Crohn’s Disease
What is it?
Crohn’s disease is an inflammatory bowel
disease (IBD), which is a general name for
diseases that cause the intestine to become
inflamed. This inflammation often causes abdominal
cramps and diarrhea. Crohn’s disease usually
occurs in the lowest part of the small intestine,
called the ileum, as well as the large intestine.
However, it can affect any part of the digestive
tract, from the mouth to the anus. Crohn's disease
is sometimes called ileitis or enteritis.
Who gets it?
Both men and women can get Crohn's disease.
About 20 percent of people with Crohn's disease
have a blood relative with some form of IBD. Most
people with Crohn’s disease are diagnosed between
the ages of 15 to 35, but it can be diagnosed at
almost any age.
What causes it?
No specific cause of Crohn’s disease has been
identified. Because many sufferers of Crohn’s
disease also have immune disorders, some
researchers believe some type of infection may
trigger the immune system and cause the
inflammation seen with Crohn's disease.
What are the symptoms?
The most common symptoms of Crohn's disease are
abdominal pain and diarrhea. Examination may
reveal a lump or fullness in the lower right part
of the abdomen. Other symptoms may include rectal
bleeding, weight loss, fever, and fatigue. Because
the disease tends to thicken the intestinal wall
with swelling and scar tissue, the intestine often
becomes blocked. Intestinal blockage can result in
constipation, vomiting, and severe pain. The
inflammation of Crohn’s disease can cause ulcers
in the intestinal wall. Sores or ulcers may also
tunnel through the affected area into surrounding
tissues such as the bladder, vagina, or skin.
These tunnels are called “fistulas.” Pockets of
infection called “abscesses” may also occur.
Crohn’s disease interferes with the intestine’s
ability to absorb nutrients from foods, so
patients may also show signs of malnutrition.
Other symptoms that occur as complications of
Crohn’s disease may include kidney or gallstones,
arthritis, eye or mouth inflammation, skin
disorders, and diseases of the liver and biliary
system. Symptoms in children generally include
joint pain, fever, anemia, and slow growth.
Children with Crohn's disease may also suffer from
developmental delays. Symptoms of Crohn’s disease
often come and go. Patients may be free of
symptoms for long periods of time, and flare-ups
can range from mild to severe.
How is it diagnosed?
Your physician will conduct a thorough physical
exam and may order a series of tests. Blood tests
may show anemia, a high white blood cell count,
and low albumin levels. Your doctor may also check
a stool sample for bleeding or infection in the
intestines. Other diagnostic tests commonly used
include an upper gastrointestinal (GI) series to
look at the small intestine, or a colonoscopy to
look for inflammation or bleeding in the large
intestine. A biopsy of tissue from the lining of
the intestine may also confirm the diagnosis.
Barium enema X rays may be helpful in determining
how much of the intestine is involved in the
disease. The barium gives your doctor a more
detailed view of the intestine.
What is the treatment?
While Crohn’s disease has no known cure, there
are many treatments available to reduce the
inflammation, correct nutritional problems, and
relieve symptoms. Treatment may include a
combination of medicines, or surgery, depending
upon the location and severity of disease, and any
complications. The three most common drug
therapies are mesalamine substances,
corticosteroids, immunosuppressive agents. Drugs
containing mesalamine help control inflammation.
Possible side effects include nausea, vomiting,
heartburn, diarrhea, and headache. Corticosteroids
control inflammation. While corticosteroids are
very effective in relieving abdominal pain and
improving appetite, they can cause serious side
effects. For this reason, they are generally not
used for a prolonged period of time.
Immunosuppressive agents are drugs that suppress
the immune system, which means they block the
immune reaction that contributes to inflammation.
These drugs usually decrease the need for
corticosteriods, but require monitoring for
toxicity. The drug infliximab (brand name Remicade)
is a promising treatment for moderate to severe
Crohn's disease that does not respond to standard
therapies. Certain antibiotics are often
prescribed to relieve the symptoms of Crohn’s
disease by treating bacterial overgrowth in the
small intestine caused by stricture, fistulas, or
surgery. Commonly prescribed antibiotics include
ciprofloxacin and metronidazole. Diarrhea is often
treated with diphenoxylate or loperamide.
Dehydration is relieved by fluids and
electrolytes. Doctors may recommend special
high-calorie liquid formulas, especially for
children with delayed growth. Rarely, patients
with severe nutritional deficiencies must receive
concentrated nutrients intravenously. A physician
may recommend surgery in severe cases where the
intestine is obstructed, or abscesses or fistulas
won’t heal. The diseased section of the intestine
is removed and the remaining intestine is joined
together. However, while surgery may relieve
symptoms indefinitely, it is not a cure. The
inflammation tends to return next to the area of
intestine that has been removed. Some people who
have Crohn's need an ileostomy. In this case, a
small opening is made in the front of the
abdominal wall, and the tip of the ileum is
brought to the skin's surface. The opening is
called a stoma. A pouch is worn over the opening
to collect waste, and the patient empties the
pouch as needed.
Self-care
tips
If you have Crohn’s
disease, follow your doctor’s treatment plan.
It may be helpful to avoid milk products. Get
plenty of rest and try to exercise regularly.
As with any illness, a good support system
is important. With medication and occasional
hospitalizations, most people with Crohn's disease can
lead normal, active lives.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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