Crohn’s disease is a chronic bowel disease that causes severe inflammation of the digestive tract. It is associated with abdominal pain, diarrhea, and may affect your quality of life. Crohn’s disease is characterized by alternating between times of flare-ups and remissions. It is named after Dr. Burill B. Crohn, who, in 1932, was the first to describe the disease.
The National Digestive Diseases Information Clearing House estimates that more than 400,000 Americans suffer from Crohn’s. However, according to the U.S. Centers for Disease Control and Prevention (CDC), exact numbers are difficult to confirm due to a lack of standards around diagnosis, as well as wrongly classified cases of the disease.
Crohn’s is included in a larger group of illnesses known as inflammatory bowel diseases. It can appear anywhere along the gastrointestinal tract, from the mouth to the anus. However, it is typically found in the distal small bowel and colon. Crohn’s can also develop anywhere in the intestinal tract. This makes it difficult to diagnose and treat.
Over time, ulcerations (small sores) will develop and extend through the layers of the intestinal tract. This can cause severe complications such as:
- strictures (intestinal narrowing)
- fistulas (abnormal tunneling)
- anal fissures (painful tears in the skin around the anal area)
- ulcers of the gastrointestinal tract
- malabsorption (not absorbing nutrients, leading to weight loss)
The cause of Crohn’s disease is unknown. It’s an autoimmune disorder. That means that a combination of genetics and environment cause your immune system to attack your own intestinal cells.
Some risk factors are known. Unfortunately, none of these are preventable.
Crohn’s disease most affects people between the ages of 15 and 35.
Those with a family history of Crohn’s are at a higher risk.
History of Autoimmune Disorders
If other autoimmune disorders are present (such as rheumatoid arthritis) you have a higher risk for developing Crohn’s disease.
Although people of all races have the disease, Crohn’s is found more often among people from Eastern Europe and American Jews of European descent.
Symptoms of Crohn’s vary depending on the severity of the disease and the location of the inflammation. The universal symptoms, however, are severe abdominal pain and cramping during a severe episode. Other symptoms can include weight loss, diarrhea that may contain blood or mucus, fever, and fatigue.
Because it involves the immune system, symptoms of Crohn’s disease can also be found outside of the gastrointestinal tract. The disease can also include arthritis, skin rash, sores inside of the mouth, osteoporosis, and gallstones.
Crohn’s disease is difficult to diagnose because the symptoms can mimic many other diseases, such as a parasitic infection, diverticulitis, a common disease found in the large intestine, celiac disease, a condition that damages the small intestine, and colon cancer. Another reason that Crohn’s is difficult to diagnose is that there is no specific blood test to identify the disease.
A doctor will consider a variety of factors in diagnosing Crohn’s disease. These include:
History and Physical Exam
Your doctor will begin with a detailed history of your symptoms and any ask about a family history of autoimmune disorders.
This is done to check for any intestinal narrowing or obstruction, which can be a medical emergency.
An ultrasound will rule out diseases of other abdominal organs such as the liver, gall bladder, or pancreas.
CT Scan or MRI
These imaging methods are used to determine any complications of the disease such as fistulas or abscesses.
This is the gold standard for diagnosis of Crohn’s disease. A colonoscopy enables a doctor to see the inside of the intestinal wall and remove a tissue sample for further examination.
There is no cure for Crohn’s disease. Doctors can only try to prevent complications and control inflammation. Since the disease alternates between periods of remission and flare-ups, treatment focuses on helping you avoid an episode. Treatment varies based on the site and severity of disease as well.
Some treatment options include:
Many different medications are used to manage Crohn’s disease. They may be used alone, or in combinations.
Corticosteroids can be used to control inflammation and quiet the immune system. Because of the side effects of chronic use, steroids are often prescribed for a short-term during a flare-up.
Aminosalicylates are anti-inflammatory drugs that treat mild to moderate symptoms and help keep you in remission.
Immunosuppressive agents are prescribed to help you maintain remission by calming an over-active immune system.
Antibiotics are prescribed to prevent and treat infection or decrease the overgrowth of bacteria in the gastrointestinal tract.
Biologic agents are similar to drugs used in chemotherapy and are given for more severe cases. These medications may be given orally, intravenously, or by self-injection.
Depending on the location and severity of the condition, it may be necessary to remove a diseased portion of the intestine. Unfortunately, this doesn’t cure the disease. Crohn’s is a chronic condition that often will reoccur later in life. There are also times when it is necessary to remove an ulceration or blockage in the digestive tract.
Surgery is done cautiously and every attempt is made to preserve as much intestine length as possible to avoid further complications.
People with Crohn’s disease are often underweight because intestinal inflammation interferes with the absorption of food. Nutritional counseling and dietary supplements may be used.
Stress can increase the frequency and severity of flare-ups. Stress management and emotional support are important to a successful treatment plan.
Crohn’s flare-ups cannot be prevented. Certain lifestyle changes, however, can decrease the severity of a flare-up:
A low fiber diet can decrease bowel frequency and help reduce diarrhea. Many Crohn’s patients find that diarrhea and flatulence improves by limiting gas-producing foods such as beans, cabbage, broccoli, raw fruits, and juices. Limiting dairy has also been helpful in managing the condition. A dietitian may also recommend six small, frequent meals per day instead of three large ones.
Limiting stress and learning to manage it with exercise and relaxation techniques can help decrease symptoms.
Recent studies have shown that even light smoking can increase the intensity of flare-ups.
Patients who have Crohn’s must take their medications exactly as prescribed and follow their treatment plan in order to prevent complications and hospitalizations.
Crohn’s disease can be a lifelong challenge. Following your doctor’s advice and sticking with your diet and treatment plan can greatly improve your quality of life.