A form of inflammatory bowl disease (IBD), Crohn's disease usually affects the intestines. However, it may occur anywhere from the mouth to the anus. It was named after Dr. Burrill B. Crohn who first reported the disease in 1932, along with other doctors.
Crohn's disease is an autoimmune disorder. This means that the body's immune system attacks healthy issue by mistake. Individuals who have Crohn's disease have chronic (ongoing) inflammation of the Gastrointestinal tract (GI tract).
This disease can affect the large intestine, small intestine, liver, rectum, or mouth. It also makes the intestinal wall thick.
There are different types of Crohn's disease depending on which part of the body is affected.
- Ilecolitis: This is the most common form. It effects the ileum (end of the mall intestine) and the colon (large intestine).
- Iletis: Crohn's disease only affecting the ileum (the end f the small intestine).
- Gastroduodenal Crohn's disease: This form of Crohn's disease affects the stomach and the duodenum (the beginning of the small intestine).
- Jejunoileitis: This type causes patchy areas of swelling in the jejumum (upper half of the small intestine).
- Crohn's (granulomatous) colitis: This type only affects the colon.
People with Crohn's disease have a higher risk of getting small bowl and colon cancer.
Crohn's disease may also be called Regional enteritis, Ileitis, and Granulomatous ileoclotitis.
Symptoms of Crohn's disease may come and go and range from mild to severe. The symptoms are different and related to the part of the body that is infected.
Symptoms of Crohn's disease are:
- painful stomach cramps
- weight loss
- loss of appetite
- tenesmus - pain when passing stool
- persistent, watery diarrhea
There may be other symptoms, including:
- wwelling of the eye
- abnormal connections (fistulas) around the rectal area that may cause pus, mucus, or stools to drain
- joint swelling and pain
- bloody stools or bleeding from the rectum
- ulcers (sores) in the mouth or on the skin
- swollen gums
- skin lumps
If a doctor notices any of the following during a physical exam, he or she may suspect Crohn's disease.
- abdominal mass
- abdominal tenderness
- mouth ulcers
- joint Swelling
The following tests can be used to diagnose Crohn's disease:
- barium enema or upper GI series
- colonoscopy or sigmoidoscopy
- computed tomography (CT scan) of the abdominal area
- endoscopy or capsule endoscopy
- magnetic Resonance imaging (MRI) of the abdominal area
A doctor might also request a stool culture to make sure the symptoms are not caused by something else.
Crohn's disease can also change the results of these tests:
- c-reactive protein
- erythrocyte sedimentation rate
- fecal fat
- liver function tests
- white blood cell count
There is not yet a cure for Crohn's disease. Doctor's try to focus the treatment on preventing flare-ups and reducing the symptoms.
It is important for people with Crohn's disease to eat a healthy diet. Patients should try to eat enough calories, protein, and essential nutrients from different food groups. There is not a specific diet that has been proven to make Crohn's disease better or worse, and most food problems vary from person to person.
There are types of food that make diarrhea and gas worse. To help with symptoms, try:
- eating small meals throughout the day
- drink small amounts of water throughout the day
- stay away from high-fiber foods such as bran, beans, nuts, and seeds
- stay away from foods high in fat like heavy cream, margarine, or butter
- if dairy fat is a problem, limit the amount of dairy food. Low-lactose cheeses (Swiss and Cheddar), and a product such as Lactaid, can help digest lactose
- stay away from foods such as beans, which are known to cause gas
Be sure to ask a doctor about supplements that might be needed. These include vitamins and minerals such as:
- iron supplements (if anemic)
- calcium and Vitamin D for strong bones
- vitamin B12 to prevent anemia
There is medication to treat serious diarrhea problems. Loperamide (Imodium) is available over the counter. However, it is important to talk to a doctor before taking these medicines.
Other medicines that can be helpful in reducing symptoms:
- fiber supplements to ease constipation
- Tylenol for pain
- aspirin, Advil, Motrin, Aleve, Naproxen, and ibuprofen (all NSAIDs, or nonsteroidal anti-inflammatory drugs) can make symptoms worse
A doctor may also prescribe pain medicine in serious cases.
Other prescription medicine that may be used includes:
- aminosalicylates (or 5-ASAs; for mild to moderate symptoms). These may be taken orally or may be given rectally.
- corticosteroids (for severe symptoms). These may be taken orally or given rectally.
- azathioprine and 6-mercaptopurine. These reduce the reaction of the immune system.
- antibiotics for abscesses or fistulas
- For severe cases that do not respond to any other treatment - Biologic therapy. These include infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia), and natalizumab (Tysabri).
A procedure called a bowl resection may be done if medicines do not work. A surgeon will remove a diseased or damaged part of the intestine to drain an abscess. This will not cure the condition, but it will help with symptoms. In some extreme cases, patients will have to have their entire colon (large intestine) removed. They may or may not have to have the rectum removed.
The precise cause of Crohn's disease not yet known. However, there are certain factors that are thought to play a role. Genetics environmental factors are suspected to be a part of the cause.
If the body over-reacts to normal intestinal bacteria, then it is likely that Crohn's disease will appear.
Although Crohn's disease may appear at any age, it most commonly seen in people between the ages of 15 and 35. It is also seen most commonly in Jewish community as compared to other ethnic groups.
It is important for patient's with Crohn's disease to have a good relationship with their doctor, and with a gastroenterologist. Communication between doctors and patients are the key to managing this disease. It might be helpful to come to appointments with a list of questions for the doctor.
Here are some questions that could be helpful:
- Could the symptoms be caused by something else?
- What tests are needed to find what is causing the symptoms?
- Should the tests be done routinely or only during flare-ups?
- What parts of the GI tract is the disease affecting?
- Are there any signs that the medication needs to be changed?
- If a dose is missed, or if medication is stopped, will there be any side-effects?
- How long should it take for the medication to work or for signs that the medication is not helping?
- Are there side-effects of the medication and if so what should be done if they appear?
- What should the patient do if the symptoms come back? Are there any symptoms that could be an emergency/
- Are there any over-the-counter medications that could help?
- Should the patient contact a dietitian or take any specific nutritional supplements?
- What lifestyle changes need to be made?
- How far apart should appointments be scheduled?
Organizations that might be helpful include:
- National Institute of Diabetes and Digestive and Kidney Diseases
- Crohn's and Colitis Foundation of America
- American Society for Gastrointestinal Endoscopy
- North Amreican Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Research is being done to develop new treatments for Crohn's disease and genetic studies are expected to give new insights into the disease. Scientists hope to find a way to reverse the damage done by inflammation of the intestines. They are also trying to find ways to prevent the disease from developing at all.
Researchers are beginning to understand the ways in which a person's immune system response to normal intestinal bacteria plays a role in the development of Crohn's disease. They are looking at the composition, behavior, and exact role of intestinal bacteria in the symptoms of Crohn's disease.
Living with Crohn's disease can be very stressful. One may often be anxious or embarrassed about having a bowel accident. Additionally, stressful events in one's life can lead to digestive problems. Stay in communication with a doctor about how stress and Crohn's disease are related.
Crohn's disease can lead to other complications, such as:
- hemorrhage (bleeding)
- children can have stunted growth
- fistulas (abnormal connections between the intestines and other parts of the body)
- abscesses (infections)
- the intestine can narrow
- nutritional deficiency
- lesions in the eye
- joint swelling
A patient should contact their health care provider if:
- they have serious stomach (abdominal) pain
- their diarrhea cannot be controlled with changing their diet or over-the-counter medicine
- they have lost weight. Or, if they are a child, they cannot gain weight
- rectal bleeding, drainage, or sores are experienced
- they have a fever that lasts more than 2 to 3 days
- their nausea and vomiting lasts more than one day
- skin sores or lesions do not heal
- joint pain keeps them from doing their normal daily activities
- medication for their condition is causing side-effects