Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jeremy Swartzberg

Jeremy Swartzberg, MD

Hospital Medicine

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1190

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Crohn’s disease (CD) is an intestinal disease that causes inflammation in the lining anywhere in the digestive system, from the mouth to the anus. Most often, it affects the end of the small intestine (ileum) where it connects to the colon (large intestine). It is a chronic illness.

Sometimes there are no symptoms and no treatment is needed. Other times, symptoms may suddenly flare up. Medication and dietary changes are often effective treatments. In some cases, surgery may be needed. 

Crohn’s disease can affect people of any age, but it most often affects adults:

  • Age 15 to 35
  • Age 70 or older


If you have Crohn's disease, your symptoms in or around your digestive system might include:

  • Abdominal pain and cramping. 
  • Diarrhea or a sudden urge to use the bathroom. You might have diarrhea up to 10 or 20 times a day.
  • Blood in stools.
  • Loss of appetite and weight loss.
  • Fever. You might have a slight fever, or in severe cases, a fever with other symptoms that affect your entire body. High fevers are usually a sign of a infection.
  • Anemia (too few red blood cells). Bloody stools can decrease your iron level and may cause anemia.
  • Sores in your mouth.
  • Nutritional deficiencies. These happen because your intestines may not be able to absorb nutrients from food. Common deficiencies are lowered levels of vitamin B12, folic acid, and iron.

Symptoms in or around your anus may include:

  • Abnormal tunnels or openings (fistulas). Fistulas sometimes form between organs (such as the bladder, vagina, or skin) because Crohn's disease causes inflammation and ulcers in the deep layers of the intestinal wall.
  • Pockets of infection (abscesses).
  • Small tears in the anus (anal fissures).
  • Skin tags that may resemble hemorrhoids. These are caused by inflamed skin. 

Symptoms and complications outside the digestive system may include:

  • Joint pain, eye problems, or a skin rash. These problems are more common in Crohn’s disease than in ulcerative colitis, the other major inflammatory bowel disease.
  • Delayed growth and sexual development. Children who have Crohn’s disease may suffer from delayed growth and sexual development. 


Crohn's disease can be difficult to diagnose, and there is no single test for it. Crohn’s disease often goes undiagnosed for years because:

  • Symptoms generally develop over time
  • Other diseases (such as irritable bowel syndrome) have similar symptoms 

When you come in for an appointment, we will start with a discussion of your medical history. Then, we will do a physical exam and perform one or more of the following tests:

  • Either a flexible sigmoidoscopy or colonoscopy and/or an upper endoscopy (camera tests). These help us to examine the lining of your intestines. Biopsies (tissue samples) can be obtained during these procedures, which can help us confirm the diagnosis.
  • Stool analysis helps us confirm that there is no infection. We look for blood, inflammation, signs of bacterial infection, or parasites.
  • Computed tomography (CT) or magnetic resonance imaging (MRI) are radiology tests. They are used in severe cases and take pictures inside your body.
  • Small bowel follow-through X-ray allows us to see if there are any obstructions in your small intestine.
  • Barium enema lets us examine the colon (large intestine). This is a rare test, but is sometimes useful.
  • Capsule endoscopy is used in rare cases to examine the lining of your small intestine to look for inflammation.

Causes and Risk Factors

We do not know the cause of Crohn’s disease. Research suggests that it may be related to an abnormal response by your immune system to some intestinal bacteria. 

Risk factors

Certain people are at greater risk of developing Crohn's disease than others. Some risk factors, such as genetics, can’t be changed or controlled. Other factors, such as lifestyle choices, can be altered to lower your risk.

Risk factors include:

  • Smoking. Cigarette smoking increases your risk for Crohn's disease and poor health. It can also reduce the success of treatment or worsen your symptoms.
  • Family history of Crohn's disease. Your risk increases if an immediate family member, such as a parent, brother, or sister, has the disease.
  • Ethnicity. People with Ashkenazi Jewish ancestry are at higher risk.
  • Age. People 20 to 30 years old are at higher risk.
  • Living in a city or in an industrialized country. Research suggests that environmental factors, including a diet high in sugar, may play a role.


Unfortunately, there is no cure for Crohn's disease, but treatment can reduce pain and discomfort. Most people who have Crohn's disease continue to lead healthy and active lives.

Your treatment will depend on your symptoms and how severe they are. We will work together to choose one or more of the following treatments:

  • Lifestyle changes
  • Medications
  • Complementary and alternative medicine
  • Surgery

We might need to try more than one combination of treatments to ease your symptoms. Long-term treatment is usually necessary to manage Crohn’s disease. 

Be aware of foods that trigger symptoms and avoid them. These may be different for each patient. For patients with a history of intestinal obstruction, we recommend avoiding raw fruits and vegetables, seeds, nuts, and popcorn.

Prescription medications

Medication treatment for Crohn’s disease depends on:

  • How severe your symptoms are.
  • Which parts of the intestines are affected.
  • Whether you are experiencing any complications.

If you have mild to moderate symptoms, we may recommend:

  • Aminosalicylates. These medications reduce inflammation. They can be used to treat an acute flare-up and to prevent symptoms from coming back. They can be taken as a tablet, enema, or suppository.

If you have moderate to severe symptoms, we may recommend:

  • Corticosteroids. These medications also reduce inflammation. They are more potent than aminosalicylates. Because side effects can develop with long-term use of corticosteroids, they are usually used short-term to get an acute flare-up under control.
  • Immunomodulator medicines. These medications prevent inflammation by suppressing the immune system. They are useful for preventing symptoms from coming back, but are not helpful for acute flare-ups.
  • Biologic therapies. These medicines block your body’s inflammatory response and help reduce inflammation in your intestinal tract. They can be used to treat acute flare-ups when symptoms do not respond to corticosteroids, and also help prevent symptoms from recurring when taken long-term. Some biologic agents are given as an intravenous (IV) infusion, while others are an injection. 

Your doctor will help you decide which medicine is best for you.


Surgery is not a common treatment for Crohn’s disease, but we may recommended it in certain situations, such as:

  • When medicine cannot control your symptoms.
  • When you have serious side effects from medicine.
  • When you have severe bleeding that requires ongoing blood transfusions.
  • When your symptoms can only be controlled with long-term use of corticosteroids.
  • If you have complications such as abscesses or tears in the anal area, abnormal connections between the intestines and other internal organs, or holes in your colon.
  • If cancer or precancerous tissue is found during a colonoscopy or biopsy.
  • When you have a bowel obstruction that does not resolve with treatment by medications.

Surgery options include:

  • Resection. This involves removing the diseased portion of the intestines and reattaching the healthy ends. This type of surgery does not cure Crohn's disease, which often comes back near the surgery site.
  • Strictureplasty. This involves widening the intestine to decrease obstruction of the bowels. This is sometimes done at the same time as resection or when a person has had resection in the past.
  • Proctocolectomy and ileostomy. This involves removing the colon (large intestine) and rectum and leaving the lower end of the small intestine (the ileum). The anus is sewn closed, and a small opening called a stoma is made in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body. There, stool empties into a small plastic pouch called an ostomy bag.
  • Balloon dilation. This procedure uses an endoscope (a long, thin tube with a video camera on the end) to make part of the intestine wider.
Additional References:

Complementary and Alternative Medicines

Because there is no cure for Crohn's disease, many people consider complementary and alternative medicine (CAM) to help ease symptoms. While not all of these therapies have been proven to be effective, many may improve your overall well-being.

If you are interested in trying CAM, we strongly recommend that you consult with us first. Some CAM therapies such as herbs, vitamins, and other nutritional supplements can have negative side effects when taken with prescription or over-the-counter medicines. We can work together to manage your medications.

Some common CAM therapies include:

  • Nutritional supplements (probiotics, curcumin, and fish oils)
  • Vitamin supplements (vitamins D and B12)

Scientists are just beginning to document the benefits of mind-body and herbal approaches for chronic health issues like Crohn’s disease. You can try some CAM approaches to see if they help reduce your symptoms.

We recommend that CAM approaches be combined with a healthy diet and a regular exercise routine. 

Additional References:

Why Treatment is Important

In some cases, Crohn’s disease can lead to more serious problems. 

Malnutrition or nutritional deficiencies. If the disease has progressed for a long time, protein, calorie, and vitamin levels may be reduced. Nutritional supplements and medical treatment are usually effective in replacing these nutrients.

Sores or ulcers (fistulas) in the digestive system. These affect about 30 percent of people with Crohn’s disease. Medical treatment can help heal small fistulas. Surgery may be needed if you experience fever or symptoms of large or multiple fistulas. 

Abscesses or a collection of pus. Sometimes fistulas develop into an abscess near the intestine. If this happens, we may drain the infected area.

Obstruction or intestinal blockage. This results from swelling and scar tissue. Symptoms may include cramps, stomach pain, and vomiting. Medication can help reduce inflammation, but surgery might be needed if the obstruction is severe and does not respond to treatment.

An increased risk of arthritis. There are two kinds of arthritis:

  • Peripheral arthritis affects many people who have ulcerative colitis or Crohn’s disease. Symptoms include pain, swelling, and stiffness in one or more arm or leg joints (wrists, knees, and ankles). Treatment is very helpful for reducing symptoms. Peripheral arthritis does not cause permanent damage.
  • Spinal arthritis (spondylitis) is more rare. Symptoms include pain and stiffness in the spinal column joints, which tend to be worse in the morning. If left untreated, spinal arthritis can cause bones in the vertebral column to fuse (grow together). Physical activity and physical therapy are very helpful for reducing symptoms and improving range of motion in the spine.

Increased risk of developing osteoporosis. The long-term use of certain medicines, such as corticosteroids, can interfere with normal bone development and growth. If you take these corticosteroids for more than 2 to 3 months, you may need to take calcium and vitamin D supplements or other medicines to prevent osteoporosis.

Other complications include liver disease, kidney stones, gallstones, and mouth ulcers that prevent swallowing or eating.

Lifestyle Changes

Symptoms of Crohn’s disease can last for many years, but they often get better with lifestyle changes and medications. To reduce the symptoms of the disease, you should:

  • Take your medicines regularly. This can help reduce sudden attacks (flare-ups) and keep the disease in remission (a period without symptoms). Many of the newer medications are long-term and can reduce or stop most symptoms.
  • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief. NSAIDs have been linked to flare-ups. Instead, we recommend taking acetaminophen (Tylenol).
  • Don’t smoke. Smoking makes Crohn’s disease worse and causes many other health problems. If you smoke and are ready to quit, we can help.
  • Eat a healthy diet. Aim for a balanced diet with plenty of fruits, vegetables, and whole grains.
  • Avoid trigger foods. If a particular food causes your symptoms to flare up, avoid it. Triggers may be different for each person. If you have a history of intestinal obstruction, you should avoid raw fruits and vegetables, seeds, nuts, and popcorn.
  • Have screening tests for colorectal cancer. If your Crohn’s disease affects your colon, you may have a slightly increased risk of developing colon cancer. In this case, we recommend regular colonoscopies 8 to 10 years after disease onset. Screening can help us find cancer early, when it is easier to treat. 

We can help you develop a strategy to manage your symptoms and live a healthy, active life.

Additional References:

Your Care with Me

Crohn’s disease is a chronic long-term condition. Either I, or another gastroenterologist in our department, will manage your ongoing care.  I will work closely with your personal physician, who will continue to oversee your care for non-Crohn’s health issues.

Mild symptoms of Crohn’s disease can be treated at home.

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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