What is Crohn's disease?
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.
Symptoms can be unpleasant. They include 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.
Having a support system that understands the experience of having Crohn's is important. IBD Healthline is a free app for people with a Crohn's diagnosis. The app is available on the AppStore and Google Play. Download here: https://go.onelink.me/LOC7/3e87f450.
Pain is commonly felt on the lower right side of the abdomen, but can affect many areas of the gut.
Crohn's disease symptoms vary depending on which part of the gut is affected. Symptoms often include:
- Pain: The level of pain varies between individuals and depends on 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: These are a common symptom.
- Diarrhea: This can range from 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: There may be time when the appetite is very low.
- Weight loss: This can result from a loss of appetite.
- Anemia: A loss of blood can lead to anemia.
- Rectal bleeding and anal fissures: The skin of the anus becomes cracked, leading to pain and bleeding.
Other possible symptoms:
- uveitis (eye inflammation)
- skin rash and inflammation
- liver or bile duct inflammation
- delayed growth or sexual development, in children
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.
Children with Crohn's disease might need high-calorie liquid formulas, especially if their growth is being affected.
Most patients with Crohn's disease say that the following foods can increase diarrhea and cramping:
- bulky grains
- dairy products
- spicy foods
Some people do not feel like eating. In severe cases, they may need to feed intravenously for a short period.
Bulky grains, like those contained in bread, can worsen Crohn's disease.
Treatment may involve medication, surgery, and nutritional supplements.
The aim is to control inflammation, correct nutritional problems, and relieve symptoms.
There is no cure for Crohn's disease, but some treatments can help 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 people can have long periods, even years, without any symptoms. This is known as remission. However, there will usually be recurrences.
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.
- 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.
Biologics are a new type of drug that scientists have developed from a living organism. They reduce the body's immune response by targeting proteins that lead to inflammation.
Biologics appear to help people with Crohn's disease.
Examples of biologics for Crohn's include:
- infliximab (Remicade)
- adalimumab (Humira)
- 6-mercaptopurine (Purinethol)
- imuran (Azathioprine)
- certolizumab pegol (Cimzia)
Biologic treatments can have side effects, include vomiting, nausea, and a weaker resistance to infection.
Some studies suggest that the use of biologics can reduce the chance that a person will need abdominal surgery within 10 years to 30 percent. Before the introduction of biologics, researchers put this figure at 40–55 percent.
Biologics also appear to reduce the risk of adverse effects that can arise when a person uses corticosteroids.
There are different types of biologic drugs, and individuals react differently to them. A doctor will recommend a suitable option, and they may suggest trying an alternative or a combination of drugs if the first one does not work.
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, in which the whole colon is removed. 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 to form an opening 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.
Most people with Crohn's disease can live normal and active lives, hold jobs, raise families, and function successfully.
Smoking may increase the risk of developing Crohn's disease.
The exact cause of Crohn's disease is unclear, but it is thought to stem from an abnormal reaction in the immune system.
The theory is that the immune system attacks foods, good bacteria, and beneficial substances as if they are unwanted substances.
During the attack, white blood cells build up in the lining of the gut, and this buildup triggers inflammation. The inflammation leads to ulcerations and bowel injury.
However, it is unclear whether the abnormal immune system causes Crohn's disease or results from it.
Factors that may increase the risk of inflammation include:
- genetic factors
- the individual's immune system
- environmental factors
Around 3 in 20 people with Crohn's have a close relative with the condition. If an identical twin has Crohn's disease, the other twin has a 70 percent chance of having it, too.
A bacterium or virus may play a role. E. coli bacteria has been linked to Crohn's disease, for instance.
Smoking is another risk factor.
A doctor will ask the person about any signs and symptoms. A physical examination may reveal a lump in the abdomen, caused when loops of inflamed bowels become stuck together.
The following tests may help in the diagnosis:
- stool and blood tests
- sigmoidoscopy, where a short, flexible tube (sigmoidoscope) is used to investigate the lower bowel
- colonoscopy, where a long, flexible tube (colonoscope) is used to investigate the colon
- endoscopy, if symptoms occur in the upper part of the gut. A long, thin, flexible telescope (endoscope) goes down through the esophagus into the stomach.
- CT scan or barium enema X-ray to reveal changes inside the bowel
If symptoms are severe and frequent, the likelihood of complications is higher. The following complications may require surgery:
- internal bleeding
- stricture, where a part of the gut narrows, causing build up of scar tissue, and partial or complete blockage of the intestine
- perforation, when a small hole develops in the wall of the gut, from which contents can leak, cause infections or abscesses
- fistulas, when a channel forms between two parts of the gut
There may also be:
- a persistent iron deficiency.
- food absorption problems.
- slightly higher risk of developing bowel cancer.