Pain is commonly felt on the lower right side of the abdomen, but can affect many areas of the gut.
Crohn's disease, also called ileitis or enteritis, can affect any part of the gut, from the mouth all the way down to the anus. In the majority of cases, however, the lower part of the small intestine - the ileum - is affected.
Patients with Crohn's disease experience several unpleasant symptoms, including intestinal ulcers, discomfort and pain.
According to the Centers for Disease Control and Prevention, Crohn's disease affects 26-199 people per 100,000. Although Crohn's disease typically starts between the ages of 15 to 40, it can start at any age.
What are the symptoms of Crohn's disease?
Crohn's disease symptoms vary depending on which part of the gut is affected. Symptoms often include:
- Pain - the level of pain varies according to the patient and where the inflammation is in the gut. Most commonly, pain will be felt at the lower-right side of the abdomen.
- Ulcers in the gut - ulcers are raw areas in the gut that may bleed. If they do bleed, the patient might notice blood in their stools.
- Mouth ulcers - a common symptom.
- Diarrhea - can be mild to severe. Sometimes there may be mucus, blood, or pus. The patient may get the urge to go but find nothing comes out.
- Fatigue - individuals often feel extremely tired. Fever is also possible during fatigue.
- Altered appetite - generally, people with Crohn's disease have periods where their appetite is very low.
- Weight loss - this is common, especially when the patient experiences loss of appetite.
- Anemia - if the patient is losing blood there is a risk of anemia.
- Rectal bleeding and anal fissures - the skin of the anus becomes cracked. These may become painful and can bleed.
Other possible symptoms:
- uveitis (eye inflammation)
- skin rash and inflammation
- liver or bile duct inflammation
- in children: delayed growth or sexual development
Ulcerative colitis vs. Crohn's disease
While ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine, all layers of the intestine may be inflamed and with ulcers in Crohn's disease.
Also, inflammation occurs in Crohn's disease anywhere along the gut; in ulcerative colitis, it only appears in the large intestine (colon and rectum).
The Crohn's disease patient's bowels can have normal healthy sections in between the diseased parts, whereas, in ulcerative colitis, the damage appears in a continuous pattern.
Causes of Crohn's disease
Experts are not completely sure what causes Crohn's disease, although several theories do exist. Unfortunately, none of these theories has yet been scientifically proven. Most experts agree that the immune system reacts abnormally; the immune system:
- Attacks foods, good bacteria, and beneficial substances.
- During the attack white blood cells build up in the lining of the gut.
- The accumulation of white blood cells in the lining of the gut triggers inflammation.
- The inflammation leads to ulcerations and bowel injury.
However, it is unclear whether the abnormal immune system is the cause or the result of Crohn's disease. In other words, does Crohn's disease cause an abnormal immune system response, or does an abnormal immune system response cause Crohn's disease?
Studies indicate that the inflammation seen in the gut of Crohn's disease patients is linked to several factors:
- The patient's genes.
- The patient's immune system itself.
- The environment.
Around 3 in 20 people with Crohn's have a close relative with the condition; and, if an identical twin has Crohn's disease, the other twin has a 70 percent chance of having it, too.
Some experts believe a bacterium or virus may be a factor in causing Crohn's disease to occur. E. coli bacteria has been linked to Crohn's disease, for instance.
Smoking is another risk factor for Crohn's disease.
How is Crohn's disease diagnosed?
A doctor will check through the list of signs and symptoms. There may also be some physical signs - if loops of inflamed bowels are stuck together, a lump can be felt in the abdomen.
The following tests may help in the diagnosis:
- Stool tests.
- Blood tests.
- Sigmoidoscopy - a short, flexible tube (sigmoidoscope) is used to investigate the lower bowel.
- Solonoscopy - a long, flexible tube (colonoscope) is used to investigate the colon.
- Endoscopy - this can be used if the patient has symptoms in the upper part of their gut. A long, thin, flexible telescope (endoscope) goes down through the esophagus into the stomach.
- Barium enema X-ray - X-ray pictures of the abdomen show the inside of the bowel. Barium appears white on X-rays.
- CT scans - X-rays are used to make a 3-dimensional picture of the bowel.
Treatment for Crohn's disease
Bulky grains, like those contained in bread, can worsen Crohn's disease.
Treatment may involve medication, surgery, and/or nutritional supplements. The doctor's goal is to control inflammation, correct nutritional problems, and relieve symptoms.
There is no cure for Crohn's disease, although there are treatments that can help control the disease by reducing the number of times a patient experiences recurrences.
Crohn's disease treatment depends on:
- Where the inflammation is situated.
- The severity of the disease.
- The patient's response to previous treatment for recurring symptoms.
Some patients can have long periods without any symptoms (remission). However, there will generally be recurrences. Some people may spend years without a recurrence. As periods of remission vary so much, it can be hard to know how effective treatment has been. It is impossible to predict how long a period of remission is going to be.
Medication for Crohn's disease
- Anti-inflammation drugs - the doctor will most likely start with mesalamine (Sulfasalazine), which helps control inflammation.
- Cortisone or steroids - corticosteroids are drugs containing cortisone and steroids.
- Immunosuppressant drugs - these drugs reduce the patient's immune response. The doctor may prescribe 6-mercaptopurine or a related drug, azathioprine. Side effects include vomiting, nausea, and a weaker resistance to infection.
- Infliximab (Remicade) - this blocks the body's inflammation response.
- Antibiotics - fistulas, strictures, or prior surgery may cause bacterial overgrowth. Doctors will generally treat this by prescribing ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
- Anti-diarrheal and fluid replacements - when the inflammation subsides, diarrhea usually becomes less of a problem. However, sometimes the patient may need something for diarrhea and abdominal pain.
Children with Crohn's disease might need high-calorie liquid formulas, especially if their growth is being affected. Sometimes, patients may be fed intravenously for a short period (rarely).
Most patients with Crohn's disease say that the following foods can increase diarrhea and cramping:
- bulky grains
- dairy products
- spicy foods
The majority of Crohn's disease patients may need surgery at some point. When medications no longer control symptoms, the only solution is to operate. Surgery can relieve symptoms that did not respond to medication, or to correct complications, such as abscess, perforation, bleeding, and blockage.
Removing part of the intestine can help, but it does not cure Crohn's disease. Inflammation often returns to the area next to where the affected part of the gut was removed. Some Crohn's disease patients may require more than one operation during their lives.
In some cases, a colectomy is needed - the whole colon is removed. During the procedure, the surgeon will make a small opening in front of the abdominal wall, and the tip of the ileum is brought to the skin's surface - this opening is called a stoma. Feces exit the body through the stoma. A pouch collects the feces. Doctors say that a patient who has a stoma can carry on leading a normal and active life.
If the surgeon can remove the diseased section of the intestine and then connect the intestine again, no stoma is needed.
The patient and their doctor need to consider surgery very carefully. It is not appropriate for everyone. The patient has to bear in mind that after the operation, the disease will recur.
The majority of Crohn's disease patients are able to live normal and active lives, hold jobs, raise families, and function successfully.
If symptoms are severe and frequent, the likelihood of complications is higher. The following complications may require surgery:
- Internal bleeding.
- Stricture - a part of the gut narrows, causing build up of scar tissue, and partial or complete blockage of the intestine.
- Perforation - a small hole develops in the wall of the gut. Contents leak out of this hole and cause infections or abscesses.
- Fistulas - a channel forms between two parts of the gut.
- Persistent iron deficiency.
- Food absorption problems.
- Slightly higher risk of developing bowel cancer.