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Crohn’s Disease

Crohn’s disease is a potentially serious medical condition that results in inflammation of the Gastronintestinal Tract.

This condition is considered an Inflammatory Bowel Disease and can occur anywhere from the Oral Cavity to the anus or rectum.

The main symptoms include abdominal pain, rectal bleeding, and diarrhea. It is referred to as an Autoimmune Disease but it may also be more clearly defined as Immune Deficiency State.

This condition is perplexing and typical findings show that the immune system of the person with the condition is essentially attacking its own Gastrointestinal Tract (GI).

It is believed that the causes are diverse to include food, environmental factors, genetics, bacterial, and other factors.

Inflammation is what is seen and where most of the symptoms and pain occur. It is somewhat similar to Ulcerative Colitis, a disease that also affects the intestines.

Initial diagnosis often occurs in the late teens and early twenties. The most commonly affected area is the “terminal ileum” of the Small Intestines.

Common Potential Symptoms:

GI symptoms:

–  Abdominal pain
–  Diarrhea without blood
–  Diarrhea with blood
–  Watery stools  (Ileitis)
–  Smaller volume but increase 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
–  Difficulty eating
–  Decreased growth
–  Fever
–  Chills
–  Fatigue
–  Muscle Aches
–  Weight loss
–  Endocrine involvement
–  others

Potential Causes:

–  The specific cause is unknown
–  Genetics are strongly believed to be linked
–  Ethnic background
–  Mutations in “CARD15” gene
–  Smoking may increase the risk for the 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

–  Fistula formation
–  Is a connection or pathway from one part of the bowel to another
–  This pathway may originate in the bowel and expose outward to the skin

Inflammatory disease

–  Inflammation only
–  It does not exhibit penetrating or a stricture.

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.)  Colonoscopy – helpful in 70% of patients

2.)  Capsule Endoscopy  – a small capsule that travels through the digestive tract

3.)  Endoscopy

4.)  Small bowel follow-through – drinking a contrast and subsequent X-ray.

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 unknown
–  Disease 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 syndrome – 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