All About Crohn’s Disease
Definition & Facts
What is Crohn’s disease?
Crohn’s disease is a chronic disease that causes inflammation and irritation in your digestive tract. Most commonly, Crohn’s affects your small intestine and the beginning of your large intestine. However, the disease can affect any part of your digestive tract, from your mouth to your anus.
Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.
Crohn’s disease most often begins gradually and can become worse over time. You may have periods of remission that can last for weeks or years.
How common is Crohn’s disease?
Researchers estimate that more than half a million people in the United States have Crohn’s disease. Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world. Experts do not know the reason for this increase.
Who is more likely to develop Crohn’s disease?
Crohn’s disease can develop in people of any age and is more likely to develop in people:
- Between the ages of 20–29
- Who have a family member, most often a sibling or parent, with IBD
- Who smoke cigarettes
What are the complications of Crohn’s disease?
Crohn’s disease can thicken the wall of your intestines. Over time, the thickened areas of your intestines can narrow, which can block your intestines. A partial or complete intestinal obstruction, also called a bowel blockage, can block the movement of food or stool through your intestines.
In Crohn’s disease, inflammation can go through the wall of your intestines and create tunnels, or fistulas. Fistulas are abnormal passages between two organs, or between an organ and the outside of your body. Fistulas may become infected.
Inflammation that goes through the wall of your intestines can also lead to abscesses. Abscesses are painful, swollen, pus-filled pockets of infection.
Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
Inflammation anywhere along your digestive tract can lead to ulcers or open sores in your mouth, intestines, anus, or perineum.
Malnutrition develops when your body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
Inflammation in other areas of your body
You may have inflammation in your joints, eyes, or skin.
What other health problems do people with Crohn’s disease have?
If you have Crohn’s disease in your large intestine, you may be more likely to develop colon cancer. If you receive ongoing treatment for Crohn’s disease and stay in remission, you may reduce your chances of developing colon cancer.
Talk with your doctor about how often you should get screened for colon cancer. Screening is testing for diseases when you have no symptoms. Screening for colon cancer can include colonoscopy with biopsies. Although screening does not reduce your chances of developing colon cancer, it may help to find cancer at an early stage and improve the chance of curing the cancer.
Symptoms & Causes
What are the symptoms of Crohn’s Disease?
The most common symptoms of Crohn’s disease are:
- Cramping and pain in your abdomen
- Weight loss
Other symptoms include:
- Eye redness or pain
- Feeling tired
- Joint pain or soreness
- Nausea or loss of appetite
- Skin changes that involve red, tender bumps under the skin
Your symptoms may vary depending on the location and severity of your inflammation.
Some research suggests that stress, including the stress of living with Crohn’s disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.
What causes Crohn’s disease?
Scientists aren’t 100% sure what causes Crohn’s disease. Experts think the following factors may play a role in causing Crohn’s disease.
One cause of Crohn’s disease may be an autoimmune reaction — when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn’s disease.
Crohn’s disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohn’s disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohn’s disease.
Some studies suggest that other factors, in combination with genetic and autoimmune factors, may increase your chance of developing Crohn’s disease:
- Smoking may double your chance of developing Crohn’s disease.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, antibiotics, and birth control pills may slightly increase the chance of developing Crohn’s disease.
- A high-fat diet may also slightly increase your chance of getting Crohn’s disease.
Stress and eating certain foods do not cause Crohn’s disease.
How do doctors diagnose Crohn’s disease?
Doctors typically use a combination of tests to diagnose Crohn’s disease. Your doctor will also ask you about your medical history — including medicines you are taking — and your family history and will perform a physical exam.
During a physical exam, a doctor most often:
- Checks for bloating in your abdomen
- Listens to sounds within your abdomen using a stethoscope
- Taps on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged
Your doctor may use the following tests to help diagnose Crohn’s disease:
- Lab tests
- Intestinal endoscopy
- Upper gastrointestinal (GI) series
- Computed tomography (CT) scan
Your doctor may also perform tests to rule out other diseases, such as ulcerative colitis, diverticular disease, or cancer, that cause symptoms like those of Crohn’s disease.
What tests do doctors use to diagnose Crohn’s disease?
A health care professional may take a blood sample from you and send the sample to a lab to test for changes in:
- Red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
- White blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.
A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.
Intestinal endoscopies are the most accurate methods for diagnosing Crohn’s disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer.
Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum — the lower portion of your small intestine — to look for signs of Crohn’s disease.
A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.
During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and colon and into the lower part of your ileum. If your doctor suspects that you have Crohn’s disease, the colonoscopy will include biopsies of your ileum, colon, and rectum. You won’t feel the biopsies.
Upper GI endoscopy and enteroscopy
In an upper GI endoscopy, your doctor uses an endoscope to see inside your upper digestive tract, also called your upper GI tract.
A trained specialist performs the procedure at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI endoscopy. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.
During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.
During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope using one of the following procedures:
- Push enteroscopy, which uses a long endoscope to examine the upper portion of your small intestine
- Single- or double-balloon enteroscopy, which uses small balloons to help move the endoscope into your small intestine
- Spiral enteroscopy, which uses a tube attached to an endoscope that acts as a corkscrew to move the instrument into your small intestine
In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your digestive tract. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for a capsule endoscopy. You don’t need anesthesia for this procedure.
The test begins in a doctor’s office, where you swallow the capsule. You can leave the doctor’s office during the test. As the capsule passes through your digestive tract, the camera will record and transmit images to a small receiver device that you wear.
When the recording is done, your doctor downloads and reviews the images. The camera capsule leaves your body during a bowel movement, and you can safely flush it down the toilet.
Upper GI series
An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract.
An x-ray technician and a radiologist perform this test at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI series. You don’t need anesthesia for this procedure.
For the procedure, you’ll be asked to stand or sit in front of an x-ray machine and consume a drink with barium, a naturally occurring metal. The barium will make your upper GI tract more visible on an x-ray. You will then lie on the x-ray table, and the radiologist will watch the barium move through your upper GI tract on the x-ray and fluoroscopy.
A CT scan uses a combination of x-rays and computer technology (CT) to create images of your digestive tract.
For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure.
You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can diagnose both Crohn’s disease and the complications of the disease.
How do doctors treat Crohn’s disease?
Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.
No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, prevent flare-ups of your symptoms, and keep you in remission. At present, there is no known cure for Crohn’s.
Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.
Although no medicine cures Crohn’s disease, many can reduce symptoms and promote remission.
These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include:
Some of the common side effects of aminosalicylates include:
- Nausea and vomiting
- Pain in your abdomen
Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include:
Side effects of corticosteroids include:
- Bone mass loss
- High blood glucose
- High blood pressure
- A higher chance of developing infections
- Mood swings
- Weight gain
In most cases, doctors do not prescribe corticosteroids for long-term use.
These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include:
- 6-mercaptopurine, or 6-MP
Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:
- A low white blood cell count, which can lead to a higher chance of infection
- Feeling tired
- Nausea and vomiting
Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.
These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include:
- Anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab, and infliximab
- Anti-integrin therapies, such as natalizumab and vedolizumab
- Anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab
Doctors most often give patients infliximab every 6 to 8 weeks (about 2 months) at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.
Other medicines doctors prescribe for symptoms or complications may include:
- Acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
- Antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
- Loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods because it can increase the chance of developing megacolon — an enlargement of the colon.
If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may:
- Ask you to drink a specially formulated drink that contains important nutrients.
- Give you a drink that contains nutrients through a feeding tube inserted into your stomach or small intestine.
- Give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm
You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.
Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease. Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms.
Doctors most often recommend surgery to treat:
- Bleeding that is life-threatening
- Intestinal obstructions
- Side effects from medicines when they threaten your health
- Symptoms when medicines do not improve your condition
A surgeon can perform different types of operations to treat Crohn’s disease.
For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks (about 1 and a half months).
Small bowel resection
Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are:
- Laparoscopic, when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope — a thin tube with a tiny light and video camera on the end — through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of the small intestine. The surgeon will reconnect the ends of your intestine.
- Open surgery when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of the small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.
A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of the intestine. A surgeon can perform a subtotal colectomy by:
- Laparoscopic colectomy. When a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
- Open surgery. When a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of the large intestine and remove that section. The surgeon will reconnect the ends of your intestine.
Proctocolectomy and ileostomy
A proctocolectomy is a surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum.
The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.
A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma, and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever it occurs.
How do doctors treat the complications of Crohn’s disease?
Your doctor may recommend treatments for the following complications of Crohn’s disease:
A complete intestinal obstruction is life-threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
In most cases, the treatment for Crohn’s disease will also treat your ulcers.
You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
Inflammation in other areas of your body
Your doctor can treat inflammation by changing your medicines or prescribing new medicines.
Eating, Diet, & Nutrition
How can my diet help the symptoms of Crohn’s disease?
Changing your diet can help reduce symptoms. Your doctor may recommend that you make changes to your diet such as:
- Avoiding carbonated, or “fizzy,” drinks
- Avoiding popcorn, vegetable skins, nuts, and other high-fiber foods during symptom flares
- Drinking more liquids
- Eating smaller meals more often
- Keeping a food diary to help identify foods that cause problems
Depending on your symptoms or medicines, your doctor may recommend a specific diet, such as a diet that is:
- High calorie
- Low fat
- Low fiber
- Low salt
Talk with your doctor or Trellus Health Care Team about specific dietary recommendations and changes.
Your doctor may recommend nutritional supplements and vitamins if you do not absorb enough nutrients. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.
Source: National Institute of Diabetes and Digestive and Kidney Diseases