Crohn’s disease is an inflammatory bowel disease (IBD), which causes inflammation of your digestive tract. It can lead to severe diarrhea, abdominal pain, fatigue, malnutrition, and weight loss. Inflammation caused by Crohn’s disease involves different areas of the digestive tract in different people.
The inflammation caused by Crohn’s disease often spreads deep into the layers of affected bowel tissue. Apart from being painful, Crohn’s disease can be life-threatening.
The cure for Crohn’s disease is yet unknown, though therapies can greatly reduce its symptoms and even bring about long-term remission.
Symptoms of Crohn’s disease
Crohn’s disease affects only the last segment of the small intestine (ileum) in some people. However in others, the disease is limited to the large intestine (colon). The most common areas affected by Crohn’s disease are the last part of the small intestine and the colon.
Signs and symptoms of Crohn’s disease can range from mild to severe. They usually develop gradually, but can also occur abruptly. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include:
- Abdominal pain and crapmping
- Sores in mouth
- Blood in stool
- Reduced appetite and weight loss
- Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)
Severe signs and symptoms may include:
- Inflammation of skin, eyes and joints
- Inflammation of the liver or bile ducts
- Delayed growth or sexual development, in children
When to see a doctor
See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn’s disease, such as:
- Abdominal pain
- Unexplained fever lasting more than two days
- Blood in your stool
- Ongoing bouts of diarrhea that don’t respond to over-the-counter medications
- Unexplained weight loss
Causes of Crohn’s disease
The exact cause of Crohn’s disease remains unknown. Diet and stress were earlier suspected, but now doctors know that these factors may worsen but don’t cause Crohn’s disease. A number of factors, such as heredity and a malfunctioning immune system, are likely responsible for its development.
- Immune system.A virus or bacterium may trigger Crohn’s disease. When your immune system tries to combat the attacking microorganism, an abnormal immune response triggers the immune system to attack the cells in the digestive tract, too.
- Crohn’s is more common in people who have family members with the disease, so genes may play a role in making people more susceptible. However, some people with Crohn’s disease don’t have a family history of the disease.
Risk factors for Crohn’s disease may include:
- Crohn’s disease can occur at any age, but a person is more likely to develop the condition at a younger age. Most people who develop Crohn’s disease are diagnosed before they’re around 30 years old.
- Although Crohn’s disease can affect any ethnic group, whites and people of Eastern European (Ashkenazi) Jewish descent have the highest risk. However, the incidence of Crohn’s disease is increasing among blacks who live in North America and the United Kingdom.
- Family history.You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease. As many as 1 in 5 people with Crohn’s disease has a family member with the disease.
- Cigarette smoking.Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease. Smoking also leads to more-severe disease and a greater risk of undergoing surgery. It’s vital to stop smoking.
- Nonsteroidal anti-inflammatory medications.These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium (Voltaren) and others. While they do not cause Crohn’s disase, they can cause inflammation of the bowel that deteriorates the symptoms of Crohn’s disease.
- Where you live.If you live in an urban area or in an industrialized country, you’re more prone to develop Crohn’s disease. This suggests that environmental factors, including a diet high in fat or refined foods, may play a role in Crohn’s disease.
Crohn’s disease may lead to one or more of the following complications:
- Bowel obstruction.Crohn’s disease affects the thickness of the intestinal wall, which causes parts of the bowel to scar and narrow over time. It may then cause a blockage in the flow of digestive contents. Surgery may be used to remove the diseased portion of the bowel.
- Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your genital area, anus and mouth.
- Sometimes ulcers can spread completely through the intestinal wall, creating an abnormal connection between different body parts (fistula). Fistulas can develop between your intestine and skin, or between your intestine and another organ. When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption. In some cases, a fistula may become infected and form an abscess, which can be deadly if not treated.
- Anal fissure.This is a small rip in the tissue that lines the anus or in the skin around the anus where infections can occur. It’s often associated with painful bowel movements and may cause a perianal fistula.
- Abdominal pain, diarrhea, and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nurtured. It’s also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
- Colon cancer.Having Crohn’s disease that affects your colon can increase your risk of colon cancer. General colon cancer screening guidelines for people without Crohn’s disease call for a colonoscopy every 10 years beginning at age 50.
- Medication risks.Certain Crohn’s disease drugs that act by obstructive functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase risk of infection. Corticosteroids can be linked to a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure. Consult your doctor to determine risks and benefits of medications.
After ruling out other possible causes for your signs and symptoms, your doctor will likely diagnose Crohn’s disease. There is no one test to diagnose Crohn’s disease.
READ ALSO: Inflammatory Bowel Disease (IBD)
Your doctor will likely use a combination of tests to help confirm a diagnosis of Crohn’s disease, including:
- Tests for anemia or infection.Your doctor may suggest blood tests to check for anemia (a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues) or to check for signs of infection.
- Fecal occult blood test.You may need to provide a stool sample so that your doctor can test for hidden (occult) blood in your stool.
- This test views your colon and the very end of your ileum (terminal ileum) using a thin, flexible, lighted tube with an attached camera. Your doctor can also take small samples of tissue (biopsy) for laboratory analysis, which may help confirm a diagnosis. If clusters of inflammatory cells called granulomas are present, it can help confirm the diagnosis of Crohn’s.
- Computerized tomography (CT).This is a special X-ray technique that provides more detail than a standard X-ray. This test examines the entire bowel as well as at tissues outside the bowel. CT enterography is a special CT scan that provides better images of the small bowel. This test has replaced barium X-rays in many medical centers.
- Magnetic resonance imaging (MRI).An MRI scanner uses a magnetic field and radio waves to create detailed images of organs and tissues. MRI is particularly useful for evaluating a fistula around the anal area (pelvic MRI) or the small intestine (MR enterography).
- Capsule endoscopy.For this test, you swallow a capsule that has a camera in it. The camera takes pictures of your small intestine, which are transmitted to a recorder you wear on your belt. The images are then downloaded to a computer, displayed on a monitor and checked for signs of Crohn’s disease. The camera exits your body painlessly in your stool. You may still need endoscopy with biopsy to confirm the diagnosis of Crohn’s disease.
- Balloon-assisted enteroscopy.A scope is used with a device called an overtube to enable the doctor examine the small bowel where standard endoscopes don’t reach.
There is currently no cure for Crohn’s disease, and there is no one treatment that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in your body, but they don’t work for everyone with Crohn’s disease. Doctors generally use them only if you don’t respond to other treatments.
Corticosteroids may be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids may also be used in combination with an immune system suppressor.
- Oral 5-aminosalicylates.These drugs include sulfasalazine (Azulfidine), which contains sulfa, and mesalamine (Asacol HD, Delzicol, others). Oral 5-aminosalicylates have been widely used in the past but now are generally considered of limited benefit.
Immune system suppressors
These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone. Immunosuppressant drugs include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan).These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting.
- Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia).These drugs, called TNF inhibitors or biologics, work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
- Methotrexate (Trexall).This drug is sometimes used for people with Crohn’s disease who don’t respond well to other medications. You will need to be followed closely for side effects.
- Natalizumab (Tysabri) and vedolizumab (Entyvio).These drugs work by stopping certain immune cell molecules — integrins — from binding to other cells in your intestinal lining. Because natalizumab is associated with a rare but serious risk of progressive multifocal leukoencephalopathy — a brain disease that usually leads to death or severe disability — you must be enrolled in a special restricted distribution program to use it.
Vedolizumab recently was approved for Crohn’s disease. It works like natalizumab but appears not to carry a risk of brain disease.
- Ustekinumab (Stelara).This drug is used to treat psoriasis. Studies have shown that it’s useful in treating Crohn’s disease as well and may be used when other medical treatments fail.
Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Scientists also think antibiotics can help reduce harmful intestinal bacteria that may play a role in activating the intestinal immune system, leading to inflammation. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:
- Anti-diarrheals.A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.
- Pain relievers.Your doctor may recommend acetaminophen, but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve). These drugs are likely to aggravate your symptoms.
- Iron supplements.If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.
- Vitamin B-12 shots.Crohn’s disease can lead to vitamin B-12 deficiency. Vitamin B-12 helps promotes normal growth/development, prevent anemia, and helps proper nerve function.
- Calcium and vitamin D supplements.Crohn’s disease and steroids used to treat it can increase your risk of osteoporosis, so you may need to take a calcium supplement.
Your doctor may recommend a special diet given through a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can allow the bowel to rest to reduce inflammation in the short term.
Your doctor may use nutrition therapy short term and combine it with medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.
Your doctor may also recommend a diet low in fiber to reduce the risk of intestinal blockage if you have a narrowed bowel (stricture).
If diet and lifestyle changes, drug therapy, or other treatments fail to relieve your symptoms, your doctor may recommend surgery. Nearly half of those with Crohn’s disease will require at least one surgery. But, surgery does not cure Crohn’s disease.
During surgery, the damaged portion of your digestive tract is removed and then reconnected to the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn’s disease are usually short-term. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.
Lifestyle and home remedies
Changes in your diet and lifestyle may help control your symptoms.
Certain foods and beverages can worsen your signs and symptoms, especially during a flare-up. It can be helpful to keep a food diary so as to keep track of what you’re consuming, as well as how you feel. If you discover some foods are causing your symptoms to flare, you can try getting rid of them. Here are some suggestions that may help:
- Limit intake of dairy products.Most people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant when your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help.
- Try low-fat foods.You may not be able to digest or absorb fat normally if your small intestine is affected by the disease. Try avoiding butter, margarine, cream sauces and fried foods.
- Limit fiber.If you have inflammatory bowel disease, foods high in fiber, such as fresh fruits, vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.
- Avoid other problem foods.Avoid alcohol, spicy foods, and caffeine because they may make your signs and symptoms worse.
Other dietary measures
- Eat small portion.You may find you feel better eating four small meals a day rather than two or three larger ones.
- Drink lots of water.Try to drink plenty of fluids daily especially water. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse. Avoid carbonated drinks because they frequently produce gas.
- Consider multivitamins.Crohn’s disease can interfere with your ability to absorb nutrients, so multivitamin and mineral supplements are often helpful. Consult your doctor before taking any vitamins or supplements.
Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries. Quitting smoking can improve the overall health of your digestive tract, as well as provide many other health benefits.
Although stress doesn’t cause Crohn’s disease, it can make your signs and symptoms worse and may trigger flare-ups. Although it’s not always possible to avoid stress, you can learn ways to help manage it, such as:
- Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that’s right for you.
- This stress-reduction technique may help you reduce muscle tension and slow your heart rate with the help of a feedback machine. The goal is to help you enter a relaxed state so that you can cope more easily with stress.
- Regular relaxation and breathing exercises.One way to cope with stress is to regularly relax and use techniques such as deep, slow breathing to calm down. You can take classes in yoga and meditation or use books, CDs or DVDs at home.
Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). However, there are few well-designed studies of their safety and effectiveness.
Some commonly used therapies include:
- Herbal and nutritional supplements.Most alternative therapies aren’t regulated by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. Note that natural herbs and supplements can have side effects and cause dangerous interactions. See your doctor before trying any herbal supplement.
- Some people may find acupuncture or hypnosis useful for the management of Crohn’s.
- Prebiotics are natural compounds found in plants, such as artichokes, that help fuel beneficial intestinal bacteria.
Coping and support
Crohn’s disease doesn’t just affect you physically — it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. All of these factors can alter your life and may lead to depression. Here are some things you can do:
- Be informed.One of the best ways to be more in control is to find out as much as possible about Crohn’s disease. Look for information from the Crohn’s & Colitis Foundation.
- Join a support group.Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among others with Crohn’s disease.
- Talk to a therapist.Some people find it helpful to consult a mental health professional who’s familiar with inflammatory bowel disease and the emotional difficulties it can cause.
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