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Crohn's disease
Definition
Crohn's disease is a form of inflammatory bowel disease (IBD). It usually affects the intestines, but may occur anywhere from the mouth to the end of the rectum (anus).
Ulcerative colitis is a related condition.
Alternative Names
Inflammatory bowel disease - Crohn's disease; Regional enteritis; Ileitis; Granulomatous ileocolitis; IBD- Crohn's disease
Causes
The exact cause of Crohn's disease is unknown. It is a condition that occurs when your body's immune system mistakenly attacks and destroys healthy body tissue (autoimmune disorder).
People with Crohn's disease have ongoing (chronic) inflammation of the gastrointestinal tract (GI tract). Crohn's disease may involve the small intestine, the large intestine, the rectum, or the mouth. The inflammation causes the intestinal wall to become thick.
The following seem to play a role in Crohn's disease:
- Your genes and family history (people of Jewish descent are at higher risk)
- Environmental factors
- Tendency of your body to over-react to normal bacteria in the intestines
- Smoking
Crohn's disease may occur at any age. It usually occurs in people between ages 15 - 35.
Symptoms
Symptoms depend on what part of the gastrointestinal tract is affected. Symptoms range from mild to severe, and can come and go with periods of flare-ups.
The main symptoms of Crohn's disease are:
- Crampy abdominal (belly area) pain
- Fever
- Fatigue
- Loss of appetite
- Pain with passing stool (tenesmus)
- Persistent, watery diarrhea
- Weight loss
Other symptoms may include:
- Constipation
- Eye inflammation
- Fistulas (usually around the rectal area, may cause draining of pus, mucus, or stools)
- Joint pain and swelling
- Mouth ulcers
- Rectal bleeding and bloody stools
- Skin lumps or sores (ulcers)
- Swollen gums
Exams and Tests
A physical examination may reveal an abdominal mass or tenderness, skin rash, swollen joints, or mouth ulcers.
Tests to diagnose Crohn's disease include:
- Barium enema or upper GI series
- Colonoscopy or sigmoidoscopy
- Computed tomography (CT scan) of the abdomen
- Endoscopy, including capsule endoscopy
- Magnetic resonance imaging (MRI) of the abdomen
- Enteroscopy
A stool culture may be done to rule out other possible causes of the symptoms.
This disease may also alter the results of the following tests:
- Albumin
- C-reactive protein
- Erythrocyte sedimentation rate
- Fecal fat
- Hemoglobin
- Liver function tests
- White blood cell count
Treatment
DIET AND NUTRITION
You should eat a well-balanced, healthy diet. Include enough calories, protein, and nutrients from a variety of food groups.
No specific diet has been shown to make Crohn's symptoms better or worse. Specific food problems may vary from person to person.
However, certain types of foods can make diarrhea and gas worse. To help ease symptoms, try:
- Eating small amounts of food throughout the day.
- Drinking lots of water (drink small amounts often throughout the day).
- Avoiding high-fiber foods (bran, beans, nuts, seeds, and popcorn).
- Avoiding fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
- Limiting dairy products if you have problems digesting dairy fats. Try low-lactose cheeses, such as Swiss and cheddar, and an enzyme product, such as Lactaid, to help break down lactose.
- Avoiding foods that you know cause gas, such as beans.
Ask your doctor about extra vitamins and minerals you may need:
- Iron supplements (if you are anemic)
- Calcium and vitamin D supplements to help keep your bones strong
- Vitamin B12 to prevent anemia
STRESS
You may feel worried, embarrassed, or even sad and depressed about having a bowel disease. Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can worsen digestive problems.
Ask your doctor or nurse for tips on how to manage your stress.
MEDICATIONS
You can take medication to treat very bad diarrhea. Loperamide (Imodium) can be bought without a prescription. Always talk to your doctor or nurse before using these drugs.
Other medicines to help with symptoms include:
- Fiber supplements may help your symptoms. You can buy psyllium powder (Metamucil) or methylcellulose (Citrucel) without a prescription. Ask your doctor about these products and all laxative medicines.
- Acetaminophen (Tylenol) for mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) which can make your symptoms worse.
Your doctor may also give you a prescription for stronger pain medicines, such as:
- Aminosalicylates (5-ASAs) - medicines that help control mild to moderate symptoms. Some forms of the drug are taken by mouth; others must be given rectally.
- Corticosteroids (prednisone and methylprednisolone) - treat moderate to severe Crohn's disease. They may be taken by mouth or inserted into the rectum.
- Medicines such as azathioprine or 6-mercaptopurine - quiet the immune system's reaction.
- Antibiotics - treat abscesses or fistulas.
- Biologic therapy - used for severe Crohn's disease that does not respond to any other types of medication. Medicines in this group include Infliximab (Remicade) and adalimumab (Humira), certolizumab (Cimzia), and natalizumab (Tysabri).
SURGERY
Some people with Chron's disease may need surgery to remove a damaged or diseased part of the intestine (bowel resection). In some cases the entire large intestine (colon) is removed, with or without the rectum.
Patients who have Crohn's disease that does not respond to medications may need surgery to treat problems such as:
- Bleeding (hemorrhage)
- Failure to grow (in children)
- Fistulas (abnormal connections between the intestines and another area of the body)
- Infections (abscesses)
- Narrowing (strictures) of the intestine
Surgeries that may be done include:
- Ileostomy
- Large bowel resection
- Small bowel resection
- Total abdominal colectomy
- Total proctocolectomy with ileostomy
Support Groups
The Crohn's and Colitis Foundation of American offers support groups throughout the United States.Outlook (Prognosis)
There is no cure for Crohn's disease. The condition is marked by periods of improvement followed by flare-ups of symptoms.
If you stop or change your medications for any reason, let your doctor know right away.
You have a higher risk for small bowel and colon cancer if you have Crohn's disease.
Possible Complications
- Abscess
- Bowel obstructions
- Erythema nodosum
- Fistulas in the following areas:
- Bladder
- Skin
- Vagina
- Slow growth and sexual development in children
- Swelling of the joints
- Lesions in the eye
- Nutritional deficiency (commonly vitamin B12 deficiency)
- Pyoderma gangrenosum
When to Contact a Medical Professional
Call for an appointment with your health care provider if:
- You have very bad abdominal pain
- You cannot control your diarrhea with diet changes and drugs
- You have lost weight, or a child is not gaining weight
- You have rectal bleeding, drainage, or sores
- You have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F without an illness
- You have nausea and vomiting that lasts for more than a day
- You have skin sores or lesions that do not heal
- You have joint pain that prevents you from doing your everyday activities
- You have side effects from any drugs prescribed for your condition
References
Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104(2):465-483.
Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.
Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 111.
Lichenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 143.
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.
