Not all Crohn's disease is the same. Your immune system uses specific pathways to cause inflammation—and understanding yours is the key to finding the right treatment.
If you've been living with Crohn's disease, you know the drill: try a medication, wait 3-6 months, get scoped, find out it's not working, try another one. Repeat for years while your disease progresses.
Why does this happen? Because different Crohn's patients have different immune pathways driving their disease. A medication that works brilliantly for one patient does nothing for another—not because the medication is bad, but because it's targeting the wrong pathway.
Understanding which pathway is driving YOUR inflammation
What's happening in your body: IL-23 activates special immune cells called Th17 cells, which then release IL-17 and IL-22. These cause deep inflammation in your intestinal wall, leading to ulcers, strictures, and fistulas.
Think of it like this: IL-23 is the "general" giving orders, and Th17 cells are the "soldiers" carrying them out. If you block the general (IL-23), the soldiers don't know what to do.
What we test:
IL-23, IL-17A, IL-17F, IL-22, IL-21
If this is YOUR pathway, these medications target it:
Skyrizi (risankizumab), Stelara (ustekinumab), Tremfya (guselkumab)
What's happening in your body: TNF-α (tumor necrosis factor alpha) is one of the most powerful inflammatory signals. When elevated, it causes rapid tissue destruction, severe inflammation, and can affect your whole body.
Think of it like this: TNF-α is like an alarm that won't stop ringing—it keeps recruiting more immune cells to attack your intestines. Anti-TNF medications turn off this alarm.
What we test:
TNF-α, IL-1β, IL-6, soluble TNF receptors
If this is YOUR pathway, these medications target it:
Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab), Simponi (golimumab)
What's happening in your body: Immune cells use integrin molecules like "GPS directions" to find your intestines. In some Crohn's patients, too many immune cells are being directed to the gut—even though they're not needed there.
Think of it like this: Imagine your intestines are sending out a distress signal, and immune cells from all over your body keep showing up like too many firefighters at a small fire—they end up causing more damage than the original problem.
What we test:
α4β7 integrin expression, MAdCAM-1, gut-homing markers
If this is YOUR pathway, these medications target it:
Entyvio (vedolizumab) - gut-specific, doesn't suppress whole immune system
Instead of trying anti-TNF first "because that's what we always try," you can start with the medication that targets YOUR pathway.
Skip the 6-month "let's see if this works" experiments. Know which pathway to target from day one.
Every month on the wrong medication allows more bowel damage. Finding the right treatment faster protects your intestines.
Pathway testing doesn't guarantee the medication will work—nothing can do that. But it dramatically increases your odds by matching you to treatments designed for your immune signature. It's the difference between educated treatment selection and rolling the dice.
Stop guessing which medication might work. Get tested and find out which pathways are driving your disease.
See Crohn's Testing Options →