Crohn’s Disease

Crohn’s Disease is diagnosed and treated by the GI Division of Premier Medical Group.

What is Crohn’s Disease?

Crohn’s disease is a form of IBD, or inflammatory bowel disease. Portions of the digestive tract swell and develop deep sores called ulcers. The part of the GI tract most often affected is the end portion of the small intestine, also referred to as the “ileum,” and the first part of the large intestine. Crohn’s is a lifelong disease which affects both men and women equally and also seems to run in families. The disease occurs in people of all ages, but it most often begins between the ages of 13 and 30. People who smoke are more likely to develop Crohn’s, as are people of European Jewish heritage.

In Crohn’s disease, when inflammation spreads into the lining of the affected portion of the GI tract, swelling and pain occurs and can make the intestines empty frequently, resulting in diarrhea. Chronic inflammation may yield scar tissue. This builds up in the GI tract and a stricture forms, which is a narrowed passageway that can slow up the movement of food through the intestine. This can cause cramps and pain and at times blockage in the small intestines.

What causes Crohn's disease?

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Although the cause of Crohn’s disease is unknown, it is believed that it is the result of an abnormal reaction by the body’s immune system to some bacteria in your intestine.  The immune system normally protects people from infection by identifying and destroying bacteria, viruses, or other potentially harmful foreign substances, but with Crohn’s disease, it attacks the “harmless” or beneficial bacteria, and food. This all leads to a production of white blood cells which accumulate in the intestines, creating inflammation. The inflammation can cause injury to your intestines such as sores and ulcers, or narrowing called stricture.

Studies show that the inflammation in the intestinal tract of people with Crohn’s disease is influenced by several factors: the person’s immune system, the inherited genes, and the environment.

The chances of getting Crohn’s disease are higher if a close family member has it. People of Eastern European and Jewish family background may have a higher chance of getting Crohn’s disease, as do those who smoke.

What are the symptoms of Crohn’s disease?

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The most common symptoms of Crohn’s disease are cramping and abdominal pain.

Other symptoms can include:

  • Abdominal pain
  • Frequent diarrhea
  • Fever
  • Fatigue
  • Anemia
  • Reduced appetite
  • Weight loss
  • Rectal bleeding

These can vary from mild to severe, depending on the person and severity of the disease.

Other possible symptoms of Crohn’s diseases include:

  • Blood in the stool or rectal bleeding
  • Arthritis
  • Skin rash, lumps, sores, or other skin problems
  • Fever
  • Constipation
  • Joint pain
  • Ulcers in the mouth or swelling of the gums

How is Crohn’s disease diagnosed?

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Crohn’s disease is not easy to diagnose. The symptoms are similar to ulcerative colitis, irritable bowel syndrome, and other IBDs (Inflammatory bowel diseases). Both Crohn’s disease and ulcerative colitis cause abdominal pain and diarrhea, making them difficult to identify.

The only way to diagnose Crohn’s disease is by performing tests, such as blood tests and visual tests. Normally, the doctor performs a signoidoscopy, or colonoscopy, or endoscopy, and X-Rays to accurately make the diagnosis. The major difference between Crohn’s and ulcerative colitis is the area each affects. Crohn’s can affect any area of the digestive tract, while UC is limited to the colon and rectum.

More often, though, the area of the GI tract most affected with Crohn’s is the last section of the small intestine, referred to as the ileum.

 

How is Crohn’s disease treated?

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Treatment will differ with patients, but may include medications, stress reduction, surgery, diet recommendations, nutritional supplements, or a combination of treatments. At this time, there is no known cure for Crohn’s disease. The primary goal is to control the symptoms and limit inflammation. Treatment with medications will depend on the severity of the disease, and the reaction of the medications to the patient. These medications include cortisone or steroids, immune system suppressors, anti-diarrheal drugs and antibiotics. If the Crohn’s disease is very severe, your doctor may prescribe a medication called Remicade to block the body’s inflammation response.

Foods can trigger symptoms, although no specific diet exists. Patients need to learn what foods trigger the symptoms. It’s helpful to keep a food journal in these cases.

Categories of medications that treat Crohn’s include:

  • Antibiotics
  • Aminosalicylates (5-ASAs)
  • Corticosteroids
  • Immune modifiers (immunomodulators)
  • Biologic therapies (biologics)

Over-the-counter (OTC) medications occasionally used:

  • Anti-diarrheals
  • Pain relievers
  • Nutritional supplements

Dietary suggestions to help treat symptoms include:

  • Limit dairy products and caffeine
  • Avoid fatty and fried foods (any prepared with heavy cream, butter, or margarine)
  • Stop smoking
  • Eat smaller meals spaced out throughout the day
  • Avoid foods that cause gas such as spicy foods, certain vegetables (cabbage, broccoli, cauliflower), and citrus or raw fruits
  • Drink plenty of water

Surgery

About two-thirds of people with Crohn’s disease will require surgery at some point in their lives. This happens when medications are not relieving the symptoms or complications such as intestinal blockage, perforation, bleeding, or abscess—a painful, swollen, pus-filled area caused by infection—occurs. Several types of surgery are used for the treatment of Crohn’s:

  • Proctocolectomy:This is a surgery which removes the rectum and part of the colon or the entire colon. This surgery is performed by a specialized surgeon.  While the surgeon is performing the proctocolectomy, he or she also performs an ileostomy. This procedure attaches the ileum (end of small intestine) to an opening made in the abdomen called a stoma. About the size of a quarter, an ostomy pouch is then attached to the stoma and worn outside the body to collect stool. You will be instructed how to use the pouch and how to empty it several times a day, and how to keep it clean. Most people with an ostomy pouch are able to live normal, active lives. Performed under anesthesia, a full recovery can take 4 to 6 weeks.
  • Intestinal resection surgeryThis surgery is performed when only a diseased section of intestine is removed. The diseased section is cut out and the ends of the healthy parts are connected. This is done under general anesthesia, and full recovery can take 3 to 4 weeks.

Crohn’s disease can occur after surgery, and often does. People considering surgery should receive counseling about the benefits and risks compared with other treatments.

The best way for people to manage their Crohn’s disease is to learn as much as they can about it. More than half a million people in the United States who have been diagnosed with Crohn’s disease have learned that inflammation is the root of their symptoms. Treatment can help control Crohn’s disease and make flare-ups less frequent, but no cure exists. Some people with Crohn’s disease may need long-lasting medical care, while others have long periods of remission, symptom-free. Because of the changing pattern of the disease, it’s challenging to be certain a treatment has helped. Despite all this, most people with Crohn’s disease live full lives, balancing careers, families, and activities.

FAQs about Crohn's Disease

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Q: Can smoking make Crohn’s disease worse?

A: Studies show that people who smoke may have increased complications and also need higher doses of steroid and other medications. People who smoke also are more likely to need surgery.

Q: Is pregnancy safe for women with Crohn’s disease?

A: Yes, while women with Crohn’s disease can become pregnant and have a baby, it’s important to discuss the risks with your doctor. Most babies are not affected by the condition.

Q: Can stress make Crohn’s disease worse?

A: While stress does not cause Crohn’s disease, increased stress can trigger a flare-up. It’s important to learn relaxation techniques and get enough sleep. Counseling may also be helpful.

Q: Does diet affect Crohn’s disease?

A: Foods do not cause Crohn’s, but certain foods can aggravate the disease such as milk products, bulky grains, hot spices, caffeine, and alcohol. These can cause diarrhea. Eating a nutritious and well balanced diet is important. Your doctor may recommend a nutritionist to help you plan the right diet for your needs.