For many people with Crohn’s disease, reaching remission—when inflammation is no longer detectable—seems like a major victory.
However, a significant number of patients continue to experience troubling symptoms even when their condition is classified as “quiescent,” meaning inflammation is absent.
A recent study by University of Michigan researchers sheds light on a potential explanation: sulfur-producing bacteria in the gut.
This new research builds on a previous study by the same team, which found an abundance of sulfur-producing bacteria in the microbiomes of Crohn’s disease patients who had persistent symptoms despite being in remission.
These bacteria are known to generate hydrogen sulfide, a gas that can negatively affect gut function.
Hydrogen sulfide has two significant effects on the gut. First, it can weaken the intestinal barrier, a protective layer that allows nutrients to pass through while keeping harmful substances out.
When this barrier is compromised—a condition sometimes referred to as “leaky gut”—toxins can enter the bloodstream and trigger discomfort. Second, hydrogen sulfide can increase visceral hypersensitivity, making the gut more sensitive to pain and other sensations.
The study, titled “Why Symptoms Linger in Quiescent Crohn’s Disease: Investigating the Impact of Sulfidogenic Microbes and Sulfur Metabolic Pathways,” analyzed stool samples from patients with quiescent Crohn’s disease.
Among 39 patients with ongoing symptoms, researchers found a significant enrichment of sulfur-producing bacteria and related sulfur metabolic activity, compared to 274 patients who were in remission without symptoms.
This discovery strengthens the idea that the gut microbiome—specifically, these sulfur-producing microbes—could play a key role in persistent symptoms.
Interestingly, some experts previously theorized that hard-to-detect, low-grade inflammation might be the cause of these symptoms.
However, the new findings suggest that even patients in deep remission, with no detectable inflammation, can have persistent symptoms. This points to the microbiome and its metabolic activity as an important area for further investigation.
The persistent symptoms of quiescent Crohn’s disease pose a major challenge for patients and healthcare providers alike. For patients, lingering symptoms can severely impact quality of life, leading to difficulties in daily activities and emotional well-being.
As Dr. Allen Lee, co-senior author of the study, noted, “The symptom burden in our patients with quiescent Crohn’s disease and persistent symptoms was actually very similar to patients with active Crohn’s disease.” This highlights the significant gap in treatment for those in remission.
Beyond quality of life, these lingering symptoms can also lead to higher medical costs and an increased risk of opioid use. Many patients turn to additional treatments to manage discomfort, which can strain both their health and finances.
To address these challenges, the research team is exploring new potential treatments. One promising area of study is the impact of diet. The researchers have begun a pilot study to test whether a low-sulfur diet could reduce symptoms in patients with persistent issues.
By limiting the sulfur available to gut bacteria, this dietary approach might help lower the production of hydrogen sulfide and alleviate symptoms.
Future research will focus on confirming the link between sulfur-producing bacteria and quiescent Crohn’s disease through larger studies.
The goal is to better understand the complex relationship between the microbiome and persistent symptoms, paving the way for new therapies that could improve the lives of many patients.
This study highlights the importance of looking beyond inflammation when treating Crohn’s disease. For those who continue to struggle with symptoms despite being in remission, understanding the role of the microbiome may offer hope for more effective solutions.
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The research findings can be found in Inflammatory Bowel Diseases.
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