What is Crohn’s disease?
Crohn’s disease is a type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.
Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people. This inflammation often spreads into the deeper layers of the bowel.
Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
While there’s no known cure for Crohn’s disease, therapies can greatly reduce its signs and symptoms and even bring about long-term remission and healing of inflammation. With treatment, many people with Crohn’s disease are able to function well.
Crohn’s disease gets its name from American gastroenterologist Dr. Burrill Crohn (1884-1983).
Who might get Crohn’s disease?
Crohn’s disease typically appears in younger people – often in their late teens, 20s or early 30s. However, this condition can happen at any age. It’s equally common in men and women. Crohn’s disease can also be see in young children.
If you’re a cigarette smoker, your risk of Crohn’s disease might be higher than non-smokers.
What are the types of Crohn’s disease?Crohn’s disease can affect different sections of the digestive tract. Types of Crohn’s disease include:
1. Ileocolitis: Inflammation occurs in the small intestine and part of the large intestine, or colon. Ileocolitis is the most common type of Crohn’s disease.
2. Ileitis: Swelling and inflammation develop in the small intestine (ileum).
3. Gastroduodenal: Inflammation and irritation affect the stomach and the top of the small intestine (the duodenum).
4. Jejunoileitis: Patchy areas of inflammation develop in the upper half of the small intestine (called the jejunum).
In Crohn’s disease, any part of your small or large intestine can be involved, and it may be continuous or may involve multiple segments. In some people, the disease is confined to the colon, which is part of the large intestine.
Signs and symptoms of Crohn’s disease can range from mild to severe. They usually develop gradually, but sometimes will come on suddenly, without warning. 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 cramping.
▪️Blood in your stool.
▪️Reduced appetite and weight loss.
▪️Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula).
Other signs and symptoms.
People with severe Crohn’s disease may also experience:
▪️Inflammation of skin, eyes and joints.
▪️ Inflammation of the liver or bile ducts.
▪️ Kidney stones.
▪️ Iron deficiency (anemia).
▪️ Delayed growth or sexual development, in children.
The exact cause of Crohn’s disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate, but don’t cause, Crohn’s disease. Several factors, such as heredity and a malfunctioning immune system, likely play a role in its development.
▪️ Immune system. It’s possible that a virus or bacterium may trigger Crohn’s disease; however, scientists have yet to identify such a trigger. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
▪️ Heredity. 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, most people with Crohn’s disease don’t have a family history of the disease.
Risk factors for Crohn’s disease may include:
▪️ Age. Crohn’s disease can occur at any age, but you’re likely to develop the condition when you’re young. Most people who develop Crohn’s disease are diagnosed before they’re around 30 years old.
▪️ Ethnicity. Although Crohn’s disease can affect any ethnic group, whites have the highest risk, especially people of Eastern European (Ashkenazi) Jewish descent. However, the incidence of Crohn’s disease is increasing among Black people who live in North America and the United Kingdom.
▪️ Family history. You’re at higher risk if you have a first-degree 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 having surgery. If you smoke, it’s important to stop.
▪️ Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. While they do not cause Crohn’s disease, they can lead to inflammation of the bowel that makes Crohn’s disease worse.
Crohn’s disease may lead to one or more of the following complications:
▪️ Bowel obstruction. Crohn’s disease can affect the entire thickness of the intestinal wall. Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents. You may require surgery to remove the diseased portion of your bowel.
▪️ Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum).
▪️ Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different body parts. Fistulas can develop between your intestine and your skin, or between your intestine and another organ. Fistulas near or around the anal area (perianal) are the most common kind.
When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption. Fistulas may form between loops of bowel, in the bladder or vagina, or through the skin, causing continuous drainage of bowel contents to your skin.
In some cases, a fistula may become infected and form an abscess, which can be life-threatening if not treated.
▪️ Anal fissure. This is a small tear 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 lead to a perianal fistula.
▪️ Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. 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 increases 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. Ask your doctor whether you need to have this test done sooner and more frequently.
▪️ Other health problems. Crohn’s disease can cause problems in other parts of the body. Among these problems are anemia, skin disorders, osteoporosis, arthritis, and gallbladder or liver disease.
▪️ Medication risks. Certain Crohn’s disease drugs that act by blocking 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 associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure, among other conditions. Work with your doctor to determine risks and benefits of medications.
▪️ Blood clots. Crohn’s disease increases the risk of blood clots in veins and arteries.
How is Crohn’s disease diagnosed?
Most people with Crohn’s first see a healthcare provider because of ongoing diarrhea, belly cramping or unexplained weight loss. If you have a child who has been experiencing the symptoms of Crohn’s disease, reach out to your pediatrician.
To find the cause of your symptoms, your healthcare provider may order one or more of these tests:
▪️ Blood test: A blood test checks for high numbers of white blood cells that may indicate inflammation or infection. The test also checks for low red blood cell count, or anemia. Approximately one in three people with Crohn’s disease have anemia.
▪️ Stool test: This test looks at a sample of your stool to check for bacteria or parasites. It can rule out infections that cause chronic diarrhea.
▪️ Colonoscopy: During a colonoscopy, your doctor uses an endoscope (thin tube with an attached light and camera) to examine the inside of your colon. Your doctor may take a tissue sample (biopsy) from the colon to test for signs of inflammation.
▪️ Computed tomography (CT) scan: A CT scan creates images of the digestive tract. It tells your healthcare provider how severe the intestinal inflammation is.
▪️ Upper gastrointestinal (GI) endoscopy: Your doctor threads a long, thin tube called an endoscope through your mouth and into your throat. An attached camera allows your doctor to see inside. During an upper endoscopy, your doctor may also take tissue samples.
▪️ Upper gastrointestinal (GI) exam: X-ray images used during an upper GI exam allow your doctor to watch as a swallowed barium liquid moves through your digestive tract.
How is Crohn’s disease managed or treated?
Treatment for Crohn’s disease varies depending on what’s causing your symptoms and how severe they are for you. In children, the goal in treatment is to induce remission (the time between symptom flare-ups), maintain remission and manage any complications of Crohn’s disease over time.
Your healthcare provider may recommend one or more of these treatments for Crohn’s disease:
▪️ Antibiotics: Antibiotics can prevent or treat infections. Severe infections can lead to abscesses (pockets of pus). Or they can cause fistulas (openings or tunnels that connect two organs that don’t normally connect).
▪️ Antidiarrheal medication: Prescription medications like loperamide (Imodium A-D®) can stop severe diarrhea.
▪️ Biologics: These medications include monoclonal antibodies to suppress the immune response.
▪️ Bowel rest: To give your intestines a chance to heal, your provider may recommend going without food or drink for several days or longer. To get the nutrition you need, you may receive intravenous (parenteral) nutrition. Only drink a prescribed liquid or have a feeding tube during this time.
▪️ Corticosteroids: Cortisone, prednisone and other corticosteroids ease inflammation brought on by autoimmune disease.
▪️ Immunomodulators: These drugs calm inflammation by suppressing an overactive immune system. They include azathioprine and cyclosporine.
▪️ Surgery: Surgery won’t cure Crohn’s disease, but it can treat complications. You may need surgery to correct intestinal perforations (holes), blockages or bleeding.
When should I call the doctor?
You should call your healthcare provider if you experience:
1. Blood in stool.
3. Extreme weight loss.
5. Inability to pass gas.
6. Nausea and vomiting.
7. Severe abdominal pain.
8. Signs of a flare-up.
9. Uncontrollable diarrhea.
10. Weakness or fatigue that may be signs of anemia.
Lifestyle and home remedies.
Sometimes you may feel helpless when facing Crohn’s disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.
There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.
It can be helpful to keep a food diary to track what you’re eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them.
Here are some general dietary suggestions that may help to manage your condition:
▪️ Limit dairy products. Many 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 — that is, your body can’t digest the milk sugar (lactose) in dairy. foods. Using an enzyme product such as Lactaid may help.
▪️Eat small meals. You may find that you feel better eating five or six small meals a day rather than two or three larger ones.
▪️Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
▪️Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
▪️Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
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:
▪️ Exercise. 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.
▪️ Biofeedback. This stress-reduction technique may help you decrease 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.