What is Crohn’s Disease?
Named after Dr. Burrill B. Crohn, who first described the disease in 1932 along with colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, Crohn’s disease belongs to a group of conditions known as Inflammatory Bowel Diseases (IBD).
Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Crohn’s disease can also affect the entire thickness of the bowel wall.
Recognizing the Signs and Symptoms
Crohn’s disease can affect any part of the GI tract. While symptoms vary from patient to patient and some may be more common than others, the tell-tale symptoms of Crohn’s disease include:
Symptoms related to inflammation of the GI tract:
- Persistent Diarrhea
- Rectal bleeding
- Urgent need to move bowels
- Abdominal cramps and pain
- Sensation of incomplete evacuation
- Constipation (can lead to bowel obstruction)
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What are the Causes of Crohn’s Disease? Who is Affected?
- Men and Women are equally likely to be affected, and while the disease can occur at any age, Crohn’s is more prevalent among adolescents and young adults between the ages of 15 and 35.
- The causes of Crohn’s Disease are not well understood. Diet and stress may aggravate Crohn’s Disease, but they do not cause the disease on their own. Recent research suggests hereditary, genetics, and/or environmental factors contribute to the development of Crohn’s Disease.
- The GI tract normally contains harmless bacteria, many of which aid in digestion. The immune system usually attacks and kills foreign invaders, such as bacteria, viruses, fungi, and other microorganisms. Under normal circumstances, the harmless bacteria in the intestines are protected from such an attack.
- In people with IBD, these bacteria are mistaken for harmful invaders and the immune system mounts a response. Cells travel out of the blood to the intestines and produce inflammation (a normal immune system response). However, the inflammation does not subside, leading to chronic inflammation, ulceration, thickening of the intestinal wall, and eventually causing patient symptoms.
- Crohn’s tends to run in families, so if you or a close relative have the disease, your family members have a significantly increased chance of developing Crohn’s. Studies have shown that 5% to 20% of affected individuals have a first – degree relative (parents, child, or sibling) with one of the diseases.
- The environment in which you live also appears to play a role. Crohn’s is more common in developed countries rather than undeveloped countries, in urban rather than rural areas, and in northern rather than southern climates.
Types of Crohn’s Disease and Associated Symptoms
If you are diagnosed with Crohn’s Disease, it’s important to know and understand which part of your GI tract is affected and how this may affect the symptoms and complications you experience.
The most common form of Crohn’s, ileocolitis affects the end of the small intestine (the ileum) and the large intestine (the colon). Symptoms include diarrhea and cramping or pain in the right lower part or middle of the abdomen. This type is often accompanied by significant weight loss.
This type affects only the ileum. Symptoms are the same as ileocolitis. In severe cases, complications may include fistulas or inflammatory abscess in right lower quadrant of abdomen.
Gastroduodenal Crohn’s disease
This type affects the stomach and the beginning of the small intestine(the duodenum). Symptoms include loss of appetite, weight loss, nausea, and vomiting.
This type is characterized by patchy areas of inflammation in the upper half of the small intestine (the jejunum). Symptoms include mild to intense abdominal pain and cramps following meals, as well as diarrhea. In severe cases or after prolonged periods, fistulas may form.
Crohn’s (granulomatous) colitis
This type affects the colon only. Symptoms include diarrhea, rectal bleeding, and disease around the anus (abscess, fistulas, ulcers). Skin lesions and joint pains are more common in this form of Crohn’s than in others
Crohn’s Diagnosis & Testing
Crohn’s disease is characterized by a range of signs and symptoms, so there is no single test that can determine the diagnosis of Crohn’s with certainty.
Early Tests and Exams
Early steps in the diagnostic process can include laboratory tests of blood and stool matter, as well as X-rays of the upper and lower GI tract including the use of Barium, a chemical that helps doctors see more details of your GI tract by increasing contrast of the X-Ray image.
Endoscopy and Biopsy
There are two types of endoscopic examinations: a colonoscopy and an upper endoscopy.
- Colonoscopy involves insertion of a flexible tube through the opening of the anus and allows for the examination of the colon, the lowest part of the large intestine.
- Upper Endoscopy involves the insertion of a flexible tube through the opening of the mouth, down the esophagus, into the stomach, and as far as the duodenum, the first part of the small intestine
A colonoscopy to look for any polyps or pre-cancerous changes in the setting of colitis. Chromoendoscopy is a technique of spraying a blue liquid dye during the colonoscopy in order to increase the ability of the endoscopist specialist to detect slight changes in the lining of your intestine.
Small Intestinal Imaging
Typically, these tests include drinking an oral “contrast” and having a fluoroscopic x-ray, Computed Tomography (CT) scan, or Magnetic Resonance Imaging scan. These pictures are transmitted to a receiver belt. The camera is then expelled through a bowel movement. Specialized endoscopies to visualize the small intestine, sometimes called “balloon endoscopy”, may be needed for areas of the intestine that are hard to reach.
Crohn’s Treatment Options
A combination of treatment options can help you stay in control of the disease that there is no standard treatment that will work for all patients. Each patient’s situation is different and treatment must be followed for each circumstance.
Medication treating Crohn’s disease is designed to suppress your immune system’s abnormal inflammatory response that is causing your symptoms. Medication can also be used to decrease the frequency of symptom flare ups (maintaining remission). With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced. Several types of medication are being used to treat Crohn’s disease today.
In some circumstances, a health care provider may recommend adding an additional therapy that will work in combination with the initial therapy to increase its effectiveness. For example, combination therapy could include the addition of a biologic to an immunomodulator. As with all therapy, there are risks and benefits of combination therapy. Combining therapies can increase the effectiveness of IBD treatment, but there may also be an increased risk of additional side effects and toxicity.
Diet & Nutrition
For people diagnosed with Crohn’s disease, it is essential to maintain good nutrition because Crohn’s often reduces your appetite while increasing your body’s energy needs. Additionally, common Crohn’s symptoms like diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals.
Surgery becomes necessary when medications can no longer control symptoms, or if you develop a fistula, fissure, or intestinal obstruction. Surgery often involves removal of the diseased segment of bowel (resection), the two ends of healthy bowel are then joined together (anastomosis). While these procedures may cause your symptoms to disappear for many years, Crohn’s frequently recurs later in life.