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Crohn's Disease

Crohn's Disease

Overview of Crohn's Disease
What is Crohn's Disease?
Who Gets Crohn's Disease?
What Causes Crohn's Disease?
What are the Symptoms of Crohn's Disease?
What are the Complications of Crohn’s Disease?
How is Crohn's Disease Diagnosed?
What is the Role of Diet and Stress in Crohn's Disease?
Treatment of Chrohn's Disease

Overview of Crohn's Disease

(Image: NIH Publication No. 12-3140, December, 2011)

Crohn's disease causes inflammation (swelling, irritation) of the gastrointestinal (GI) tract.  Symptoms of diarrhea, rectal bleeding, and abdominal cramps may be intermittent or constant and may last a lifetime. There is not yet a cure for Crohn's disease, but special diets and newer medications may reduce inflammation, ease symptoms, and reduce the risk of complications. Surgery is an option when medications are not enough.

Crohn's is a challenging disease. Handling the ups and downs of symptoms over the years may be stressful. The symptoms vary from person to person, and a treatment that is effective in one person might not work in another. That's why patients need personalized advice, close monitoring, and highly individualized therapy.
   
The good news is that current therapies for Crohn's disease are more effective at relieving symptoms, helping patients avoid surgery and giving them a more predictable and active everyday life.

One of the best ways to get effective comprehensive care is to build a long-term relationship with a GI specialist in Crohn's disease. By educating yourself about the disease and by working with a gastroenterologist who knows you well, you may get better control over the disease and lead a full life.

In this Conditions section, we explain why Temple is a top choice for any patient or family facing Crohn's disease and we describe the causes, symptoms, and potential complications of Crohn's disease, as well as how it is diagnosed and the potential impacts of factors such as diet AND stress.

What is Crohn's Disease?

Crohn's disease is a chronic condition that may cause inflammation in any part of the GI tract—from the mouth to the anus. Inflammation is swelling or irritation that may lead to sores, ulcers, scarring—and painful symptoms. Most often, the inflammation strikes in the lower part of the small intestine (the ileum) and the beginning part of the large intestine (the colon). The disease was named after Dr. Burrill Crohn, who first described the condition in 1932.

Crohn's disease is one of the two main types of Inflammatory Bowel Disease (IBD). The other is ulcerative colitis. The two diseases are similar, but the inflammation in Crohn's is more widespread throughout the GI tract than in ulcerative colitis, which only affects the colon. Also, in Crohn's the inflammation may often penetrates deeper into spotty patches along the GI tract. Normal healthy areas may often appear in between the inflamed patches. By contrast, in ulcerative colitis, the swelling is continuous and may involve part of the colon or its entirety. The inflammation in ulcerative colitis usually does not penetrate as deeply as in Crohn's disease. 

Inflammatory Bowel Disease = Crohn's Disease OR Ulcerative Colitis
Irritable Bowel Syndrome ≠ Inflammatory Bowel Disease

It is important to distinguish between Crohn's disease and other diseases that cause similar symptoms—like ulcerative colitis, irritable bowel syndrome, celiac disease (sprue, or gluten intolerance), or cancer—because these other diseases require different therapies. Early diagnosis of Crohn's may lead to earlier therapy, which may help prevent serious complications or the need for hospitalization or surgery. About half of patients with Crohn's disease eventually need surgery, but better medications are reducing that need.

Who Gets Crohn’s Disease?

More than half a million Americans have Crohn's disease. Most people are young (between 15 and 30 years of age) when their symptoms of Crohn's disease start. Both men and women get Crohn's disease. It tends to run in families. As many as one in five people with Crohn's disease has a relative with Inflammatory Bowel Disease. Increasing numbers of African American and Hispanic patients are now being diagnosed with Crohn's disease.

What causes Crohn's Disease?

The exact cause of Crohn's disease is not known. Multiple factors are likely involved. Many suspect that the immune system, which normally protects the body against infections, attacks the patient's own healthy bacteria or tissues in the GI tract. This misguided immune reaction triggers chronic inflammation. A person's genes and the environment—where you live and what you eat—also may play a role in Crohn's, possibly by sparking the immune system. Diet and stress may aggravate the disease.

What are the Symptoms of Crohn's Disease?

The most common symptoms of Crohn's disease are:

  • Pain or cramps in the abdominal area
  • Persistent diarrhea (watery stools, often with an urgent need to move the bowels)
  • Bleeding from the intestine

Other symptoms may include: loss of appetite, weight loss, fever, fatigue, and night sweats. The types of symptoms and their severity vary from person to person.

What are the Potential Complications of Crohn's Disease?

Some people with Crohn’s disease develop serious problems such as:

  • Strictures or narrowings, due to inflammatory swelling and scar tissue that narrows the intestine and prevents waste material from moving normally. If severe, strictures may cause intestinal blockages. 
  • Fistulas, which are deep ulcers that keep penetrating deeper into surrounding tissues to form pockets or tunnel-like "side routes" from the intestine; they may become infected and lead to abscesses.
  • Fissures or tears in the lining of the anus
  • Nutritional problems due to lack of protein, vitamins, or calories; this may be due to loss of appetite related to stomach pain, problems absorbing nutrients from the inflamed intestine, or poor diet
  • Anemia that causes fatigue (feeling tired all the time); this may be due to the chronic bleeding and loss of red blood cells or due to poor nutrition
  • Increased cancer risk in patients with extensive inflammatory colitis; a regular program of monitoring with colonoscopies may reduce this risk of colorectal cancer

Other complications may include arthritis, skin problems, kidney stones or gallstones, liver function problems, osteoporosis, and medication side effects. Children with Crohn's may have delayed development and stunted growth (due to loss of nutrients). Women with Crohn's may have problems with infertility. A pregnant women with Crohn's Disease may have a healthy baby but careful planning and monitoring is recommended. 

How is Crohn's Disease Diagnosed?

The most common tests to diagnose Crohn's disease and rule out other possible causes of your symptoms include, in part:

  • History and physical exam: First, your gastroenterologist will listen carefully to your description of symptoms and then ask questions about your symptoms and how they affect your life. A physical exam may check for any external signs of disease (such as skin changes, arthritis, inflamed eyes or mouth).
  • Blood tests and stool tests:  Blood tests may detect low red blood cells (indicating anemia), high white blood cells (indicating an infection or inflammation), or specific antibodies (indicating an immune reaction). Analysis of a stool sample may help check for intestinal bleeding or infection.
  • X-rays: Standard X-rays of the upper (and possibly lower) GI tract may help to show intestinal inflammation, ulcers, narrowing, strictures, or fistulas. This is sometimes called radiography. The patient drinks a chalky barium solution before the upper GI X-ray so the outline of the intestine shows up better on the film.
  • Lower Endoscopy (colonoscopy or sigmoidoscopy): The GI specialist may also use a special instrument to look inside your colon. Before the procedure, you take a laxative to clear out your bowels. During the procedure you may be sedated and you lie on your side. A long thin flexible tube (an endoscope) with tiny camera tip is inserted through the opening of the anus. As the instrument is moved carefully along the length of the colon, the doctor looks closely at the surface of the colon on a video screen. Samples (or biopsies) of inflamed tissue may be taken for examination under a microscope. A sigmoidoscopy uses a short instrument to examine only the lower part of the colon. A colonoscopy uses a longer tube that allows visual inspection of the whole 3-foot length of the colon. To diagnose Crohn's disease, a full colonoscopy is usually needed. At Temple, we sometimes also use a special technique called chromoendoscopy to stain the colon before endoscopy examination; this highlights areas of potential early cancer (dysplasia) and allows more precise sampling (biopsy), which may lead to earlier diagnosis and treatment of cancer.
  • Upper Endoscopy (esophagogastroduodenoscopy, or EGD): In some cases, the gastroenterologist will examine the upper portion of the GI tract—including the esophagus, the stomach, and the beginning of the small intestine (called the duodenum). For this upper endoscopy procedure, a long thin flexible tube (an endoscope) with a tiny camera tip is inserted through the mouth and down through the esophagus and stomach to the first portion of the small intestine. The EGD is often used to check for sources of bleeding or causes of pain.
  • Capsule Endoscopy: A capsule endoscopy is like a miniature mobile endoscopy—you swallow a pill-size camera and it takes photos as it passes through the GI tract. For about 8 hours or so, the photos are transmitted wirelessly to a small recorder device you wear on a belt or harness. After the camera-capsule comes out into the toilet during a normal bowel movement (it can be flushed away), you return the recording device to your GI specialist who analyzes the photos. Capsule endoscopy is a good way to examine the small intestine, which is hard to see with either the traditional lower endoscopy (colonoscopy) or the upper endoscopy. This allows doctors to see any inflammation or other problems like bleeding, tumors, or polyps.
  • Imaging Tests (CT and MR enterography): In some cases, a computerized tomography (CT) scan will check for disease inflammation or complications (such as fistulas, tumors, bowel obstruction, or bleeding). A CT takes many X-rays at once and creates a highly detailed 3-D image of the small intestines and other GI tract structures. Sometimes, a specialized CT called CT enterography is used to obtain a greater amount of detail of the small intestine. To evaluate certain areas or to avoid repeated exposures to the low-dose radiation of X-rays (especially in young patients who may need many imaging tests over the course of a long lifetime), a special magnetic resonance (MR) imaging test called MR enterography may be used instead of CT enterography. The MR test does not use X-rays; instead, it uses radiofrequency waves and a large magnet to create a picture of the GI tract.

The Temple Inflammatory Bowel Disease Program is experienced in the diagnosis of Crohn's disease with all the tests mentioned above. Temple gastroenterologists are also pioneers in the use of double-balloon enteroscopy to examine and treat the small intestine—an area that cannot be reached by standard colonoscopy. For advanced CT or MR imaging, patients have access to the GI radiology experts at Temple University Hospital. This group is highly experienced in all CT and MR imaging techniques, including special narrow-band imaging to monitor for cancer.

Your gastroenterologist can explain the risks associated with the diagnostic procedures needed to evaluate your conditions.

What are the Roles of Diet and Stress in Crohn's Disease?

Many people with Crohn's disease think that a particular food is causing their abdominal pain and diarrhea. Although diet is not a direct cause of the disease, diet may affect how healthy you feel. For example, specific foods like milk products or bulky grains may increase diarrhea or cramping. Also, if your stomach always hurts, you may not eat properly or your GI inflammation may prevent you from absorbing nutrients.

Many patients also find that stress may trigger a flare-up of symptoms. Again, while there is no evidence that stress actually causes Crohn's disease, living with a painful chronic disease like Crohn's can undoubtedly add to the stress of everyday life. This disease- and symptom-related stress, in a vicious cycle, may make the symptoms worse in some people.

These many connections between Crohn's disease and diet and stress explain why any treatment program should include education and clear instructions on good food choices, proper nutrition, and stress reduction.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to a full team of nutrition specialists, psychiatrists, counselors, nurse educators and support groups. We are prepared to help patients control their disease with better diet, exercise, and relaxation methods. In some cases, special supplements are recommended. Those having a severe bout of disease activity may be assisted with temporary intravenous nutrition.

Treatment of Crohn's Disease

Learn more about treatment for Crohn's disease. Click here.

To schedule an appointment, click here or call 800-TEMPLE-MED [800-836-7536].