Crohn’s disease is a chronic bowel disease that causes severe inflammation of your digestive tract and affects your quality of life. It is associated with abdominal pain and diarrhea and is characterized by alternating phases of flare-ups and remissions. It is named after Dr. Burill B. Crohn who in 1932 was the first to identify the disease.
More than 400,000 Americans suffer from Crohn’s. Exact numbers are difficult to confirm due to a lack of standards in diagnosis, as well as wrongly classified cases of the disease.
Crohn’s is included in a larger group of illnesses known as inflammatory bowel diseases. It can appear anywhere along the gastrointestinal tract, from the mouth to the anus. It is typically found in the distal small bowel and colon. Crohn’s can also develop anywhere in the intestinal tract, making it difficult to diagnose and treat.
Over time, ulcerations, or small sores, will develop and extend through the layers of your intestinal tract. This can cause severe complications such as:
- strictures, or intestinal narrowing
- fistulas, or abnormal tunneling between two different sections of the gastrointestinal tract
- anal fissures, which are painful tears in the skin around the anal area
- ulcers of the gastrointestinal tract
- malabsorption, not being able to absorb nutrients, leading to weight loss
Symptoms of Crohn’s vary depending on the severity of the disease and the location of the inflammation. All people with Crohn’s experience severe abdominal pain and cramping during a severe episode. Other symptoms can include:
Because Crohn’s affects the immune system, symptoms can also be found outside your gastrointestinal tract and can include:
The cause of Crohn’s disease is unknown. It’s an autoimmune disorder in which a combination of genetics and environment cause your immune system to attack your own intestinal cells.
Risk factors for Crohn's are difficult to prevent because they include unchangeable factors such as age, family history, medical history, and race/ethnicity.
Crohn’s disease most often affects people between the ages of 15 and 40.
Those with a family history of Crohn’s are at a significantly higher risk of developing the disease.
History of autoimmune disorders
If other autoimmune disorders are present, such as rheumatoid arthritis, you may have a higher risk for developing Crohn’s disease.
Although people of all races have the disease, Crohn’s is found more often among people from Eastern Europe, and American Jews of European descent.
Crohn’s disease is difficult to diagnose because the symptoms can mimic many other conditions and diseases, such as:
- a parasitic infection
- diverticulitis, a common condition found in the large intestine
- celiac disease, a condition that damages the small intestine
- colon cancer
Another reason Crohn’s is difficult to diagnose is the lack of a specific blood test to identify the disease.
Your doctor will consider a variety of factors in diagnosing Crohn’s disease, including your medical history, a physical exam, and a variety of tests.
History and physical exam
Your doctor will begin by asking you for a detailed history of your symptoms and about any family history of autoimmune disorders or bowel diseases.
This checks for any intestinal narrowing or obstruction, which can be a medical emergency.
An ultrasound will rule out diseases in abdominal organs such as:
- gall bladder
CT Scan or MRI
These imaging methods are used to determine any complications of the disease such as fistulas or abscesses.
This is the gold standard for diagnosing Crohn’s disease. A colonoscopy enables your doctor to see the inside of your intestinal wall and to remove a tissue sample for further examination.
There is no known cure for Crohn’s disease. You and your doctor can only prevent complications and control inflammation. Since the disease alternates between periods of remission and flare-up treatment focuses on helping you to avoid or control an episode. Treatment varies based on the site and severity of disease as well.
Some treatment options include medications, surgery, nutrition, and stress management.
Many different medications are used to manage Crohn’s disease. They may be used alone or in combinations.
- Corticosteroids: Corticosteroids can be used to control inflammation and control your immune system. Because of the side effects of chronic steroid use, steroids are often prescribed short-term during a flare-up.
- Aminosalicylates: These anti-inflammatory drugs treat mild to moderate symptoms and help keep you in remission.
- Immunosuppressive agents: These agents are prescribed to help you maintain remission by suppressing your over-active immune system.
- Antibiotics: Antibiotics prevent and treat infection or decrease the overgrowth of bacteria in your gastrointestinal tract.
- Biological agents: Similar to drugs used in chemotherapy, biological agents are given for more severe cases. These medications may be given orally, intravenously, or by self-injection.
Depending on the location and severity of your condition, it may be necessary to remove a diseased portion of your intestine. There are also times when it is necessary to remove an ulceration or blockage in your digestive tract. These treatments do not cure the disease. Crohn’s is a chronic condition that often will reoccur later in life.
During surgery, every attempt is made to preserve as much intestine length as possible to avoid further complications.
People with Crohn’s disease are often underweight because intestinal inflammation interferes with the absorption of food. Nutritional counseling and dietary supplements may be used.
Certain lifestyle changes can decrease the severity of a flare-up, but there is no known way to eliminate flare-ups altogether. Measures you can take to help prevent them include dietary changes, stress management, and quitting smoking.
A low-fiber diet can decrease bowel frequency and help reduce diarrhea. Many people with Crohn’s find that diarrhea and flatulence improve by limiting dairy, as well as gas-producing foods such as:
- raw fruits and juices
Dieticians often recommend six small, frequent meals per day instead of three large ones.
Limiting stress and learning to manage it with exercise and relaxation techniques can help decrease Crohn’s symptoms.
Recent studies have shown that even light smoking can increase the intensity of flare-ups.
People with Crohn’s must take their medications exactly as prescribed and follow their treatment plan in order to prevent complications and hospitalizations.
Crohn’s disease can be a lifelong challenge. Following your doctor’s advice and sticking with your diet and treatment plan will greatly improve your quality of life.