What is Crohn’s disease?

Named after Dr. Burrill B. Crohn, who first described the disease in 1932 along with colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer, Crohn’s disease belongs to a group of conditions known as Inflammatory Bowel Diseases (IBD). Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract.

When reading about inflammatory bowel diseases, it is important to know that Crohn’s disease is not the same thing as ulcerative colitis, another type of IBD. The symptoms of these two illnesses are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different.

Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis is limited to the colon, also called the large intestine.

Crohn’s disease can also affect the entire thickness of the bowel wall, while ulcerative colitis only involves the innermost lining of the colon. Finally, in Crohn’s disease, the inflammation of the intestine can “skip”– leaving normal areas in between patches of diseased intestine. In ulcerative colitis this does not occur.

 

Recognizing the Signs and Symptoms

Crohn’s disease can affect any part of the GI tract. While symptoms vary from patient to patient and some may be more common than others, the tell-tale symptoms of Crohn’s disease include:

Symptoms related to inflammation of the GI tract:

  • Persistent Diarrhea
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of incomplete evacuation
  • Constipation (can lead to bowel obstruction)
  • Nausea

General symptoms that may also be associated with IBD:

  • Fever
  • Loss of appetite
  • Weight Loss
  • Fatigue
  • Night sweats
  • Loss of normal menstrual cycle

Even if you think you are showing signs of Crohn’s Disease symptoms, only proper testing performed by an expert gastroenterologist can render a diagnosis.

People suffering from Crohn’s often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, Crohn’s may delay growth and development.

Crohn’s is a chronic disease, so this means patients will likely experience periods when the disease flares up and causes symptoms, followed by periods of remission when patients may not notices symptoms at all.

In more severe cases, Crohn’s can lead to tears (fissures) in the lining of the anus, which may cause pain and bleeding, especially during bowel movements. Inflammation may also cause a fistula to develop. A fistula is a tunnel that leads from one loop of intestine to another, or that connects the intestine to the bladder, vagina, or skin. This is a serious condition that requires immediate medical attention.

The symptoms depend on which part of the GI tract is affected.

 

What are the Causes of Crohn’s Disease? Who is Affected?

Crohn’s disease may affect as many as 700,000 Americans. Men and Women are equally likely to be affected, and while the disease can occur at any age, Crohn’s is more prevalent among adolescents and young adults between the ages of 15 and 35.

The causes of Crohn’s Disease are not well understood. Diet and stress may aggravate Crohn’s Disease, but they do not cause the disease on their own. Recent research suggests hereditary, genetics, and/or environmental factors contribute to the development of Crohn’s Disease.

The GI tract normally contains harmless bacteria, many of which aid in digestion. The immune system usually attacks and kills foreign invaders, such as bacteria, viruses, fungi, and other microorganisms. Under normal circumstances, the harmless bacteria in the intestines are protected from such an attack. In people with IBD, these bacteria are mistaken for harmful invaders and the immune system mounts a response. Cells travel out of the blood to the intestines and produce inflammation (a normal immune system response). However, the inflammation does not subside, leading to chronic inflammation, ulceration, thickening of the intestinal wall, and eventually causing patient symptoms.

Crohn’s tends to run in families, so if you or a close relative have the disease, your family members have a significantly increased chance of developing Crohn’s. Studies have shown that 5% to 20% of affected individuals have a first – degree relative (parents, child, or sibling) with one of the diseases. The risk is greater with Crohn’s disease than ulcerative colitis. The risk is also substantially higher when both parents have IBD. The disease is most common among people of eastern European backgrounds, including Jews of European descent. In recent years, an increasing number of cases have been reported among African American populations.

The environment in which you live also appears to play a role. Crohn’s is more common in developed countries rather than undeveloped countries, in urban rather than rural areas, and in northern rather than southern climates.

 

How is Crohn’s disease diagnosed?

Crohn’s disease is characterized by a range of signs and symptoms, so there is no single test that can determine the diagnosis of Crohn’s with certainty.

Crohn’s disease symptoms are often similar to other conditions, including bacterial infection. To diagnose you with Crohn’s, Dr. Simoni (or any gastroenterologist) needs to evaluate a combination of information and begin to exclude other potential causes of your symptoms. This process can take some time. Should you or a loved one experience symptoms, be sure to consult with Dr. Simoni as soon as possible.

– Early Tests and Exams

First, Dr. Simoni will conduct a standard physical exam of your body and interview you to learn more about your general health, diet, family history, and environment. Bring a record of your symptoms.

Early steps in the diagnostic process can include laboratory tests of blood and stool matter, as well as X-rays of the upper and lower GI tract including the use of Barium, a chemical that helps doctors see more details of your GI tract by increasing contrast of the X-Ray image.  In some cases a CT scan or MRI may be ordered depending on clinical indications.

– Endoscopy and Biopsy

Dr. Simoni will most likely recommend an endoscopy, which is the use of medical instruments to visually examine the interior of your digestive tract with a small camera mounted to the end of a lighted tube. There are three types of endoscopic examinations: a colonoscopy, an upper endoscopy, and Wireless Capsule Endoscopy (WCE).

  • Colonoscopy involves insertion of a flexible tube through the opening of the anus and allows for the examination of the colon, the lowest part of the large intestine.  More…
  • Upper Endoscopy involves the insertion of a flexible tube through the opening of the mouth, down the esophagus, into the stomach, and as far as the duodenum, the first part of the small intestine.  More…
  • Wireless Capsule Endoscopy (WCE) involves ingestion of pill-sized camera which takes pictures of the small intestine during its transit through the bowel. These pictures are transmitted to a receiver belt.  The camera is then expelled through a bowel movement.  More…

In addition to a visual examination, Dr. Simoni will often wish to obtain a biopsy of the colon or other affected areas by removing a small piece of tissue. Biopsied tissues are then analyzed in pathology to determine the presence of disease.

While endoscopy and biopsy may sound invasive, modern medical technology and techniques have made these procedures virtually painless and easily accomplished during an outpatient visit.

Alternative or additional imaging techniques for viewing the small bowel include a Specialized endoscopy to visualize the small intestine, sometimes called “balloon endoscopy”, may be needed for  areas of the intestine that are hard to reach.

 

What are the treatment options for Crohn’s disease?

A combination of treatment options can help you stay in control of your disease and help you to lead a full and rewarding life. Remember that there is no standard treatment that will work for all patients. Each patient’s situation is different and treatment must be followed for each circumstance.

Treatment for Crohn’s and other IBD varieties can include the use of medication, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of your GI tract.

– Medication

Medication treating Crohn’s disease is designed to suppress your immune system’s abnormal inflammatory response that is causing your symptoms. Suppressing inflammation not only offers relief from common symptoms like fever, diarrhea, and pain, it also allows your intestinal tissues to heal.

In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare ups (maintaining remission). With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced.

Several types of medication are being used to treat Crohn’s disease today.

– Diet & Nutrition

While Crohn’s Disease may not be the result of bad reactions to specific foods, paying special attention to your diet may help reduce symptoms, replace lost nutrients, and promote healing.

For people diagnosed with Crohn’s disease, it is essential to maintain good nutrition because Crohn’s often reduces your appetite while increasing your body’s energy needs. Additionally, common Crohn’s symptoms like diarrhea can reduce your body’s ability to absorb protein, fat, carbohydrates, as well as water, vitamins, and minerals.

Many people who experience Crohn’s disease flare ups find that soft, bland foods cause less discomfort than spicy or high-fiber foods. While your diet can remain flexible and should include a variety of foods from all food groups, your doctor will likely recommend restricting your intake of dairy if you are found to be lactose-intolerant.

– Surgery

Even with proper medication and diet, as many as two-thirds to three-quarters of people with Crohn’s disease will require surgery at some point during their lives. While surgery does not cure Crohn’s disease, it can conserve portions of your GI tract and return you to the best possible quality of life.  This is why it is imperative to make an early diagnosis and start treatment.

Surgery becomes necessary when medications can no longer control symptoms, or if you develop a fistula, fissure, or intestinal obstruction. Surgery often involves removal of the diseased segment of bowel (resection), the two ends of healthy bowel are then joined together (anastomosis). While these procedures may cause your symptoms to disappear for many years, Crohn’s frequently recurs later in life.

Key things to know about Surgery:

  • About 70% of people with Crohn’s disease eventually require surgery.
  • Different types of procedures may be performed depending on the reason, severity of illness, and location of the disease.
  • Approximately 30% of patients who have surgery for Crohn’s disease experience recurrence of their symptoms within three years and up to 60% will have recurrence within ten years.

IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult Dr. Simoni about your specific condition:

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