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Q&A: Breaking Down Crohn’s Disease

Wednesday, May 31, 2017 7:47 AM

Crohn’s disease is more on the rare side – affecting about 3 people out of 1,000 – but it can be serious if not treated. To help us understand what the disease is, symptoms and treatment, Omar Khan, MD, Gastroenterology at NorthShore, answers common questions.

CrohnsDiseaseSymptoms

What is Crohn’s disease? 

The actual cause of Crohn’s disease is unknown but it does run in some 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 Crohn's disease symptoms, while others are burdened with frequent flare-ups.

What are the symptoms of Crohn's disease?

Crohn’s disease causes diarrhea and abdominal pain. Other Crohn's disease symptoms include:

  • Loose, watery or frequent bowel movements
  • Fever
  • Rectal bleeding
  • Loss of appetite
  • Loss of weight
  • Fatigue
  • Children with Crohn’s may suffer delays in growth and 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

How is Crohn's disease diagnosed?

Most often people are diagnosed with Crohn’s before the age of 30, with up to 25% of Crohn’s disease cases seen in the pediatric population. However, it can occur in patients of all ages. Males and females are equally affected by the disease but it does appear more in Caucasians than individuals of other races. Jews, mostly Eastern European, tend to have a higher rate of the disease, but Asians, African-Americans and Hispanics are increasingly being affected.

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 tissue samples in order to determine a diagnosis of inflammatory bowel disease also known as IBD. These diagnostic tools also help to determine the extent of the disease and detect bleeding, inflammation or ulcers.

Once diagnosed with Crohn’s disease, your gastroenterologist can determine the best form of treatment to control the disease.

Are there any treatments?

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 approach helps to relieve diarrhea, rectal bleeding and abdominal pain. Treatment plans are highly personalized as the disease is unique for each person. Crohn's disease treatment options include medications and/or surgery. These options are used to enable the patient to lead a normal and healthy quality of life.

Medications

Medications used for Crohn’s disease treatment 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 they may take up to three months to begin to work.
  • Biologic therapies: These 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 thought responsible for the inflammation in IBD. Biologic drugs target specific pathways to help reduce inflammation and the chance of surgery.

While you should certainly have a discussion of the risks and benefits of these medications with your physician, please keep in mind that untreated Crohn’s disease has the highest risks of causing you long-term illness and worsened quality of life.

Surgery

Surgery is a Crohn's disease treatment option for patients who do not respond to medication. It is important that patients speak with an experienced IBD physician to best determine what specific surgical procedure is necessary for their condition. Further, an IBD specialist refers patients to specialty-trained surgeons conveniently located within NorthShore's IBD Center.

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 the surgical procedure, the diseased segment of bowel is removed. This is called a resection. These procedures can bring on many symptom-free years and often represent the best option for patients who have severe Crohn’s disease.

In severe cases of Crohn’s disease, surgeons may need to remove a patient’s colon and bring a portion of the bowel to the skin so that waste products may be emptied into a pouch attached to the abdomen: this is known as an ostomy.