Crohn's
Disease
Crohn's disease is a
long-term (chronic) condition in which inflammation causes
injury to the intestines. It typically begins in young
adulthood, most often between ages 15 and 40.
No one knows for sure what triggers
the initial intestinal inflammation at the start of Crohns
disease. Many experts think that a virus or a bacterial
infection might start the process by activating the immune
system, and that the body's immune system stays active and
creates inflammation in the intestine even after the infection
goes away.
Family members
may share genes that make Crohn's disease more likely to
develop if the right trigger occurs. Ten percent to 25% of
people who have Crohn's disease have at least one relative
with Crohn's disease or a similar disease called ulcerative
colitis. Crohnıs disease is more common in people of Jewish
heritage, relative to non-Jews.
Once Crohn's disease begins, it
can cause lifelong symptoms that come and go. The inside
lining and deeper layers of the intestine wall become
inflamed. The lining of the intestine becomes irritated, and
can thicken or wear away in spots. This creates ulcers, cracks
and fissures. Inflammation can allow an abscess (a pocket of
pus) to develop.
A unique complication of Crohns
disease is called a fistula. A fistula is an abnormal
connection between organs in the digestive tract, usually a
connection between one piece of the intestine and another. A
fistula can be created after inflammation becomes severe. To
understand how a fistula is created, consider the way the
intestine attempts to heal. Between attacks of inflammation,
the intestine recoats itself with a new lining. When the
inflammation has been severe, the intestine can lose its
ability to distinguish the inside of one piece of intestine
from the outside of another piece. As a result, it can
mistakenly build a lining along the edges of an ulcer that has
worn through the whole wall of the intestine, forming a
fistula.
The section of the small intestine
called the ileum (in the right lower abdomen) is especially
prone to damage from Crohn's disease. However, ulcers and
inflammation can occur in all areas of the digestive tract,
from the mouth all the way to the rectum. A few other parts of
the body, such as the eyes and joints, also can be affected in
people with Crohn's disease.
Symptoms
Some people with Crohn's disease
have only occasional cramps, or diarrhea that is so mild they
do not seek medical attention. However, most people who have
Crohn's disease experience long stretches of time with no
symptoms interrupted by bursts of symptoms, called an
exacerbation, when inflammation returns. During an
exacerbation, or during the initial appearance of Crohn's
disease, you might experience the following symptoms:
- Abdominal pain, usually at or below the
navel, typically worse after meals
- Diarrhea
that may contain blood
- Sores
around the anus, or drainage of pus or mucus from the anus
or anal area
- Pain
when you have a bowel movement
- Mouth
sores
- Loss of
appetite
- Joint
pains or back pain
- Pain or
vision changes in one or both eyes
- Weight
loss despite eating a normal-calorie diet
- Fever
- Weakness
or fatigue
- Stunted
growth and delayed puberty in children
Diagnosis
It may require months for your
doctor to diagnose Crohn's disease with certainty. Your doctor
will look for evidence of intestinal inflammation and try to
distinguish it from other causes of intestinal problems, such
as infection or ulcerative colitis, a related disease that
also causes intestinal inflammation. If you have Crohn's
disease, your symptoms and the results of various tests will
fit a pattern over time that is best explained by this
condition.
Tests that can indicate inflammation and show
evidence of Crohn's disease include:
- Blood
tests showing a high white blood cell count or other signs
of inflammation in your body
- A blood
test for anemia, which is a reduced number of red blood
cells
- Autoantibody tests that reveal antibodies in
the blood of people with Crohn's disease. These antibody
tests are helpful to doctors who are trying to decide
whether inflammation in the bowel is best explained by
Crohns disease, or best explained by ulcerative colitis. The
antibodies are not a reliable way to know whether
inflammation is occurring in the first place.
- Stool
(also called feces or bowel movement) tests that show
bleeding from irritated intestines, and that do not show
signs of infection
- An X-ray
test called an upper GI (gastrointestinal) series, in which
pictures are taken of your abdomen after you drink a white,
chalky barium solution that shows up on X-rays. As the
liquid trickles down, it traces the outline of your
intestines on the X-ray. An upper GI series can reveal
places in the intestine that are narrowed because the
intestine wall is thickened. It also can highlight ulcers
and show detours in the intestine, which may be a fistula.
- Flexible
sigmoidoscopy or colonoscopy tests, which use a small tube
inserted into the rectum that contains a camera and light
that allow your doctor to view the insides of your large
intestine
- Biopsy
is the removal of a small sample of tissue from the lining
of the intestine. The material is examined under a
microscope for signs of inflammation. A biopsy is most
helpful to confirm Crohn's disease and to exclude other
conditions.
Expected
Duration
Crohn's disease is a lifelong
condition, but it is not continuously active. Following a
flare-up symptoms can stay with you for weeks or months. Often
these flare-ups are separated by months or years of good
health without any symptoms.
Prevention
There is no way to prevent Crohn's
disease, but you can keep the condition from taking a heavy
toll on your body by maintaining a well-balanced, nutritious
diet. By storing up vitamins and nutrients between episodes or
flare-ups, you can decrease complications from poor nutrition,
such as weight loss or anemia. Your doctor will monitor your
blood for complications of poor nutrient
absorption.
Crohn's disease can cause a higher
risk of colon cancer, particularly if it affects a large
portion of the colon or rectum. It is important to have your
colon checked regularly for early signs of cancer or for
changes that can precede a new cancer. If you have had Crohn's
disease affecting the colon or rectum for eight years or more,
it is time for you to start getting regular testing to look
for cancer. One good strategy is to have a colonoscopy exam
every one to two years once you start regular testing.
Treatment
Medications are very effective at
improving the symptoms of Crohn's disease. Most of the drugs
work by preventing inflammation in the
intestines.
The medication commonly used first
is a group of anti-inflammatory drugs called aminosalicylates.
They are chemically related to aspirin and suppress
inflammation in the intestine and joints. They are given
either by mouth (pills) or by rectum, as an enema. Some drugs
in this group include sulfasalazine (Azulfidine), mesalamine
(Asacol, Pentasa, Canasa, Rowasa) and olsalazine (Dipentum).
Certain antibiotic drugs,
particularly metronidazole (Flagyl) and ciprofloxacin (Cipro),
help by decreasing the bacterial growth in irritated areas of
the bowel. They may have a side benefit of decreasing
inflammation, too. If you still have diarrhea, but there is no
infection, antidiarrheal medications, such as loperamide
(Lomotil) may be helpful.
Other more powerful
anti-inflammatory drugs may be helpful, but they can also
suppress your immune system so that you have an increased risk
of infections. For this reason, they are not often used on a
long-term basis. These drugs include prednisone (Deltasone,
Prednisolone, Orasone) and methylprednisolone (Medrol,
Solu-Medrol), budesonide (Entocort), azathioprine (Imuran),
6-mercaptopurine (Purinethol), cyclosporine (Neoral,
Sandimmune) and methotrexate (Rheumatrex,
Folex).
A new drug, infliximab (Remicade)
has been used in recent years for severe Crohn's disease,
particularly when a fistula has formed that does not respond
to other treatment. This medication blocks the effect of a
chemical called "tumor necrosis factor" that may be
responsible for causing inflammation in the intestine.
Surgery is another possible
treatment. In general, surgery to remove a section of the
bowel is recommended only if a person has bowel obstruction,
persistent symptoms despite medical therapy, or a non-healing
fistula. Up to 50 percent of people who have Crohn's disease
will end up having at least one operation during the course of
their disease.
When To
Call A Professional
New or changing symptoms often mean that
additional treatment is needed to keep Crohn's disease under
control. For this reason, people who have Crohn's disease
should be in frequent contact with a doctor. One serious
complication, bowel obstruction, causes vomiting or severe
abdominal pain and requires emergency treatment. This occurs
when the inside of the intestine becomes narrowed, so that the
digestive contents cannot pass through. Other symptoms that
require a doctor's immediate attention are fever (which could
indicate infection), heavy bleeding from the rectum, or black
paste-like stools (this is how blood looks after traveling a
long distance through the intestine).
Prognosis
Crohn's disease can affect people
very differently. Many people have only mild symptoms and do
not require continuous treatment with medication. Others
require multiple medications and develop complications.
Crohn's disease improves with treatment and is not a fatal
illness, but it cannot be cured. Crohn's requires people to
pay special attention to their health needs and to seek
frequent medical care, but it does not prevent most people
from having normal jobs and productive family lives. As is the
case for any chronic illness, it can be helpful for a newly
diagnosed person to seek advice from a support group of other
people with the disease.
Additional
Info
Crohn's and Colitis Foundation of
America
386 Park Ave. South
17th Floor
New York, NY
10016
Phone: (212) 685-3440
Toll-free: (800) 932-2423
Fax: (212) 779-4098
E-Mail: info@ccfa.org
http://www.ccfa.org/
National Institute of Diabetes and Digestive
and Kidney Disorders
31 Center Dr.
Bethesda, MD
20892
Phone: (301) 496-3583
http://www.niddk.nih.gov/
