Crohn's Disease

Crohn's disease overview
Causes of Crohn's disease
Symptoms of Crohn's disease
Diagnosing Crohn's disease
Complications of Crohn's disease
Diet and Crohn's disease
Stress and Crohn's disease
Pregnancy and Crohn's disease
Treatment

Crohn's disease overview

The digestive system

A persistent, long-lasting disorder, Crohn's disease causes inflammation of the digestive tract, which is also known as the gastrointestinal (GI) tract. While any part of the GI tract from the mouth to the anus can be affected by Crohn's disease, the disease most often affects the lower part of the small intestine known as the ileum. The swelling extends deep into the lining of the affected organ and can be painful. The swelling can also cause the intestines to empty frequently, resulting in diarrhea.

Crohn's disease, also known as ileitis or enteritis, is an inflammatory bowel disease – the general name for diseases that cause intestinal swelling. Crohn's disease often eludes diagnosis because it shares symptoms with other intestinal disorders such as ulcerative colitis and irritable bowel syndrome (IBS). Ulcerative colitis causes ulcers and inflammation in the top layer of the large intestine’s lining. Crohn's disease can impact all layers of the intestine, and normal healthy bowel can be found between diseased bowel sections in patients with Crohn's disease.

Crohn's disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn's disease have a blood relative who has some form of inflammatory bowel disease - most often a sibling, and sometimes a parent or child. Crohn's disease can occur in all age groups, but it is most commonly diagnosed in people between the ages of 20 and 30. Individuals of Jewish heritage have an increased risk of developing Crohn's disease, while African Americans have a decreased risk of developing Crohn's disease.

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Causes of Crohn's disease

There are no proven causes of Crohn's disease, although several theories have been proposed. The most popular theory is that the immune system (which is made from cells and different proteins that protect the body against infection) reacts abnormally in people with Crohn's disease, and mistakes foods, bacteria, and other substances for being foreign. This triggers the immune system to attack these "invaders." In doing so, white blood cells proliferate in the intestinal lining; this produces chronic infection, and leads to ulcerations and bowel injury.

Scientists do not know whether the abnormal functioning of the immune system seen in people with Crohn's disease is a cause or result of the disease. Research indicates that the inflammation seen in the GI tract of patients with Crohn's disease involves a number of factors: the immune system itself, the environment, and the genes the patient has inherited. Inflammation may be caused by the immune system's reaction to antigens – foreign substances found in the environment. Antigens themselves may also cause the inflammation associated with Crohn's disease. Some scientists think that anti-tumor necrosis factor (TNF), a protein produced by the immune system, may be a possible cause for this inflammation.

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Symptoms of Crohn's disease

The severity and extent of symptoms varies from patient to patient, although individuals with Crohn's disease most commonly experience diarrhea and abdominal pain, usually in the lower right area. Other possible symptoms include rectal bleeding, skin problems, weight loss, fever, and arthritis. Bleeding that accompanies Crohn's disease can be serious and persistent, potentially leading to anemia. Children with Crohn's disease may experience delayed development and stunted growth.

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Diagnosing Crohn's disease

For Crohn's disease to be properly diagnosed, a series of tests and a thorough physical exam may be required.

Doctors may order blood tests to determine whether an individual has a high white blood cell count, a sign of inflammation in the body. Blood tests can also show anemia, a possible indication of bleeding in the intestines. Another test using a stool sample can reveal whether a patient has intestinal bleeding or infection.

An upper gastrointestinal (GI) series may also be ordered so the doctor can examine the small intestine. Prior to this examination, patients drink a chalky solution known as barium that coats the lining of the small intestine. When X-rays are taken, barium shows up white on the films, revealing intestinal abnormalities or inflammations. If Crohn's disease is diagnosed through these tests, additional X-rays of both the upper and lower digestive tract may be necessary to reveal the extent of the disease.

A visual exam (either a sigmoidoscopy or a colonoscopy) of the colon may also be performed. A sigmoidoscopy shows the lining of the lower part of the large intestine, while a colonoscopy allows the doctor to examine the lining of the entire large intestine. For both tests, a long, flexible, lighted tube linked to a TV monitor and computer is inserted into the anus. Although both tests will reveal any inflammation or bleeding, a colonoscopy is usually a better test because the doctor can see the entire large intestine. The doctor may also perform a biopsy, which involves microscopic examination of a tissue sample from the patient’s intestinal lining.

Schedule an appointment

To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].

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Complications of Crohn's disease

The most common complication of Crohn's disease is intestinal blockage, which occurs when the intestinal wall passage is narrowed by thickening scar tissue and swelling from the disease. Crohn's disease may also cause ulcers or sores that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. Areas around the rectum and anus often become involved as well. These tunnels, known as fistulas, often become infected, sometimes requiring medication and in other cases surgery. Small tears known as fissures can also develop in the mucus membrane lining of the anus.

Nutritional complications such as protein, calorie, and vitamin deficiencies are commonly found in patients with Crohn's disease, so proper nutrition is an important concern. These deficiencies may be caused by malabsorption (poor absorption of nutrients in the GI tract), intestinal loss of protein, or inadequate dietary intake.

Some of the other complications related to Crohn's disease include: skin problems, kidney stones, gallstones, arthritis, inflammation in the eyes or mouth, or other diseases of the biliary system and liver. Some of these issues may be resolved during treatment for Crohn's disease, but others may require separate treatment.

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Diet and Crohn's disease

Patients with Crohn's disease frequently experience a diminished appetite. With less desire to eat, patients can have trouble obtaining the nutrition they need for healing and good health. Crohn's disease is also associated with diarrhea and poor absorption of necessary nutrients. Although no one diet or set of dietary rules has been proven effective for treating or preventing Crohn's disease, patients should follow a nutritious diet and avoid foods that appear to worsen symptoms.

Vitamins should not be taken unless recommended by a doctor.

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Stress and Crohn's disease

There is no evidence that identifies stress as a cause of Crohn's disease, although people with the disease sometimes report added stress in their lives related to managing a chronic illness. Additionally, some people report a flare-up in disease during stressful situations or events. Stress-related flare-ups of Crohn's disease are no more likely to occur in one type of person than another. Ensuring sufficient sleep and good eating habits along with relaxation techniques like slow breathing can help individuals who find there is a connection between their stress level and a worsening of their symptoms.

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Pregnancy and Crohn's disease

Although pregnancy and delivery is usually not complicated by Crohn's disease, women with the disease should talk to their doctor before pregnancy. Most children born to women with Crohn's disease are unaffected. If a child does develop Crohn's disease, they are sometimes more severely affected than adults, and in some instances experience slowed growth and delayed sexual development.

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