Crohn's Disease
What is Crohn's disease?
Crohn's disease and ulcerative colitis are the illnesses called inflammatory bowel disease (IBD). These two diseases are very much alike.
In Crohn's disease, inflammation can be found in the lining of the intestine. It can also involve the whole thickness of the bowel wall. Crohn's disease is usually in the lower part of the small intestine, called the ileum. However, it can affect any part of the digestive tract, from where food is taken in (the mouth) to where food comes out (the anus).
Ulcerative colitis only affects the colon. The inflammation can cause pain. It can also make the colon empty often, which causes diarrhea.
Some patients with Crohn's disease have long periods of remission (when symptoms disappear). This may last months or years. However, there is no way to tell when a remission will happen or when disease symptoms will return. There is no cure for Crohn's disease.
About one million Americans have IBD, inflammatory bowel disease. People of all age groups can have Crohn's disease, but it usually begins in the late teens and early adulthood. Twenty percent of all Crohn's cases affect children.
The disease affects males and females equally, but Crohn's disease tends to run in families and certain ethnic groups. About twenty percent of people with Crohn's disease have a blood relative with some type of IBD. For those patients with a family history, it is very likely that Crohn's disease will begin in the teens and twenties.
What causes Crohn's disease?
There is no known cause for Crohn's disease, but there are many theories. One theory is that the body's immune system reacts to a virus or bacteria. This reaction causes inflammation in the intestine.
It has been proven that people with Crohn's disease have abnormalities (problems) in the immune system, the part of the body responsible for fighting off infection. It is not known if these abnormalities are a cause of the disease or a result of the disease. There is little evidence that Crohn's disease is caused by emotional distress.
What are the symptoms of Crohn's disease?
Crohn's disease can be hard to diagnose, as its symptoms can be like other intestinal disorders. Patients can have a wide range of symptoms. However, each person may experience symptoms in a different way.
- Loose, watery, or frequent bowel movements (diarrhea)
- Abdominal pain
- Rectal bleeding (blood on bowel movements)
- Fever
- Lack of appetite
- Weight loss
- Stunted growth
- Fatigue (tiredness)
- Joint pain
Some patients may be in remission for a long time, which means they are free of symptoms.
How is Crohn's disease diagnosed?
A complete physical exam and medical history are taken to help diagnose Crohn's disease. In addition, several tests may be needed.
- Blood tests check for anemia (low red blood cell count). The tests can also show if there is an increased number of white blood cells, which might mean that there is an infection or inflammation somewhere in the body.
- Stool cultures tell if there is an infection by a parasite, virus or bacteria. Stool can also be tested for occult (hidden) blood that is not seen on the stool.
- Upper endoscopy is a procedure that uses a small, flexible tube with a light and a camera lens at the end (endoscope). This allows the doctor to examine the inside of the esophagus, stomach and duodenum (the first part of the small intestine). Tissue samples may be taken for further examination (see biopsy).
- Colonoscopy is a test that uses a long, flexible tube with a light and camera lens at the end (colonoscope). This allows the doctor to examine the large intestine. Tissue samples may be taken for further examination (see biopsy).
- Biopsy is a tissue sample that is taken for examination and testing in a laboratory. For Crohn's disease, the tissue sample is taken from inside the digestive tract. A biopsy is usually done during a colonoscopy or upper endoscopy.
- Barium enema / X-ray is a test that examines the large intestine for abnormalities. A chalky fluid called barium is put into the rectum as an enema. The barium coats the inside of the colon so that it will show up on an X-ray film or picture. An X-ray of the abdomen shows strictures (narrowed areas), blockages and other problems.
- Upper gastrointestinal (GI) series is a procedure that examines the stomach and small intestine. Barium is swallowed and then followed through the intestine with an X-ray.
What is the treatment for Crohn's disease?
There is no cure for Crohn's disease, but treatment can help control the disease. The treatment depends upon many things:
- Location of the disease
- Problems that the disease may be causing
- How the patient responds to treatment
- The amount of inflammation that is present
The goal of the treatment is to:
- Control the inflammation
- Correct problems the patient may be having with nutrition
- Relieve symptoms such as pain, diarrhea or rectal bleeding
- Help keep the disease in remission
When the disease is under control, treatment tries to keep the symptoms from coming back (a "flare"). Treatment may include:
Medication:
Many different types of drugs are used to treat Crohn's disease.
- Anti-inflammatory drugs (aminosalicylates or 5-ASA drugs) are usually used to treat mild to medium symptoms. Some examples are Asacol", Pentasa", Dipentum" and Colazal".
- Cortiocosteroids, such as prednisone, help to put a patient with medium to severe symptoms into remission. These drugs are not good to use for a long time because of side effects.
- Drugs that suppress or quiet the immune system (immunomodulators) are used in medium to severe Crohn's disease to help patients stay in remission. Some examples are Imuran" (azathioprine), purinethol (6-MP) and methotrexate.
- Antibiotics may also be used to treat bacteria in the small intestine that can keep the inflammation going. Some examples are Flagyl" (metronidazole) and Cipro" (ciprofloxacin).
- Infliximab, (brand name Remicade"), is a newer drug approved by the U.S. Food and Drug Administration for treating medium to severe Crohn's disease that does not respond to the other medications. This medicine must be given through a vein (intravenously).
Food and vitamin supplements:
Good nutrition is an important part of treating Crohn's disease. No special diet has been proven to be the best for preventing or treating Crohn's disease. Some patients find that symptoms are worse when they have milk, alcohol, hot spices or food containing fiber. Nutritional supplements or special high-calorie liquid formulas are sometimes suggested, especially for children with poor growth.
Surgery:
When medication is not able to control the disease or when there are other problems (such as a tight area or hole in the bowel), surgery is needed. Crohn's disease may be helped by having surgery to remove part of the intestine. During surgery, two ends of the healthy bowel are joined together (anastomosis).
In some patients, it may not be possible to join the two ends of the bowel together. In this case, a small opening is made in the front of the abdominal wall. Then the tip of the bowel is brought to the skin's surface (this is called an ostomy). The opening is called a stoma. Waste leaves the body through the stoma and goes into a bag worn over the opening. Patients with ostomies can live normal, active lives.
Surgery may make symptoms better, but it will not cure Crohn's disease, as the disease can come back. Get as much information as you can about surgery from your doctors, nurses and other patients before making your decision about surgery.
Revised 8/03, 6/05
