Crohn's disease is a chronic condition in which there is chronic inflammation in the gastrointestinal (GI) tract or "bowel." It is one type of inflammatory bowel disease (IBD). Another type of IBD is ulcerative colitis. While Crohn's disease can affect any part of the digestive system from the mouth to the anus, it occurs more commonly in the ileum (part of the small intestine) and colon (large intestine).
Most cases of Crohn's disease are diagnosed before the age of 30, but it can affect people of any age group. Crohn's disease isn't usually fatal, but it can be a lifelong inconvenience. There is no definitive cure.
The exact cause of Crohn's disease is unclear, although there is an autoimmune element. That means the body's natural defenses, which are normally supposed to fight infection, think the intestine is foreign and attack the body's own tissue, leading to inflammation. Autoimmune diseases run in families. About one-quarter of Crohn's patients have relatives who also suffer from IBD.
It is also believed that a virus or bacteria may be involved, which may cause the initial damage to the lining of the GI tract. However, it is not yet known which organism might be involved.
Symptoms and Complications
The first signs of Crohn's disease are usually abdominal pains and diarrhea after eating. Other symptoms include:
- abdominal tenderness or swelling
- blood in the stool
- loss of appetite
- rectal bleeding
- stomach cramps
- weight loss
Some symptoms do not affect the digestive system. These include joint pain, eye inflammation or red eye, and skin problems. Children tend to show more of these symptoms, and they may lack abdominal pain or diarrhea until later in life.
Crohn's disease tends to come and go. A person can often go months without a symptom. During a flare-up, the bleeding can be quite severe. Some people with active Crohn's disease develop anemia (lack of blood iron from blood loss), leading to weakness and pale skin.
Crohn's disease is associated with several complications, many of which are linked to the constant inflammation of the bowel and to the person's abnormal immune system. Here are some of the most common ones:
- partial obstruction of the bowel, which causes vomiting and constipation
- poor absorption of food (malabsorption), which results in nutritional deficiencies
- fistulas, which are sores that tunnel through from the GI tract to another organ (like the bladder or vagina), to other parts of the intestine, or to the skin surface (they may exit the body near the anus). Fistulas are often very painful and can be life threatening if left untreated.
- anal fissures, which are cracks in the anus that may be painful and cause bleeding
- strictures (abnormal narrowing of a portion of the intestine)
- increased risk of colorectal cancer
- skin problems
- inflammation in the eyes or mouth
- stunted growth in children
A few people with Crohn's disease have no problems in the short term except for one or more symptoms such as skin lesions or arthritis. These people sometimes wait years before they are diagnosed with Crohn's disease.
Making the Diagnosis
The two main diagnostic tools are X-ray and colonoscopy. Colonoscopy involves inserting an endoscope, a flexible tube with a tiny camera on the end, into the anus to explore the inner walls of the intestine.
Many times, the small intestine is then evaluated, often by X-ray, CT scan, or a swallowed capsule that takes pictures that the doctor reviews on a computer monitor.
It is also necessary to give a blood sample to check for anemia, and a stool sample to eliminate the possibility of infectious colitis (a bacterial or parasitic infection in the large bowel).
Treatment and Prevention
While there is no cure, Crohn's disease is treatable. Many medications can help control the symptoms of Crohn's disease. These include:
- Corticosteroids such as budesonide*, hydrocortisone, and prednisone are used short term to reduce swelling and tissue damage.
- Immune modifiers such as azathioprine, 6-mercaptopurine, and methotrexate help suppress the immune system so that the body stops attacking its own tissues. These treatments may be used long term.
- Sulfasalazine, an anti-inflammatory medication, may be used in mild cases of Crohn's disease.
- Biologic response modifiers , also known as biologics, such as adalimumab, infliximab, ustekinumab and vedolizumab, are given as injections to people with moderate-to-severe symptoms when other treatments are not effective.
- Antibiotics such as metronidazole and ciprofloxacin can prevent and treat bacterial growth in infected wounds in the bowels.
- Loperamide or other drugs to slow down intestinal transit may be taken to alleviate general cramps and diarrhea, but should not be used in severe cases.
A good diet is just as important as medications in the treatment of Crohn's disease. Not only are some foods gentler on an inflamed intestine, it's also vital to get the right nutrition even when the gut isn't processing food efficiently. The wrong diet can lead to weight loss and more symptoms. There are special high-calorie liquid supplements that can help. Your doctor will make recommendations on dietary requirements and may test certain vitamin levels in your blood every 1 to 2 years.
Unlike ulcerative colitis, Crohn's can't be completely cured by surgery. Removing an inflamed part of the colon may offer many symptom-free years, but eventually, inflammation recurs at the site where the two cut ends have been joined together, causing symptoms to appear again.
Surgery may involve removal of part of the colon or small intestine, removing the inflamed part in the middle and reattaching the loose ends. If the rectum is diseased, however, it is removed with the whole colon.
The small intestine is then attached to a hole created in the side of the abdomen, creating an ileostomy. If only a part of the colon has been removed and the remaining portion is attached to a hole created in the side of the abdomen, the opening is called a colostomy. Waste collects in an external pouch attached to these openings, and needs to be changed on a regular basis. These pouches can emit smells and noises. A person considering surgery must weigh the risks and benefits of surgery very carefully with their doctor, bearing in mind that it's not always a complete solution but may be necessary in certain circumstances.
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