Crohn’s Disease

Crohn’s disease is an 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, and the inflammation can often spread deep into layers of affected bowel tissue. Crohn’s disease can be both painful and debilitating. 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 .

Symptoms

In some people with Crohn’s disease, only the last segment of the small intestine (ileum) is affected. In others, the disease is confined to the colon (part of the large intestine). 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 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:

  • Diarrhea
  • Fever
  • Fatigue
  • Abdominal pain and cramping
  • Blood in your stool
  • Mouth sores
  • Reduced appetite and weight loss
  • Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)

Causes

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. A number of 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. 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.

Diagnosis

When you come in to see one of our NYC gastroenterologists, the first step to diagnosis and treatment is a standard physical exam of your body. Your doctor will speak to you and ask questions about your overall health, diet and nutrition, family history, and your daily routine.

  • Your doctor may order diagnostic testing to look for signs of Crohn’s disease and rule out other possible medical conditions.

  • Your first tests will likely include laboratory tests of your blood and stool.

  • Further testing could include X-rays of the upper and lower GI tract. Your doctor may recommend a test that uses a contrast chemical that helps your doctors see a more clear and detailed picture of your GI tract. The type of contrast used varies by test

Your doctor may recommend an endoscopy to get a detailed look at the inside of your  colon using a small camera mounted to the end of a lighted tube.

Endoscopies used in Crohn’s disease testing include:

  • A colonoscopy allows doctors to examine the colon, the lowest part of your large intestine, by inserting a flexible, lighted tube through the opening to your anus.

  • An upper endoscopy lets doctors see the gastrointestinal tract from the top down, using a flexible, lighted tube that’s inserted through your mouth, down the esophagus, into your stomach and as far down as the duodenum, which is the first section of your small intestine.

Treatment

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. Corticosteroids such as prednisone and budesonide (Entocort EC) can help reduce inflammation in your body.
  • 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. Examples of these drucgs include Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan) and Biologic agents such as Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). Methotrexate (Trexall) is sometimes used in patients who don’t respond to other treatments. Other medications include Natalizumab (Tysabri) (restricted distribution), vedolizumab (Entyvio), and Ustekinumab (Stelara).
  • Antibiotics: Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Some researchers also think antibiotics 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)
  • Nutrition Therapy: Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.

 

Sources

Hopefully you’ve learned a lot from our page!

To read more about Chron’s Disease, we recommend the following sources:

The Mayo Clinic

Crohn’s & Colitis Foundation

National Institute of Diabetes and Digestive and Kidney Diseases 

*** IMPORTANT DISCLAIMER: The content herein is provided for general informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. In no way does any of the information provided reflect definitive medical advice and self diagnoses should not be made based on information obtained online. Always consult your doctor before starting or changing treatment. If you think you may have a medical emergency, please call your doctor or 911 immediately.