are concerned about steroid dependency, Cary Gastroenterology can help evaluate your current treatment plan and discuss whether a treat-to-target approach might benefit you. Our team specializes in inflammatory bowel disease and stays current with the latest evidence-based treatment strategies. Contact us today to request an appointment and learn more about comprehensive Crohn’s disease care.



    1https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts
    2https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-crohns-disease