Is a potentially serious condition that causes inflammation of the gastronintestinal tract
Can occur anywhere from the oral cavity to the anus.
It is referred to as an autoimmune disease
This condtition is perplexing and typical findings show that the immune system of the person with the condition is essentially attacking its own GI tract
As a result a measured Inflammation is seen.
It is a type of inflammatory bowel disease
Is somewhat similar to ulcerative collitis ulcerative colitis
Initial diagnosis often occurs in the late teens and early twenties
The most commonly affected area is the “terminal ileum” of the small intestines.
Symptoms:
GI symptoms
- Abdominal pain
- Diarrhea without blood
- Diarrhea with blood
- Watery stools (Ileitis)
- Smaller volume but increse frequency (Colitis)
- In severe cases – 20 bowel movements per day
- Bloating
- Flatulence
- Nausea
- Vomiting
- Perianal discomfort
- Perianal itching
- Malabsorption
Systemic and Other symptoms
- Mouth Ulcers
- Difficulty swallowing
- Difficutty eating
- Decreased growth
- Fever
- Chills
- Fatigue
- Muscle Aches
- Weight loss
- Endocrine involvement
- others
Causes:
- The specific cause is unkown
- Genetics are strongly believed to be linked
- Ethnic background
- Mutations in “CARD15” gene
- Smoking may increase risk for condition in submission to be reactivated
- Immune system involvement
- Involvement of primary T cell
- Possible impaired cytokines
Types by location:
Ileocolic Crohn’s disease (40-50%)
- ileum + large intestine involvement
Crohn’s ileitis (20-30%)
- ileum only
Crohn’s colitis (15-20%)
- large intestines
*** although symptoms outside these three types have been seen – it is rare.
Types by findings of disease
Stricturing disease
- Narrowing of the bowel
- Often seen is bowel obstruction
- Feces may change structurally
Penetrating disease
- Fistuale formation
- Is a connection or pathway from one part of bowel to another
- A pathway may originate in the bowel and expose outward to skin
Inflammatory disease
- Inflammation only
- Does not exhibit penetrating or stricuturing
Complications
- Bowel obstruction
- Fistulas
- Strictures
- Adhesions
- Infections
- Primary Sclerosing Cholangitis
- Increased risk for colon cancer and small intestine cancer
- Anemia
- Difficulty during pregnancy
- others
Diagnosis
Several steps or evaluations are important in the diagnosis of crohn’s
1.) Colonscopy – helpful in 70% of patients
2.) Capsule Endoscopy - small capsule that travels through digestive tract
3.) Endoscopy
4.) Small bowel follow-through - drinking a contrast and subesquent X-rays
5.) CT
6.) MRI
7.) Blood work: CBC, CMP, Vitamin B12, Iron, ESR, C-reactive protein and others
8.) Stool culture
Treatment
- Current a cure is unkown
- Diease transitions from remission and active forms
- The goal of treatment is to prevent relapse of symptoms as long as possible
Medications:
- Antibiotics
. Flagyl [Metronidazole]
. Ciprofloxin
. others
- Inflammatory Drugs
. 5-aminosalicylic acid [Mesalazine] - mild-to-moderate disease
- Corticosteroids
. Prednisone
. Hydrocortisone
- Immunomodulators
. Azathioprine [Imuran]
. Mercaptopurine
. Infiximab
. Methotrexate
. Adalimumab
Surgery
- Often useful when obstruction occurs
- Partial bowel resection can improve symptoms in some individuals
- Following surgery – increased risk for stricture
- Short bowel syndome – a complication seen in those with more than 1/2 bowel removed.
. diarrhea is main symptom
Diet and other management options
1.) Diet
- certain foods may trigger worsening symptoms
- some individuals may benefit from low fiber diet
2.) Proper Hydration
3.) Stop smoking
4.) Exercise (as tolerated)
5.) Proper sleep pattern