Crohn's Disease

Crohn's disease is an uncomfortable inflammation of the digestive tract. It usually attacks the small intestine but can also be found anywhere from the mouth to the anus.

The American Academy of Family Physicians says Crohn's is one of the Inflammatory Bowel Diseases (IBD). The other IBD is ulcerative colitis (Read about "Ulcerative Colitis") which causes inflammation and ulcers in the top layer of the lining of the large intestine. Crohn's on the other hand extends deep into the tissue of the affected organ. Up to a million people may suffer from the disease according to the Crohn's & Colitis Foundation of America. Neither Crohn's nor ulcerative colitis should be confused with irritable bowel syndrome or IBS, which is a non-chronic condition. (Read about "Irritable Bowel Syndrome")

Symptoms and diagnosis

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), the first signals of Crohn's are abdominal pain and diarrhea. (Read about "Diarrhea") The pain is usually below the naval and on the right side. There are other early warning signs:

• weight loss
• loss of appetite
• fever
• joint pains
• rectal bleeding (Read about "Gastrointestinal Bleeding")

Since many of the symptoms also could point to other problems, NIDDK says a careful physical exam and other tests are needed to diagnose Crohn's. A correct diagnosis can take time. Some of the tests your doctor can use are:

• Blood tests to check for anemia caused by bleeding and to check for high white cell count which could indicate inflammation (Read about "Laboratory Testing" "Complete Blood Count")
• An upper gastrointestinal (GI) series to take a look at the upper intestine with x-rays (Read about "X-rays")
• Colonoscopy and/or flexible sigmoidoscopy where a small flexible tube with lights and a camera are inserted into the anus to see into the large intestine (Read about "Colonoscopy" "Flexible Sigmoidoscopy")
• Capsule endoscopy also known as the camera pill is a swallowable capsule containing a tiny camera that has Food and Drug Administration (FDA) approval. It takes pictures twice a second as it glides through the small intestine. It is then excreted from the body. It is intended to visualize the inside of the small intestine to detect polyps, cancer or causes of bleeding and anemia. (Read about "Endoscopy" "Gastrointestinal Bleeding" "Anemia")

Causes and complications

Unfortunately, no one is sure of the cause of Crohn's. There does seem to be a hereditary factor. (Read about "Genetics" "Family Health History") The National Digestive Diseases Information Clearinghouse states that 20 to 25 percent of patients may have a close relative with IBD. The Crohn's and Colitis Foundation of America says that the most common theory today is that a virus or bacteria cause the inflammation. (Read about "Microorganisms")

The most common complication is a blockage of the intestine. Crohn's can also cause ulcers that become infected and can tunnel deep into the tissue and on to other organs. There can also be nutritional complications with the body unable to absorb nutrients.

According to the Crohn's and Colitis Foundation of America, there are other complications associated with Crohn's:

• joint inflammation, arthritis (Read about "Arthritis and Rheumatic Diseases")
• skin problems (Read about "Skin")
• inflammation of the eyes or mouth (Read about "The Eye" "Oral Health")
• kidney stones (Read about "Kidney Stones")
• gallstones (Read about "Gallstones")

Sometimes these complications clear up as the Crohn's is treated. They sometimes require separate treatment.

Treatment

NIDDK says there is no cure for Crohn's. Treatments are designed to decrease the inflammation and relieve the symptoms. Various medications can be used to control the inflammation. They include:

• anti-inflammatory drugs, such as sulfasalazine, mesalamine, aminosalicylates and corticosteroids
• immune system suppressors such as azathioprine, mercaptopurine, infliximab, adalimumab, natalizumab, certolizumab pegol and cyclosporine
• antidiarrheals or laxatives, depending on symptoms
• supplements, such as iron, calcium and vitamin D

Immune modifiers or immune system suppressors are drugs that target the immune system to reduce inflammation. Biologic response modifiers can also act on the immune system. (Read about "The Immune System") Some of them are genetically engineered antibodies that block inflammation caused by a protein called tumor necrosis factor. The Food and Drug Administration (FDA) approved several of these drugs for patients with moderate to severe Crohn's disease who have not found relief with other treatments. Some of these drugs are also used to treat the inflammation of other diseases, such as rheumatoid arthritis. (Read about "Rheumatoid Arthritis") There are side effects of the drugs. Tuberculosis, fungal infections and other serious opportunistic infections including histoplasmosis, listeriosis and pneumocystosis, have been reported. (Read about "Tuberculosis" "Listeriosis") Some of these infections have been fatal.

In addition to drugs to control inflammation, other types of medications may be used. Antibiotics (Read about "Antibiotics") can be used to treat bacteria that may be flourishing in ulcers. (Read about "Peptic Ulcers") Pain relievers can be used. Medications can also be used to treat different symptoms such as constipation or diarrhea. (Read about "Constipation" "Diarrhea") Diarrhea will usually subside as the inflammation does, but you can also ask your doctor about antidiarrheal agents. Patients who are dehydrated (Read about "Dehydration") because of diarrhea may need treatment with fluids and electrolytes. Iron supplements may be needed to avoid anemia if there is a lot of gastrointestinal bleeding. (Read about "Iron Supplements" "Anemia" "Gastrointestinal Bleeding") If you are using corticosteroids, you should talk to your doctor about taking supplemental calcium (Read about "Calcium") and vitamin D to reduce the risk of osteoporosis. (Read about "Vitamins & Minerals" "Osteoporosis")

Surgery

The Crohn's and Colitis Foundation of America says surgery is usually considered a last resort for Crohn's patients. The diseased portion of the small intestine can be removed and the two healthy sections are joined together. NIDDK says this should not be considered a cure. Often Crohn's reappears near the junction and spreads. If the large intestine is diseased, a doctor may recommend the removal of the intestine. In this case, a small opening is made in the wall of the abdomen, which will be used to expel waste. A pouch is worn over the opening to collect the waste. This treatment is called a colostomy.

Living with Crohn's

Crohn's disease may go into remission for years after treatment. Crohn's is a serious chronic disease but is usually not considered a fatal illness.

Related Information:

    Digestive System

    Diverticular Disease