What is Crohn’s disease?

Crohn’s disease is a chronic, or long-term condition that causes the digestive tract to become inflamed. It is a kind of disease of the inflammatory bowel. Crohn’s disease can be serious, debilitating and life-threatening at times.

Crohn’s disease, also known as ileitis or enteritis, can affect any part of the intestine, from the mouth up to the anus. Nevertheless, the lower part of the small intestine-the ileum-is compromised in most cases.

Symptoms can be disagreeable. These include ulcers, swelling and discomfort in the intestines.

According to the Centers for Disease Control and Prevention, Crohn’s disease affects 26-199 people per 100,000. Although Crohn’s disease typically starts between the ages of 15 to 40, it can start at any age.

Symptoms

Signs of Crohn’s disease vary depending on which part of the intestine is affected. In many cases the signs include:

• Pain: The level of pain varies between individuals and depends on where the inflammation is in the gut. Most commonly, pain will be felt at the lower-right side of the abdomen.
• Ulcers in the gut: Ulcers are raw areas in the gut that may bleed. If they do bleed, the patient might notice blood in their stools.
• Mouth ulcers: These are a common symptom.
• Diarrhea: This can range from mild to severe. Sometimes there may be mucus, blood, or pus. The patient may get the urge to go but find nothing comes out.
• Fatigue: Individuals often feel extremely tired. Fever is also possible during fatigue.
• Altered appetite: There may be time when the appetite is very low.
• Weight loss: This can result from a loss of appetite.
• Anemia: A loss of blood can lead to anemia.
• Rectal bleeding and anal fissures: The skin of the anus becomes cracked, leading to pain and bleeding.

Other possible symptoms:

• arthritis
• uveitis (eye inflammation)
• skin rash and inflammation
• liver or bile duct inflammation
• delayed growth or sexual development, in children

Ulcerative colitis vs. Crohn’s disease

While ulcerative colitis causes inflammation and ulcers in the top layer of the large intestine lining, in Crohn’s disease, all layers of the intestine may become inflamed with ulcers.

Inflammation occurs almost anywhere along the intestine in Crohn’s disease; in ulcerative colitis, it happens only in the large intestine (colon and rectum).

The bowels of the Crohn’s disease patient may have normal healthy sections between the diseased parts, while in ulcerative colitis the damage may occur in a continuous pattern.

Diet

Children with Crohn’s disease may need liquid formulas with high calories, particularly if they are impaired by their development.

Most Crohn’s disease patients say diarrhea and cramping will increase the following foods:

• bulky grains
• dairy products
• spicy foods
• alcohol

Some people do not feel like eating. In severe cases, they may need to feed intravenously for a short period.

Treatment

Medication, surgery, and nutritional supplements may be used for care.

The goal is to control inflammation, correct nutritional issues and ease the symptoms.

Crohn’s disease has no cure, but some medications can improve by reducing the number of times that a patient experiences recurrences.

Care for Crohn’s disease relies on:

• where the inflammation is situated
• the severity of the disease
• complications
• the patient’s response to previous treatment for recurring symptoms

Some people without symptoms can have long periods, even years. This is called remission. There’ll usually be recurrences, however.

Given that remission periods vary so greatly, it can be difficult to know how effective treatment was. It is impossible to predict how long a remission period will last.

Medication for Crohn’s disease

• Anti-inflammation drugs – the doctor will most likely start with mesalamine (Sulfasalazine), which helps control inflammation.
• Cortisone or steroids – corticosteroids are drugs containing cortisone and steroids.
• Antibiotics – fistulas, strictures, or prior surgery may cause bacterial overgrowth. Doctors will generally treat this by prescribing ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
• Anti-diarrheal and fluid replacements – when the inflammation subsides, diarrhea usually becomes less of a problem. However, sometimes the patient may need something for diarrhea and abdominal pain.

Biologics

Biologics is a new type of drug, developed by scientists from a living organism. By targeting proteins that contribute to inflammation, they reduce the immune response of the body.

Biologics appear to help people suffering from Crohn’s disease.

Examples of Crohn’s biologics are:

• infliximab (Remicade)
• adalimumab (Humira)
• 6-mercaptopurine (Purinethol)
• methotrexate
• imuran (Azathioprine)
• certolizumab pegol (Cimzia)

Biological medications can have side effects, including diarrhea, nausea and a reduced infection tolerance.

Some studies suggest that using biologics could reduce a person’s chance of needing abdominal surgery to 30 percent within 10 years. Researchers placed this figure at 40–55 per cent before the introduction of biologics.

Biologics often tend to lower the risk of adverse effects that may arise when someone uses corticosteroids.

There are different types of biologic drugs and people respond to them differently. A doctor should prescribe an appropriate option, and if the first one doesn’t work they may suggest trying an alternative or a combination of drugs.

Surgery

Many patients suffering from Crohn’s disease may need surgery at some point. When medications no longer control symptoms, then the only option is to work. Operation may alleviate symptoms that have not responded to medication, or correct complications such as abscess, perforation, bleeding and blockage.

Removal of part of the intestine may improve, but Crohn’s disease is not cured. Inflammation also returns to the area next to where the portion of the gut affected has been removed. Many patients with Crohn’s disease may need more than one surgery throughout their lives.

In some cases, it involves a colectomy, in which the whole colon is removed. The surgeon must make a small opening in front of the abdominal wall, then bring the tip of the ileum to the surface of the skin to form an opening called a stoma. Feces pass through the stoma to leave the body. The feces was contained in a jar. Doctors say a patient who has a stoma will continue to lead a regular, active life.

If the surgeon can remove the diseased intestinal segment and then re-connect the intestine, no stoma is required.

The patient and their doctor need to think very carefully about the surgery. It doesn’t suit everybody. The patient has to bear in mind that the disease will recur after the procedure.

Many people with Crohn’s disease are capable of living regular and active lives, keeping jobs, raising families and working effectively.

Causes

The exact cause of Crohn’s disease is unknown but it is suspected to result from an irregular immune system reaction.

The idea is that food, good bacteria and beneficial substances are targeted by the immune system as if they were undesirable substances.

White blood cells build up in the gut lining during the attack and this buildup causes inflammation. The inflammation causes ulcerations and damage to the intestines.

It is unclear though whether the abnormal immune system induces or results from Crohn’s disease.

Factors that may increase the risk of inflammation include:

• genetic factors
• the individual’s immune system
• environmental factors

For Crohn’s around 3 in 20 people have a close relative with the condition. If an identical twin develops Crohn’s disease, then the other twin also has a 70% chance of having it.

A bacterium or virus may play a part in this. E. For example, the coli bacteria were linked to Crohn’s disease.

Smoking is one more contributing factor.

Diagnosis

Any signs and symptoms a doctor should ask the person. A physical examination can show a lump inside the abdomen, caused by stuck together loops of inflamed intestines.

The following tests may help in the diagnosis:

• stool and blood tests
• biopsy
• sigmoidoscopy, where a short, flexible tube (sigmoidoscope) is used to investigate the lower bowel
• colonoscopy, where a long, flexible tube (colonoscope) is used to investigate the colon
• endoscopy, if symptoms occur in the upper part of the gut. A long, thin, flexible telescope (endoscope) goes down through the esophagus into the stomach.
• CT scan or barium enema X-ray to reveal changes inside the bowel

Complications

When signs are serious and recurrent, there is greater probability of complications.

• internal bleeding
• stricture, where a part of the gut narrows, causing build up of scar tissue, and partial or complete blockage of the intestine
• perforation, when a small hole develops in the wall of the gut, from which contents can leak, cause infections or abscesses
• fistulas, when a channel forms between two parts of the gut

There may also be:

• a persistent iron deficiency.
• food absorption problems.
• slightly higher risk of developing bowel cancer.