Inclusion Criteria:
- Able and willing to provide informed consent.
- 18-89 years of age.
- English speaking.
- Diagnosis of CD based on typical clinical and histologic features.
- Active disease on endoscopy:
- SES-CD >= 6
- SES-CD >= 4 for isolated ileal disease
- Current CD therapies are in the maintenance phase of dosing at the time of randomization.
- Any ongoing CD therapy (apart from steroid use) must be at stable doses for 4 weeks prior to randomization and remain stable over study course.
- Steroid use 20mg or less by 5 days prior to randomization.
- Steroid use stipulations:
- Prednisone must be tapered below 20mg after 7 days.
- Any use of budesonide over the study period is allowed although tapering is encouraged.
- Rescue medications: Steroid courses (up to 40mg for two weeks with a planned taper) are allowed at the discretion of the treating provider. Study drug therapy will be stopped on a case-by-case basis on discussion with the participant and treating provider.
- Women who are not post-menopausal (at least 12 months of non-therapy induced amenorrhea) or surgically sterile (e.g., absence of ovaries and/or uterus) must remain abstinent or use a highly effective form of birth control (e.g., oral contraception, transdermal patch, barrier, intrauterine device).
o Periodic abstinence and early withdraw are not acceptable methods.
- Able to comply with study measures in the opinion of the investigator.
Exclusion Criteria:
- Extensive bowel resection: i.e., subtotal colectomy or substantial removal of small bowel where short bowel syndrome could be a concern.
- Documented gastroparesis
- History of pylorus non-preserving gastric surgery, e.g., Roux-en-Y gastric bypass.
- Symptomatic stricture defined as a stricture that:
- Cannot be traversed by the colonoscope,
- Requires intervention to be traversed,
- Is otherwise responsible for the predominant clinical picture, in the opinion of the investigator.
- Presence of ileostomy or colostomy.
- Entero-vesicular fistula (i.e., fistula from bowel to bladder).
- Suspicion of ischemic colitis, radiation colitis or microscopic colitis.
- Diagnosis of ulcerative colitis.
- Active or untreated infection.
- Adenomatous polyps that have not been removed.
- Use of antibiotics within 14-days of randomization.
- Current pregnancy.
- Current breastfeeding or planning to breastfeed over the study period.
- History of anaphylactic food allergies.
- End stage liver disease or cirrhosis.
- Anticipated need for antibiotics over the study period.
- Anticipated surgical procedure over the study period.
- An absolute neutrophil count <500 cell/µL.
- Diagnosis of a primary immunodeficiency.
- Active malignancy requiring the use of chemotherapeutic agent (except for localized non-melanomatous skin cancers).
- Patients receiving active cytotoxic therapy for solid tumors and hematologic malignancies.
- Any solid organ transplant within 6 months of randomization.
- Use of chimeric antigen receptor T-cell therapy or hematopoietic cell transplant within the past 12 months
- Life expectancy <=6 months.