Crohn's Disease

Crohn’s disease is a common type of chronic inflammatory bowel disease (IBD)—the second being ulcerative colitis (UC)—that affects more than half a million people in the United States. Although the disease has been traditionally associated with Caucasian patients between the ages of 15 and 35, cases of Crohn’s disease among other ethnicities have been increasing. Because Crohn’s disease can affect individuals at such a young age, it is believed by analysts that the disease itself is quite under-diagnosed, with many affected patients living with the disease for years before seeing a doctor about their symptoms. The disease can affect people of any age or sex. About 10 percent of Crohn’s disease cases affect very young children, ranging from newborns to kids aged 17. Crohn’s disease also affects the elderly, people over the age of 60—an age after which the chances of contracting most disorders relating to the gastrointestinal tract (GI tract) increases significantly. Crohn’s disease is more commonly reported in urban areas in the developed world.

Causes of Crohn’s Disease

Overall, the cause of Crohn’s disease is unknown. Medical researchers have devoted much time and effort into finding a specific trigger, but the only conclusions have indicated that the cause is closely related to an individual’s:

•    Genes—ongoing research suggests that genetics play a big role in determining which who is susceptible to the disease. If one of your family members has been diagnosed with a form of inflammatory bowel disease—Crohn’s disease, ulcerative colitis or rarer forms—then it increases your chances of being diagnosed by nearly 10 times. The risk increases even more if the family member affected is a brother or sister.

•    Immune System—defined by many specialists as an auto-immune disease, Crohn’s disease is characterized by a dysfunctional immune system that cannot recover or regain balance after being stimulated by an internal or external irritant, or antigen, such as a virus or bacteria).

•    Surrounding Environmental Factors—antigens in the environment may be a directly cause inflammation of the bowel tissue. They also may cause the body’s immune system to react defensively in a way that spins out of control.

Symptoms of Crohn’s Disease

Crohn’s disease is generally characterized by chronic inflammation in the area of the body where the small intestine and large intestine meet. If you experience diarrhea, cramping, abdominal pain, fever, rectal bleeding and any combination of these symptoms for more than a couple of weeks, you may be affected by Crohn’s disease. Keep in mind that symptoms of any disease can vary widely, depending on the individual. Symptoms can also come in spurts, occurring at sporadically and at different levels of severity, and can change over time. Sometimes the patient can feel perfectly healthy and fine.

Other symptoms of Crohn’s disease include a reduced appetite and significant weight loss, possibly results of the persistent diarrhea and stomach pain. Patients often report feeling very tired and health complications such as pain in their joints or improper liver function. In severe cases, Crohn’s disease can lead to painful sores on the surface of the skin, as well. It can also result is anal fissures and perforation, or tearing of the bowel lining. Children who are born with the disease or contract it at a very young age may also have developmental issues.

Although most commonly affecting the junction between the small and large bowel, Crohn’s disease can affect any portion of the GI tract.  Crohn’s disease dose dramatically increase the individual’s risk for developing colon cancer later in life, and screening colonoscopies will be needed much more routinely than in individuals without this disease to diagnose and treat early cancers before they grow.

Treatment of Crohn’s Disease

Since Crohn’s disease is chronic and has no immediate cure, the goal of most treatment plans revolves around finding ways to reduce symptoms and prevent frequent relapses or “flare-ups.” There are several medications available for these purposes today, including antibiotics and immune system suppressants. Patients with severe cases may also opt for resection surgery, especially if medication has proved to be ineffective or if the patient is suffering from ruptured tissue in the colorectal area. During a resection surgery, part of the bowel tissue or other diseased intestinal tissue is removed.

Patients with Crohn’s disease are also at much higher risk of having nutritional deficiencies including vitamin D, B12, and iron.  Those who have had surgery to remove parts of their intestines or colon are at even higher risk, and should be monitored routinely by a physician to ensure that their levels are adequate.  Many patients end up taking supplements either by mouth or scheduled injection to help bolster their reserves.  Long term deficiencies in these vitamins can lead to bone weakness (osteoporosis), decreased vision, heart disease, and possibly mood changes.

Patients can also avoid certain foods to prevent agitation of the intestines. Particularly during a “flare-up,” patients should opt for foods bland, soft foods that don’t trigger bouts of diarrhea. Some patients also find foods high in fiber useful for easing constipation and regulating bowel movements. Again, keep in mind that each body will react different, so staying aware of your eating habits if you’ve been diagnosed with Crohn’s disease can dramatically increase your quality of life. Talk to a colonoscopy specialist is you’d like advice on how to manage Crohn’s disease or if you need to be tested.  If you have already been diagnosed with Crohn’s disease, make sure that you are in regular contact with your gastroenterologist.

 

Reviewed 12/12/2011 by David M. Nolan, M.D.
Diplomate of the American Board of Internal Medicine, 2011
Currently a Fellow of Gastroenterology, at UCI 2011-2014