What is Crohn’s Disease?| Symptoms| Diagnosis| Treatment| Surgery| What Can You Do?| Finding a Specialist
What is Crohn’s Disease?
Eugene Yen, MD, and Laura Bianchi, MD, discussing IBD with a patient
The actual cause of Crohn’s disease is unknown but it does run in families. Once diagnosed, it’s difficult to predict exactly how the disease will affect the patient, although diarrhea and abdominal pain are signs of the disease. Some people go years without symptoms while others are burdened with frequent flare-ups. Medication and other treatment options are important tools used to manage Crohn’s disease.
Most often people are diagnosed with Crohn’s between the ages of 15 and 35. However, it can occur in the elderly and the young. Males and females are equally affected by the disease but it does appear more in Caucasians that those of other races. Jews, mostly Eastern European, tend to have a higher rate of the disease.
Crohn’s disease can impact any part of the gastrointestinal (GI) tract from the mouth to the anus and may even include the small intestine. While all layers of the intestine may be diseased, there can be healthy bowel sections interspersed – these are called “skip” areas.
Crohn’s disease causes diarrhea (sometimes bloody) and abdominal pain. Other symptoms include:
- loose, watery or frequent bowel movements
- rectal bleeding
- loss of appetite
- loss of weight
- Children with Crohn’s may suffer delays in growth and sexual development
Crohn’s disease or the medications used to treat the disease can also affect other areas of the body:
- eyes – redness and itching
- mouth – sores
- joints – swelling and pain
- skin – bumps and other lesions
- bones – osteoporosis
- kidney – stones
- liver – hepatitis and cirrhosis (a rare development)
These symptoms may be the first signs of Crohn’s disease and may appear before the bowel symptoms or right before a flare-up of the disease.
If your disease is getting worse you may experience some of the following symptoms:
- feeling faint
- weak pulse
- severe belly pain
- fever or shaking chills
Contact your physician immediately if these signs are appearing.
Diagnosing Crohn’s disease begins with a physical examination that may include stool and blood tests. Physicians use this information to rule out other causes of symptoms such as infection and anemia.
Your physician may order an X-ray study to better visualize the small intestine or colon.
Your gastroenterologist will likely examine the colon through a sigmoidoscopy or colonoscopy. These tests allow the physician to visualize the colon and obtain tissues samples in order to determine a diagnosis of inflammatory bowel disease. They are also able to determine the extent of the disease and detect bleeding, inflammation or ulcers.
Once diagnosed with Crohn’s disease, a NorthShore University HealthSystem gastroenterologist can determine the best form of treatment to control the disease.
Since Crohn’s is chronic, the goal with treatment is to quiet the abnormal inflammation in the lining of the intestines and allow the bowel to heal. This relieves patient’s diarrhea, rectal bleeding and abdominal pain. Treatment plans are highly individualized as the disease is unique for each person.
Medications used to treat Crohn’s fall into five categories:
- Aminosalicylates: These drugs work to decrease inflammation in the GI tract. They are commonly prescribed to treat mild to moderate Crohn’s disease.
- Corticosteroids: These medications affect the body’s ability to launch and maintain an inflammatory process. They also work to suppress the immune system and are used in patients with moderate to severe Crohn’s disease. While they are effective for controlling flare-ups; they are not recommended for long-term use because of side effects.
- Antibiotics: These may be used when infections, such as abscesses, occur.
- Immunomodulators: These medications override the body’s immune system so it cannot cause ongoing inflammation. Often, these are used when aminosalicylates have not been effective but may take up to three months to begin to work.
- Biologic therapies: Biologic therapies are changing the way gastroenterologists treat IBD. These are the newest class of drugs for people suffering moderate-to-severe Crohn’s disease. They are made from antibodies that bind with certain molecules to block a particular action. Biologic drugs target specific pathways to help reduce inflammation and the chance of surgery.
Surgery is an option for patients who do not respond to medication. It is important that patients speak with an experienced IBD specialist to best determine what specific surgical procedure is necessary for their condition.
Patients with Crohn’s disease may undergo surgery to repair an opening between organs (fistula) or anal tear (fissure). Intestinal obstructions or abscesses can require surgery as well. During that procedure, the diseased segment of bowel is removed. This is called a resection. The two ends of healthy bowel are joined together during a procedure called anastomosis. These procedures can bring on many symptom-free years but are not a cure as the disease often resurfaces at or near the original site.
In severe cases of Crohn’s disease, surgeons may need to remove a patient’s colon. During that procedure they bring the small bowel to the skin so that waste products may be emptied into a pouch attached to the abdomen; this is known as an ileostomy.
Medication and/or surgery are used to enable the patient to lead a normal and healthy life.
What can you do to combat Crohn’s?
Proper nutrition is important in managing Crohn’s disease since the symptoms can bring on loss of appetite, fluids, nutrients and electrolytes. Patients may find that bland, soft foods and smaller, more frequent meals help during a flare-up of the disease.
A well-balanced diet is recommended to combat nutritional losses. This diet includes a variety of foods from all food groups and a multivitamin.
There is no evidence that stress causes Crohn’s disease. However, people may find themselves stressed as a reaction to the symptoms. Knowledge of your options and emotional support of family, friends and physician are important in mentally managing Crohn’s.
Finding a specialist
To make an appointment with a NorthShore IBD specialist, please call 847.657.1900.