Crohn’s disease
Crohn’s disease is a form of IBD (inflammatory bowel disease). It’s associated with digestive system inflammation, and this can result in chronic diarrhea, abdominal pain, weight loss, malnutrition, and fatigue. Children, men, and women are all at a higher risk of developing this disorder.
The inflammation and irritation that occurs due to Crohn’s disease can affect different parts of the digestive system in different individuals. However, it’s more common in the large and small intestines. It can also spread towards the deep layers around the bowel. Typically, this condition can be debilitating and painful at the same time. At times, it can even result in fatal complications.
Types of Crohn’s Disease
There are several types of Crohn’s disease that can develop in different areas of the digestive tract. They include;
Gastroduodenal Crohn's disease: This is a rare condition that mostly develops in the stomach and the duodenum. The duodenum is the initial section of the small intestine.
Jejunoileitis: This form is found in the jejunum, which is the second section of the intestine. This form of Crohn's disease is less common than gastroduodenal Crohn's.
Ileitis: This condition is associated with an inflammation of the ileum, the last section of the small intestine.
Ileocolitis: This is the most common Crohn's disease variant that affects the ileum as well as the colon.
Crohn's colitis: This condition only occurs in the colon. Both Crohn's colitis and ulcerative colitis affect the colon, although Crohn's colitis may affect the intestinal lining at a deeper level.
Perianal disease: Fistulas or irregular contacts between tissues, deep tissue infections, and ulcers and sores on the outer skin within the anus are all the common symptoms of this condition.
Causes of Crohn’s Disease
The actual cause of Crohn's disease remains unknown. Initially, medical providers suspected stress and diet. However, they now believe that these aspects can aggravate Crohn's disease but do not cause it. Its occurrence is likely influenced by a number of factors, including heredity and a malfunctioning of the immune system.
The body immune system: It's likely that a virus or bacterium causes Crohn's disease, but scientists are yet to discover such a cause. An irregular immune response makes the immune system target the cells within the digestive tract, as well as it attempts to battle off the invading germs and microorganisms.
Hereditary: Crohn's disease is hereditary; hence it’s more frequent among individuals with relatives who have the condition. Therefore, genes can play a major role in causing people to more vulnerable. Most individuals with Crohn's disease, on the other hand, do not have a family history of the disorder.
Signs and Symptoms of Crohn’s Disease
Crohn's disease can involve any portion of the small or large intestine. Furthermore, it can be persistent or include several segments. The disease is limited to the colon, which is a section of the large intestine, for other people.
Crohn's disease symptoms can vary from mild to chronic. They usually appear gradually, but they may also develop abruptly and without any warning. There can also be times when you don’t have signs or symptoms (a period known as remission).
When Crohn’s disease gets active, you can begin to notice the following signs and symptoms;
Pain: The intensity of pain varies from person to person and is determined by the location of the inflammation in the stomach. Pain is most often felt around the lower-right section of the abdomen.
Gut Ulcers: Ulcers are the raw regions around the gut that can bleed. One may notice blood traces in their stools if they bleed.
Ulcers in the mouth: These are a common indication of Crohn’s disease.
Diarrhea: This may be mild or extreme. Blood, mucus, or pus can be present at times. Also, the patient can feel compelled to urinate, but nothing actually comes out.
Fatigue: Crohn’s disease patients always feel exhausted. Fever can also occur as a result of exhaustion.
Appetite changes: If you have the condition, then there might be times when your appetite is extremely poor.
Weight loss: A constant loss of appetite may cause drastic weight loss.
Anemia: This is a condition that occurs due to loss of blood.
Anal fissures and rectal bleeding: This is where the skin around the anus cracks, causing discomfort and bleeding.
Other potential symptoms that might be associated with Crohn’s disease include;
- Eye inflammation (uveitis)
- Arthritis
- Inflammation and development of a rash on the skin
- Bile duct and liver inflammation
- Tardy growth and sexual development among the children
Risk Factors of Crohn’s Disease
Some of the Crohn’s disease risk factors that increase the possibility of developing the disease include;
Age: Crohn's disease may strike at any age; however, it's more likely to occur at a younger age. Many individuals with Crohn's disease are usually diagnosed before they reach the age of 30.
Smoking cigarettes: The most significant controllable risk factor for Crohn's disease is cigarette smoking. Smoking often causes more serious illness and increases the likelihood of undergoing surgery. Therefore, it's important to quit smoking if you do.
Family history: If you have a close relative with the disease, such as a parent, child, or sibling, there are high chances of developing the condition. One of every five individuals with Crohn's disease has a close relative or family member who also has it.
NSAIDs (nonsteroidal anti-inflammatory drugs): Ibuprofen (Advil and Motrin IB), diclofenac sodium, naproxen sodium (Aleve), and others are examples of NSAIDs. Although they do not trigger Crohn's disease, they cause intestinal inflammation, which can exacerbate the condition.
Diagnosing Crohn’s Disease
There is no specific sole analytic examination to determine Crohn’s disease. However, the doctor will diagnose the disease just by ruling out certain potential causes and triggers. Through this, they can determine if the patient is infected.
A combination of various tests is run on the patient to affirm the diagnosis of the disease. These tests can thus include the following;
Laboratory tests and examinations such as:
Blood testing: The doctor carries out blood tests in order to check for any signs of infection or anemia. Anemia is an illness in which there’s a lack of enough red blood cells that transports oxygen to the body tissues.
Study of the stool: If necessary, the doctor can request a stool sample to check for any organisms, including parasites or hidden traces of blood in the stool.
Diagnostic procedures:
They can include one or a combination of the following procedures;
- Computerized tomography (CT) scan
A CT scan, which is a form of X-ray method, offers more information compared to a regular X-ray. It examines the whole bowel and tissues located outside the bowel area. On the other hand, CT enterography is a specialized CT scan that gives a clearer picture of the small intestine. In several medical facilities, this procedure has taken the place of barium X-rays.
- Capsule endoscopy
This type of test requires you to swallow a capsule that has a camera inside it. The purpose of the camera is to capture images of the small intestines. The images are in turn transmitted to a recorder the patient wears on the belt. The camera painlessly exits through your stool, and the images it has captured are downloaded to a computer and exhibited on a screen. This allows the doctor looks for any signs of the disease.
And endoscopy with biopsy might still be necessary to affirm the Crohn’s disease diagnosis. However, capsule endoscopy is not recommended in the case of a bowel obstruction.
- Magnetic Resonance Imaging (MRI) scan
MRI scanning involves the use of radio waves and strong magnetic fields to produce detailed pictures of tissues and organs. Specifically, pelvic MRI is used for assessing the Crohn’s disease fistula on the anal region. The MR enterography is used in the evaluation of the small intestines.
- Colonoscopy
This form of test is intended to help the doctor fully assess the whole colon and the end of the ileum (terminal ileum). It involves the use of a slim, flexible, and illuminated tube with a camera on one of the tips to view the colon. For lab examination, a doctor takes samples during the procedure, which helps in coming up with an analysis. Crohn’s disease diagnosis is identified with the presence of granulomas, collections of inflammatory cells.
- Balloon-assisted enteroscopy
This form of the test involves the use of scope along with an over tube device. It enables the physician to look deeper into the small bowel where the normal endoscopes cannot reach. This particular test is specifically useful after the use of the capsule endoscopy, which depicts abnormalities but with an inconclusive outcome.
Crohn’s Disease Treatment
There is no specific Crohn’s disease cure, and no single medication is effective for everyone. Reducing inflammation, which causes the signs and symptoms, is one objective of medical care. Another aim is to reduce complications in order to enhance the long-term prognosis. In the best-case scenario, this could result in both symptom relief and long-term remission.
The available Crohn’s disease treatment options that can help with the condition include;
Anti-inflammatory medication:
These medications are usually the first mode of treatment of the IBD. They thus include the following;
- Corticosteroids
This form of medication helps minimize inflammation within the body. However, they only work for selective few patients with Crohn’s disease. Examples of such drugs are prednisone and budesonide. Medical providers often recommend the when the patient is unresponsive to other forms of medication.
At times, the corticosteroids are prescribed together with an immune system suppressor and are given for three to four months. Furthermore, they are helpful in the enhancement of Crohn’s disease-associated symptoms and can stimulate remission.
- Oral 5-aminosalicylates
Sulfasalazine (Azulfidine), containing sulfa, and mesalamine (such as Asacol HD and Delzicol) are two examples of these drugs. Oral 5-aminosalicylates were commonly used before, but they are now widely regarded as having very little value.
Biologics:
This is categorized as therapy that targets the proteins which the body immune system procedure. Examples of biologics that doctors use to address Crohn’s disease are;
Vedolizumab (Entyvio) and natalizumab (Tysabri): They function by preventing integrins, which are molecules found in immune cells, from attaching to other cells within the intestinal lining.
Certolizumab pegol (Cimzia), infliximab (Remicade), and adalimumab (Humira): These medications, also known as TNF inhibitors, function by neutralizing a protein in the immune system called tumor necrosis factor (TNF).
Ustekinumab (Stelara): This drug was recently approved to address Crohn's disease by inhibiting the function of an interleukin, a protein that plays a major role in inflammation.
Immune system suppressors:
These medications help minimize inflammation by targeting the immune system, which creates inflammatory substances. For other patients, a combination of these medications is more effective than taking only one of them.
Suppressors of the immune system include;
Mercaptopurine (Purinethol and Purixan) and azathioprine (Azasan and Imuran): These medications are the most commonly prescribed immunosuppressants for inflammatory bowel disease treatment.
Methotrexate (Trexall): This medicine is sometimes prescribed for Crohn's disease patients who do not react well to other treatments. For side effects, you'll have to be closely monitored.
Antibiotics:
In patients with Crohn's disease, antibiotics can help minimize the drainage amount from abscesses and fistulas and even cure them. According to some studies, antibiotics can also help suppress dangerous intestinal bacteria. This can contribute to the stimulation of the intestinal immune system, resulting in inflammation. Ciprofloxacin (Cipro) and metronidazole (Flagyl) are two antibiotics that are often prescribed.
Crohn’s Disease Diet:
Food doesn’t cause the disease, but it may sometimes trigger Crohn’s disease flare-up. If you have been diagnosed with Crohn's disease, the doctor would probably recommend visiting a registered dietitian (RD). The role of an RD is to enable you to understand various ways in which food affects the symptoms. He or she will also inform you how changing your diet can help you feel better.
They could ask you to have a food diary at first. The purpose of this food diary is to point what you ate and how you felt afterwards.
The RD will use this information to assist you in developing a suitable eating plan. The dietary changes can help you consume more nutrients from the daily food while limiting any harmful side effects that food can have.
Additional treatment forms:
Certain medications can help ease your signs and symptoms apart from controlling inflammation. However, you should always consult the physician before using any over-the-counter drugs. The doctor can suggest one or more treatments based on the seriousness of Crohn's disease. They can include;
Pain relievers: The medical can prescribe acetaminophen (Tylenol, among others) for minor pain, but not ibuprofen (Advil and Motrin IB, among others) and naproxen sodium (Aleve). Such medications are most likely to exacerbate the symptoms, as well as your illness.
Anti-diarrheals: By bulking up the stool, a fiber supplement like psyllium powder (or Metamucil) and methylcellulose (Citrucel) will help alleviate mild to moderate diarrhea. On the other hand, Loperamide (or Imodium A-D) can help with more serious diarrhea.
Supplements and vitamins: At times, the doctor can prescribe vitamins as well as nutritional supplements if the body is not absorbing sufficient nutrients.
Surgery:
The doctor may sometimes suggest surgery if other treatment forms, including drug therapy, and diet fail to alleviate the signs and symptoms. Almost half of the people with Crohn's disease would need surgery at some point. Surgery, on the other hand, does not completely cure Crohn's disease.
The surgeon will extract the damaged part of the digestive system and then reattach the healthy parts during Crohn’s disease surgery. Fistulas and abscesses can also be treated with surgery.
The advantages of Crohn's disease surgery are typically only temporary. Recurrence of the disease is common, particularly around the reconnected tissue. To reduce these risks of recurrence, it is best to combine surgery with medication.
Complications of Crohn’s Disease
One or more of these complications can occur as a result of Crohn's disease;
Obstruction of the bowel: Crohn's disease may affect the whole intestinal wall thickness. Sections of the bowel will narrow down and scar with time, obstructing the normal movement of digestive components. Surgery might be necessary to extract the diseased section of the bowel.
Fistulas: Ulcers may sometimes spread all the way via the intestinal wall, resulting in a fistula. This is an irregular link between various body areas. Fistulas may form between the intestine and the skin, as well as between the intestine and a different organ. Typically, the most popular type of fistula is one that develops near or within the anal region (perianal).
Food can bypass parts of the bowel that are important for absorption if fistulas form in the abdomen. Fistulas can also develop between bowel loops, vagina or bladder, or skin, allowing bowel contents to drain continuously to the skin. Sometimes, a fistula can be infected and develop an abscess. This tends to be fatal if not addressed on time.
Ulcers: Severe inflammation can cause open sores known as ulcers in any part of the digestive system. This includes the anus and mouth, as well as in the genital region (perineum).
Anal fissure: A slight tear around the tissue lining the anus or in the skin within the anus may lead to infection, anal fissure. It's usually linked to painful bowel movements and can result in a perianal fistula.
Colon cancer: If you have Crohn's disease, which impairs the large intestine, you're more likely to develop colon cancer. According to general colon cancer screening recommendations, people who don’t have Crohn's disease should have a colonoscopy at least every ten years, starting at age 50. Consult the doctor to see if this examination should be performed earlier or more regularly.
Malnutrition: You might find it difficult to eat or for the intestine to take in adequate nutrients to make you nourished. This is usually due to diarrhea, cramping, or abdominal pain associated with Crohn’s disease. Anemia is also popular as a result of the low iron or vitamin B-12 levels triggered by the condition.
Medication side effects: Some types of Crohn's disease medications that work by inhibiting immune system functions have been linked to a minor increase in the incidence of cancers, including lymphoma or skin cancers. They can even make you more susceptible to infection.
On the other hand, corticosteroids have been linked to a higher risk of various conditions. They include bone fractures, osteoporosis, cataracts, diabetes, glaucoma, and high blood pressure. Talk with your medical provider in order to determine the dangers and benefits of drugs.
Formation of a blood clot: Blood clots formation within veins and arteries are more likely in people with Crohn's disease.
Addition health issues: Crohn's disease can affect other parts of the body and cause various complications. Anemia, arthritis, osteoporosis, skin conditions, and gallbladder or liver disease are among these issues.
Crohn’s Disease versus Ulcerative Colitis
Ulcerative colitis leads to inflammation and the development of ulcers around the top layer of the large intestine lining. On the other hand, Crohn's disease can cause inflammation and ulcers in all layers of the large intestine.
Inflammation develops anywhere in the stomach in Crohn's disease, but only in the large intestine in ulcerative colitis (colon and rectum). Also, the bowel of an individual with Crohn’s disease may have healthy regions between the affected parts. With ulcerative colitis, the damage occurs in a continuous outline.
Bottom Line
Generally, Crohn’s disease is fatal and a type of inflammatory conditions that result in severe inflammation of the digestive system. It’s a chronic and long-term problem that can be extremely debilitating and painful. This condition can occur and affect any section of the gut, starting from the mouth down towards the anus. In other cases, it can involve the small intestine as well.
Although there is no actual cure for Crohn’s disease, therapy can help ease the associated signs and symptoms. It can even result in long-term remission and recovery of the inflammation. Furthermore, most patients can function properly after treatment.