Crohn's Disease

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What is Crohn's disease?

Crohn's disease is an inflammatory bowel disease (IBD) that is a chronic condition that may recur at various times over a lifetime. It usually involves the small intestine, most often the lower part called the ileum. However, in some cases, both the small and large intestine are affected. Sometimes, inflammation may also affect the entire digestive tract, including the mouth, esophagus, stomach, duodenum, appendix, or anus.

Crohn's disease affects males and females equally. It appears to run in some families, with about 20 percent of people with Crohn's disease having a blood relative with some form of inflammatory bowel disease.

What are the symptoms of Crohn's disease?

The following are the most common symptoms of Crohn's disease. However, each individual may experience symptoms differently. Symptoms may include:

• Abdominal pain, often in the lower right area

• Diarrhea, sometimes bloody

• Rectal bleeding

• Weight loss

• Fever

• Joint pain

• Rectal fissure

• Rashes

Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return.

The symptoms of Crohn's disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What causes Crohn's disease?

There are many theories regarding what causes Crohn's disease. One theory suggests that some agent, perhaps a virus or a bacterium, affects the body's immune system and triggers an inflammatory reaction in the intestinal wall. Although there is a lot of evidence that patients with this disease have abnormalities of the immune system, it is not known whether the immune problems are a cause or a result of the disease. There is no evidence that Crohn's disease is caused by stress.

How is Crohn's disease diagnosed?

People who have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia may be examined for signs of Crohn's disease. In addition to a complete medical history and physical examination, diagnostic procedures for Crohn's disease may include the following:

• Blood tests. These are done to determine if there is anemia resulting from blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process.

• Stool culture. Checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a laboratory by your doctor's office. In two or three days, the test will show whether abnormal bacteria are present, determine if there is blood loss, or if an infection by a parasite or bacteria is causing the symptoms.

• Esophagogastroduodenoscopy (also called EGD or upper endoscopy). An EGD is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum (the first part of the small intestine where ab sorption of vitamins, minerals, and other nutrients begins) . A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as remove tissue for further examination if necessary.

• Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine. A colonoscopy can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

• Biopsy. A procedure performed to remove tissue or cells from the lining of the colon for examination under a microscope.

• Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs. An upper GI with a small bowel follow-through may be used to diagnose Crohn's disease.

• Lower GI (gastrointestinal) series (also called barium enema). A procedure that examines the rectum, the large intestine, and the lower part of the small intestine. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is given into the rectum as an enema. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.

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What are treatments for Crohn's disease?

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

At this time there is no cure for Crohn's disease; however, several methods are helpful in controlling it. The usual goals of treatment are to:

• Correct nutritional deficiencies.

• Control inflammation.

• Relieve abdominal pain, diarrhea, and rectal bleeding.

Treatment may include:

• Drug therapy (anti-inflammatory medications, cortisone or steroids, immune system suppressors, biologic therapies, antibiotics, anti-diarrheal medications, and fluid replacements). Abdominal cramps and diarrhea may be helped by medications, which often lessen the inflammation in the colon. More serious cases may require medications that affect the body's immune system.

• Diet and supplements. No special diet has been proven effective for preventing or treating Crohn's disease. Some symptoms are made worse by milk, alcohol, hot spices, or fiber, but this may not be true for everyone.

  • Supplements. Nutritional supplements or special high-calorie liquid formulas may sometimes be suggested, especially for children with delayed growth.

  • Feeding through a vein. A small number of patients, who temporarily need extra nutrition, may need periods of feeding by vein (intravenously).

• Surgery. Crohn's disease may be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return to the areas of the intestine next to the area that has been removed. Surgery may help to either relieve chronic symptoms of active disease that does not respond to medical therapy or to correct complications, such as intestinal blockage, perforation, abscess, or bleeding. Types of surgery may include:

  • Drainage of abscesses or removal of a section of bowel (due to blockage, resulting in a shortened bowel).

  • Ostomy. Some people must have part of their intestines removed, and a new method of removing the stool from the body is created. The surgery to create the new opening is called ostomy, and the new opening is called a stoma.

  Different types of ostomy are performed depending on how much and what part of the intestines are removed, and may include the following:

  • Ileostomy. The colon and rectum are removed and the bottom part of the small intestine (ileum) is attached to the stoma.

  • Colostomy. A surgically-created opening in the abdomen through which a small portion of the colon is brought up to the surface of the skin. Sometimes, a temporary colostomy may be performed when part of the colon has been removed and the rest of the colon needs to heal.

  • Ileoanal reservoir surgery. An alternative to a permanent ileostomy, this procedure is completed in two surgeries. First, the colon and rectum are removed and a temporary ileostomy is performed. Second, the ileostomy is closed and part of the small intestine is used to create an internal pouch to hold stool. This pouch is attached to the anus. The muscle of the rectum is left in place, so the stool in the pouch does not leak out of the anus. People who have this surgery are able to control their bowel movements.