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Crohn’s Disease Information
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 Contents of this page:
What is Crohn’s disease?
Crohn’s disease is an ongoing disorder that causes inflammation of the
digestive tract, also referred to as the gastrointestinal (GI) tract. Crohn’s
disease can affect any area of the GI tract, from the mouth to the anus, but it
most commonly affects the lower part of the small intestine, called the ileum.
The swelling extends deep into the lining of the affected organ. The swelling
can cause pain and can make the intestines empty frequently, resulting in
diarrhea.
The digestive system.
Crohn’s disease is an inflammatory bowel disease, the general name for
diseases that cause swelling in the intestines. Because the symptoms of Crohn’s
disease are similar to other intestinal disorders, such as irritable bowel
syndrome and ulcerative colitis, it can be difficult to diagnose. Ulcerative
colitis causes inflammation and ulcers in the top layer of the lining of the
large intestine. In Crohn’s disease, all layers of the intestine may be
involved, and normal healthy bowel can be found between sections of diseased
bowel.
Crohn’s disease affects men and women equally and seems to run in some
families. About 20 percent of people with Crohn’s disease have a blood relative
with some form of inflammatory bowel disease, most often a brother or sister and
sometimes a parent or child. Crohn’s disease can occur in people of all age
groups, but it is more often diagnosed in people between the ages of 20 and 30.
People of Jewish heritage have an increased risk of developing Crohn’s disease,
and African Americans are at decreased risk for developing Crohn’s disease.
Crohn’s disease may also be called ileitis or enteritis.
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What causes Crohn’s disease?
Several theories exist about what causes Crohn’s disease, but none have been
proven. The human immune system is made from cells and different proteins that
protect people from infection. The most popular theory is that the body’s immune
system reacts abnormally in people with Crohn’s disease, mistaking bacteria,
foods, and other substances for being foreign. The immune system’s response is
to attack these “invaders.” During this process, white blood cells accumulate in
the lining of the intestines, producing chronic inflammation, which leads to
ulcerations and bowel injury.
Scientists do not know if the abnormality in the functioning of the immune
system in people with Crohn’s disease is a cause, or a result, of the disease.
Research shows that the inflammation seen in the GI tract of people with Crohn’s
disease involves several factors: the genes the patient has inherited, the
immune system itself, and the environment. Foreign substances, also referred to
as antigens, are found in the environment. One possible cause for inflammation
may be the body’s reaction to these antigens, or that the antigens themselves
are the cause for the inflammation. Some scientists think that a protein
produced by the immune system, called anti-tumor necrosis factor (TNF), may be a
possible cause for the inflammation associated with Crohn’s disease.
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What are the symptoms?
The most common symptoms of Crohn’s disease are abdominal pain, often in the
lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin
problems, and fever may also occur. Bleeding may be serious and persistent,
leading to anemia. Children with Crohn’s disease may suffer delayed development
and stunted growth. The range and severity of symptoms varies.
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How is Crohn’s disease diagnosed?
A thorough physical exam and a series of tests may be required to diagnose
Crohn’s disease.
Blood tests may be done to check for anemia, which could indicate bleeding in
the intestines. Blood tests may also uncover a high white blood cell count,
which is a sign of inflammation somewhere in the body. By testing a stool
sample, the doctor can tell if there is bleeding or infection in the intestines.
The doctor may do an upper GI series to look at the small intestine. For this
test, the person drinks barium, a chalky solution that coats the lining of the
small intestine, before x rays are taken. The barium shows up white on x-ray
film, revealing inflammation or other abnormalities in the intestine. If these
tests show Crohn’s disease, more x rays of both the upper and lower digestive
tract may be necessary to see how much of the GI tract is affected by the
disease.
The doctor may also do a visual exam of the colon by performing either a
sigmoidoscopy or a colonoscopy. For both of these tests, the doctor inserts a
long, flexible, lighted tube linked to a computer and TV monitor into the anus.
A sigmoidoscopy allows the doctor to examine the lining of the lower part of the
large intestine, while a colonoscopy allows the doctor to examine the lining of
the entire large intestine. The doctor will be able to see any inflammation or
bleeding during either of these exams, although a colonoscopy is usually a
better test because the doctor can see the entire large intestine. The doctor
may also do a biopsy, which involves taking a sample of tissue from the lining
of the intestine to view with a microscope.
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What are the complications of Crohn’s disease?
The most common complication is blockage of the intestine. Blockage occurs
because the disease tends to thicken the intestinal wall with swelling and scar
tissue, narrowing the passage. Crohn’s disease may also cause sores, or ulcers,
that tunnel through the affected area into surrounding tissues, such as the
bladder, vagina, or skin. The areas around the anus and rectum are often
involved. The tunnels, called fistulas, are a common complication and often
become infected. Sometimes fistulas can be treated with medicine, but in some
cases they may require surgery. In addition to fistulas, small tears called
fissures may develop in the lining of the mucus membrane of the anus.
Nutritional complications are common in Crohn’s disease. Deficiencies of
proteins, calories, and vitamins are well documented. These deficiencies may be
caused by inadequate dietary intake, intestinal loss of protein, or poor
absorption, also referred to as malabsorption.
Other complications associated with Crohn’s disease include arthritis, skin
problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other
diseases of the liver and biliary system. Some of these problems resolve during
treatment for disease in the digestive system, but some must be treated
separately.
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What is the treatment for Crohn’s disease?
Treatment may include drugs, nutrition supplements, surgery, or a combination
of these options. The goals of treatment are to control inflammation, correct
nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea,
and rectal bleeding. At this time, treatment can help control the disease by
lowering the number of times a person experiences a recurrence, but there is no
cure. Treatment for Crohn’s disease depends on the location and severity of
disease, complications, and the person’s response to previous medical treatments
when treated for reoccurring symptoms.
Some people have long periods of remission, sometimes years, when they are
free of symptoms. However, the disease usually recurs at various times over a
person’s lifetime. This changing pattern of the disease means one cannot always
tell when a treatment has helped. Predicting when a remission may occur or when
symptoms will return is not possible.
Someone with Crohn’s disease may need medical care for a long time, with
regular doctor visits to monitor the condition.
Drug Therapy:
Anti-Inflammation Drugs. Most people are first treated with
drugs containing mesalamine, a substance that helps control inflammation.
Sulfasalazine is the most commonly used of these drugs. Patients who do not
benefit from it or who cannot tolerate it may be put on other mesalamine-containing
drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa.
Possible side effects of mesalamine-containing drugs include nausea, vomiting,
heartburn, diarrhea, and headache.
Cortisone or Steroids. Cortisone drugs and steroids—called
corticosteriods—provide very effective results. Prednisone is a common generic
name of one of the drugs in this group of medications. In the beginning, when
the disease it at its worst, prednisone is usually prescribed in a large dose.
The dosage is then lowered once symptoms have been controlled. These drugs can
cause serious side effects, including greater susceptibility to infection.
Immune System Suppressors. Drugs that suppress the immune
system are also used to treat Crohn’s disease. Most commonly prescribed are
6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work
by blocking the immune reaction that contributes to inflammation. These drugs
may cause side effects like nausea, vomiting, and diarrhea and may lower a
person’s resistance to infection. When patients are treated with a combination
of corticosteroids and immunosuppressive drugs, the dose of corticosteroids may
eventually be lowered. Some studies suggest that immunosuppressive drugs may
enhance the effectiveness of corticosteroids.
Infliximab (Remicade). This drug is the first of a group of
medications that blocks the body’s inflammation response. The U.S. Food and Drug
Administration approved the drug for the treatment of moderate to severe Crohn’s
disease that does not respond to standard therapies (mesalamine substances,
corticosteroids, immunosuppressive agents) and for the treatment of open,
draining fistulas. Infliximab, the first treatment approved specifically for
Crohn’s disease is a TNF substance. Additional research will need to be done in
order to fully understand the range of treatments Remicade may offer to help
people with Crohn’s disease.
Antibiotics. Antibiotics are used to treat bacterial
overgrowth in the small intestine caused by stricture, fistulas, or prior
surgery. For this common problem, the doctor may prescribe one or more of the
following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or
metronidazole.
Anti-Diarrheal and Fluid Replacements. Diarrhea and crampy
abdominal pain are often relieved when the inflammation subsides, but additional
medication may also be necessary. Several antidiarrheal agents could be used,
including diphenoxylate, loperamide, and codeine. Patients who are dehydrated
because of diarrhea will be treated with fluids and electrolytes.
Nutrition Supplementation
The doctor may recommend nutritional supplements, especially for children
whose growth has been slowed. Special high-calorie liquid formulas are sometimes
used for this purpose. A small number of patients may need to be fed
intravenously for a brief time through a small tube inserted into the vein of
the arm. This procedure can help patients who need extra nutrition temporarily,
those whose intestines need to rest, or those whose intestines cannot absorb
enough nutrition from food. There are no known foods that cause Crohn’s disease.
However, when people are suffering a flare in disease, foods such as bulky
grains, hot spices, alcohol, and milk products may increase diarrhea and
cramping.
Surgery
Two-thirds to three-quarters of patients with Crohn’s disease will require
surgery at some point in their lives. Surgery becomes necessary when medications
can no longer control symptoms. Surgery is used either to relieve symptoms that
do not respond to medical therapy or to correct complications such as blockage,
perforation, abscess, or bleeding in the intestine. Surgery to remove part of
the intestine can help people with Crohn’s disease, but it is not a cure.
Surgery does not eliminate the disease, and it is not uncommon for people with
Crohn’s Disease to have more than one operation, as inflammation tends to return
to the area next to where the diseased intestine was removed.
Some people who have Crohn’s disease in the large intestine need to have
their entire colon removed in an operation called a colectomy. A small opening
is made in the front of the abdominal wall, and the tip of the ileum, which is
located at the end of the small intestine, is brought to the skin’s surface.
This opening, called a stoma, is where waste exits the body. The stoma is about
the size of a quarter and is usually located in the right lower part of the
abdomen near the beltline. A pouch is worn over the opening to collect waste,
and the patient empties the pouch as needed. The majority of colectomy patients
go on to live normal, active lives.
Sometimes only the diseased section of intestine is removed and no stoma is
needed. In this operation, the intestine is cut above and below the diseased
area and reconnected.
Because Crohn’s disease often recurs after surgery, people considering it
should carefully weigh its benefits and risks compared with other treatments.
Surgery may not be appropriate for everyone. People faced with this decision
should get as much information as possible from doctors, nurses who work with
colon surgery patients (enterostomal therapists), and other patients. Patient
advocacy organizations can suggest support groups and other information
resources.
People with Crohn’s disease may feel well and be free of symptoms for
substantial spans of time when their disease is not active. Despite the need to
take medication for long periods of time and occasional hospitalizations, most
people with Crohn’s disease are able to hold jobs, raise families, and function
successfully at home and in society.
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Can diet control Crohn’s disease?
People with Crohn’s disease often experience a decrease in appetite, which
can affect their ability to receive the daily nutrition needed for good health
and healing. In addition, Crohn’s disease is associated with diarrhea and poor
absorption of necessary nutrients. No special diet has been proven effective for
preventing or treating Crohn’s disease, but it is very important that people who
have Crohn’s disease follow a nutritious diet and avoid any foods that seem to
worsen symptoms. There are no consistent dietary rules to follow that will
improve a person’s symptoms.
People should take vitamin supplements only on their doctor’s advice.
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Can stress make Crohn’s disease worse?
There is no evidence showing that stress causes Crohn’s disease. However,
people with Crohn’s disease sometimes feel increased stress in their lives from
having to live with a chronic illness. Some people with Crohn’s disease also
report that they experience a flare in disease when they are experiencing a
stressful event or situation. There is no type of person that is more likely to
experience a flare in disease than another when under stress. For people who
find there is a connection between their stress level and a worsening of their
symptoms, using relaxation techniques, such as slow breathing, and taking
special care to eat well and get enough sleep, may help them feel better.
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Is pregnancy safe for women with Crohn’s disease?
Research has shown that the course of pregnancy and delivery is usually not
impaired in women with Crohn’s disease. Even so, women with Crohn’s disease
should discuss the matter with their doctors before pregnancy. Most children
born to women with Crohn’s disease are unaffected. Children who do get the
disease are sometimes more severely affected than adults, with slowed growth and
delayed sexual development in some cases.
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Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
conducts and supports research into many kinds of digestive disorders, including
Crohn’s disease. Several clinical trials are currently evaluating the efficacy
and safety of different therapies for the treatment of Crohn’s disease. For a
complete listing of trials being conducted, visit
www.clinicaltrials.gov.
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