What is Crohn's Disease?
More research about Crohn?s disease is necessary. Researchers aren?t sure how it begins, who is most likely to develop it, or how to best manage it. Despite major treatment advances in the last three decades, no cure is available yet.
Crohn?s disease most commonly occurs in the small intestine and the colon. It can affect any part of your gastrointestinal (GI) tract, from your mouth to your anus. It can involve some parts of the GI tract and skip other parts.
The range of severity for Crohn?s is mild to debilitating. Symptoms vary and can change over time. In severe cases, the disease can lead to life-threatening flares and complications.
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.
The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue. Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
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. With treatment, many people with Crohn's disease are able to function well.
There are six variations of Crohn?s disease, all based on location. They are:
- Gastroduodenal Crohn?s disease mainly affects your stomach and the duodenum, which is the first part of your small intestine. About 5 percent of people with Crohn?s disease have this type.
- Jejunoileitis occurs in the second portion of your intestine, called the jejunum. Like gastroduodenal Crohn?s, this variation is less common.
- Ileitis is inflammation in the last part of the small intestine, or ileum. About 30 percent of people with Crohn?s disease are affected at this location.
- Ileocolitis affects the ileum and the colon and is the most common variation of Crohn?s. Approximately 50 percent of people with Crohn?s disease have this variation.
- Crohn?s colitis is found in about 20 percent of people with Crohn?s disease. It affects the colon only. Both ulcerative colitis and Crohn?s colitis impact the colon only, but Crohn?s colitis can affect deeper layers of the intestinal lining.
- Perianal disease affects about 30 percent of people with Crohn?s. This variation often involves fistulas, or abnormal connections between tissues, deep tissue infections, as well as sores and ulcers on the outer skin around the anus.
Symptoms of Crohn's Disease are :
Diarrhea is characterized by loose, watery stools or a frequent need to have a bowel movement. It usually lasts a few days and often disappears without any treatment. Diarrhea can be acute or chronic.
Acute diarrhea occurs when the condition lasts for one to two days. You might experience diarrhea as a result of a viral or bacterial infection. Other times, it could be due to food poisoning.
There?s even a condition known as traveler?s diarrhea, which happens when you have diarrhea after being exposed to bacteria or parasites while on vacation in a developing nation. Acute diarrhea is fairly common.
Seeing blood in the toilet, on the outside of your stool, or with wiping after a bowel movement is common. Fortunately, most of the causes of such rectal bleeding are not life-threatening; common causes include hemorrhoids and anal fissures. However, the only way to be certain of the cause is to be evaluated by a healthcare provider.
- Rectal bleeding is the passage of blood through the anus. The bleeding may result in bright red blood in the stool as well as maroon colored or black stool. The bleeding also may be occult (not visible with the human eye).
- The common causes of rectal bleeding from the colon include anal fissure, hemorrhoids, diverticulosis, colon cancer and polyps, colonic polyp removal, angiodysplasias, colitis, proctitis, and Meckel's diverticula.
- Rectal bleeding also may be seen with bleeding that is coming from higher in the intestinal tract, from the stomach, duodenum, small intestine, or Meckel's diverticulum.
- Rectal bleeding may not be painful; however, other symptoms that may accompany rectal bleeding are diarrhea, and abdominal cramps due to the irritation caused by the blood in the stool.
- Rectal bleeding is commonly evaluated and treated by gastroenterologists and colorectal or general surgeons.
- The origin of rectal bleeding is determined by history and physical examination, anoscopy, flexible sigmoidoscopy, colonoscopy, radionuclide scans, visceral angiograms, upper gastrointestinal endoscopy or capsule endoscopy of the small intestine, and blood tests.
- Rectal bleeding is managed first by correcting any low blood volume and anemia if present with blood transfusions and then, determining the site and cause of the bleeding, stopping the bleeding, and preventing future rebleeding.
- Rectal bleeding can be prevented if the cause of the bleeding can be found and definitively treated, for example, by removing the bleeding polyp or tumor. In addition, it may be appropriate to search for additional abnormalities, for example, polyps or angiodysplasias that have not yet bled but may do so in the future. This may require either gastrointestinal endoscopy or surgery.
Sudden, noticeable weight loss can happen after a stressful event, although it can also be a sign of a serious illness.
It's normal to lose a noticeable amount of weight after the stress of changing jobs, divorce, redundancy or bereavement.
Weight often returns to normal when you start to feel happier, after you've had time to grieve or get used to the change. Counselling and support may be needed to help you get to this stage.
Significant weight loss can also be the result of an eating disorder, such as anorexia or bulimia. If you think you have an eating disorder, talk to someone you trust and consider speaking to your GP. There are also several organisations that can provide you with information and advice, such as the eating disorders charity Beat.
If your weight loss wasn't due to one of the causes mentioned, and you didn't lose weight through dieting or exercising, see your GP, as you may have an illness that needs treating.
Abdominal pain has many potential causes. The most common causes ? such as gas pains, indigestion or a pulled muscle ? usually aren't serious. Other conditions may require more-urgent medical attention.
While the location and pattern of abdominal pain can provide important clues, its time course is particularly useful when determining its cause.
Acute abdominal pain develops, and often resolves, over a few hours to a few days. Chronic abdominal pain may be intermittent, or episodic, meaning it may come and go. This type of pain may be present for weeks to months, or even years. Some conditions cause progressive pain, which steadily gets worse over time.
Fatigue is a constant state of tiredness, even when you?ve gotten your usual amount of sleep. This symptom develops over time and causes a drop in your physical, emotional, and psychological energy levels. You?re also more likely to feel unmotivated to participate in or do activities you normally enjoy.
Some other signs of fatigue include feeling:
- physically weaker than usual
- tired, despite rest
- as though you have less stamina or endurance than normal
- mentally tired and moody
Loss of appetite means you don?t have the same desire to eat as you used to. Signs of decreased appetite include not wanting to eat, unintentional weight loss, and not feeling hungry. The idea of eating food may make you feel nauseous, as if you might vomit after eating. Long-term loss of appetite is also known as anorexia, which can have a medical or psychological cause.
It may be a warning sign from your body when you feel fatigue and loss of appetite together. Read on to see what conditions may cause these symptoms.
Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.
Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.
A fever is a higher-than-normal body temperature. It?s a sign of your body's natural fight against infection.
- For adults, a fever is when your temperature is higher than 100.4°F.
- For kids, a fever is when their temperature is higher than 100.4°F (measured rectally); 99.5°F (measured orally); or 99°F (measured under the arm).
The average normal body temperature is 98.6° Fahrenheit (or 37° Celsius). When you or your child?s temperature rises a few degrees above normal, it?s a sign that the body is healthy and fighting infection. In most cases, that?s a good thing.
But when a fever rises above 102°F it should be treated at home and, if necessary, by your healthcare provider if the fever doesn?t go down after a few days.
Crohn's Disease can be caused due to:
It isn?t clear what causes Crohn?s disease. However, the following factors may influence whether you get it:
- your immune system
- your genes
- your environment
Up to 20 percent of people with Crohn?s disease also have a parent, child, or sibling with the disease, according to the Crohn?s & Colitis Foundation.
According to a 2012 study, certain things can affect the severity of your symptoms. These include:
- whether you smoke
- your age
- whether or not the rectum is involved
- length of time you?ve had the disease
People with Crohn?s are also more likely to develop intestinal infections from bacteria, viruses, parasites, and fungi. This can affect the severity of symptoms and create complications.
Crohn?s disease and its treatments can also affect the immune system, making these types of infections worse.
Yeast infections are common in Crohn?s and can affect both the lungs and the intestinal tract. It?s important that these infections are diagnosed and properly treated with antifungal medications to prevent further complications.
Treatment for the Crohn's Disease
No single test result is enough for your doctor to diagnose Crohn?s disease. They will begin by eliminating any other possible causes of your symptoms. Making a Crohn?s disease diagnosis is a process of elimination.
Your doctor may use several types of tests to make a diagnosis:
- Blood tests can help your doctor look for certain indicators of potential problems, such as anemia and inflammation.
- A stool test can help your doctor detect blood in your GI tract.
- Your doctor may request an endoscopy to get a better image of the inside of your upper gastrointestinal tract.
- Your doctor may request a colonoscopy to examine the large bowel.
- Imaging tests like CT scans and MRI scans give your doctor more detail than an average X-ray. Both tests allow your doctor to see specific areas of your tissues and organs.
- Your doctor will likely have a tissue sample, or biopsy, taken during an endoscopy or colonoscopy for a closer look at your intestinal tract tissue.
Once your doctor has completed reviewing all the necessary tests and ruled out other possible reasons for your symptoms, they may conclude that you have Crohn?s disease.
Your doctor may go on to request these tests several more times to look for diseased tissue and determine how the disease is progressing.
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, but they don't work for everyone with Crohn's disease. Doctors generally use them only if you don't respond to other treatments.
Corticosteroids may be used for short-term (three to four months) symptom improvement and to induce remission. Corticosteroids may also be used in combination with an immune system suppressor.
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. Immunosuppressant drugs include:
Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, such as a lowered resistance to infection and inflammation of the liver. They may also cause nausea and vomiting.
Infliximab (Remicade), adalimumab (Humira) and certolizumab pegol (Cimzia). These drugs, called TNF inhibitors or biologics, work by neutralizing an immune system protein known as tumor necrosis factor (TNF).
Methotrexate (Trexall). This drug is sometimes used for people with Crohn's disease who don't respond well to other medications. You will need to be followed closely for side effects.
Natalizumab (Tysabri) and vedolizumab (Entyvio). These drugs work by stopping certain immune cell molecules ? integrins ? from binding to other cells in your intestinal lining. Because natalizumab is associated with a rare but serious risk of progressive multifocal leukoencephalopathy ? a brain disease that usually leads to death or severe disability ? you must be enrolled in a special restricted distribution program to use it.
Vedolizumab recently was approved for Crohn's disease. It works like natalizumab but appears not to carry a risk of brain disease.
Ustekinumab (Stelara). This drug is used to treat psoriasis. Studies have shown that it's useful in treating Crohn's disease as well and may be used when other medical treatments fail.
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).
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn's disease, your doctor may recommend one or more of the following:
- Anti-diarrheals. A fiber supplement, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium A-D) may be effective.
- Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) ? but not other common pain relievers, such as ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve). These drugs are likely to make your symptoms worse, and can make your disease worse as well.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and need to take iron supplements.
- Vitamin B-12 shots. Crohn's disease can cause vitamin B-12 deficiency. Vitamin B-12 helps prevent anemia, promotes normal growth and development, and is essential for proper nerve function.
- Calcium and vitamin D supplements. Crohn's disease and steroids used to treat it can increase your risk of osteoporosis, so you may need to take a calcium supplement with added vitamin D.
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.
Your doctor may use nutrition therapy short term and combine it with medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.
Your doctor may also recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel (stricture). A low residue diet is designed to reduce the size and number of your stools.
If diet and lifestyle changes, drug therapy, or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery. Nearly half of those with Crohn's disease will require at least one surgery. However, surgery does not cure Crohn's disease.
During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn's disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.
Possible complication with Crohn's Disease
Crohn's disease may lead to one or more of the following complications:
Bowel obstruction. Crohn's disease affects the thickness of the intestinal wall. Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents. You may require surgery to remove the diseased portion of your bowel.
Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum).
Fistulas. Sometimes ulcers can extend completely through the intestinal wall, creating a fistula ? an abnormal connection between different body parts. Fistulas can develop between your intestine and skin, or between your intestine and another organ. Fistulas near or around the anal area (perianal) are the most common kind.
When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption. Fistulas may occur between loops of bowel, into the bladder or vagina, or out through the skin, causing continuous drainage of bowel contents to your skin.
In some cases, a fistula may become infected and form an abscess, which can be life-threatening if not treated.
Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It's often associated with painful bowel movements and may lead to a perianal fistula.
Malnutrition. Diarrhea, abdominal pain and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. It's also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
Colon cancer. Having Crohn's disease that affects your colon increases your risk of colon cancer. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy every 10 years beginning at age 50. Ask your doctor whether you need to have this test done sooner and more frequently.
Other health problems. Crohn's disease can cause problems in other parts of the body. Among these problems are anemia, skin disorders, osteoporosis, arthritis, and gallbladder or liver disease.
Medication risks. Certain Crohn's disease drugs that act by blocking functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase risk of infection.
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