Crohn's disease

Alternative names

Inflammatory bowel disease - Crohn's disease; Regional enteritis; Ileitis; Granulomatous ileocolitis

Definition

Crohn's disease is a type of inflammatory bowel disease (IBD), named for one of the physicians who first described the disease. It is a disease that results in chronic inflammation of the gastrointestinal tract.

Crohn’s disease causes inflammation of your bowel. The disease most often affects the end part of your small bowel. However, it can affect any part of your bowel.

Crohn’s disease causes your bowel wall to thicken, which can block food from passing through. The affected area of your bowel can also fail to absorb nutrients from your food.

Left untreated, you can get problems such as abdominal pain, diarrhoea, weight loss, a hole through the wall of your bowel, problems with your back passage and fluid leaking out.

Causes, incidence, and risk factors

Autoimmune disorders occur when the immune system attacks the body's own cells. In Crohn's disease, these rogue immune cells attack the gastrointestinal system. The cause is unknown, but genetic factors seem to play a role.

Inflammation frequently occurs at the end of the small intestine that joins the large intestine, but the condition may affect any area of the digestive tract. As a result of the immune attack, the intestinal wall becomes thick, and deep ulcers may form. In addition to the bowel abnormalities, Crohn's disease can also affect other organs in the body, causing:

Complications

• Fistulas (abnormal connections between bowel and adjacent organs or skin)
• Liver inflammation
• Joint disease (arthritis)
• Eye inflammation
• Kidney stones
• Clotting problems (deep vein thrombosis)
• The disease may occur at any age, but adolescence and early adulthood are the periods of highest risk. The only known risk factors include a family history of Crohn's disease, Jewish ancestry, and smoking. About 7 out of every 100,000 people will develop Crohn's disease.

Symptoms

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An aphthous ulcer on the mucous membrane of the mouth in Crohn's disease.

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Pyoderma gangrenosum on the leg of a person with Crohn's disease

• Abdominal pain
• Fever
• Diarrhea
• Loss of appetite
• Unintentional weight loss
• Abdominal mass
• Abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine)
• Fatigue
• Gastrointestinal bleeding
• Foul-smelling stools
• Tenesmus (pain with passing stool)

Additional symptoms

Additional symptoms that may be associated with this disease include the following:

• Bloody stools
• Joint pain
• Anal Incontinence
• Swollen gums
• Constipation
• Abdominal fullness and gas
• Signs and tests

A physical examination may reveal an abdominal mass or tenderness, skin rash, swollen joints or mouth ulcers.

Tests that show findings of Crohn's disease

• Endoscopy, colonoscopy, or sigmoidoscopy with small bowel biopsy
• Small bowel follow through
• Barium enema
• Upper GI series
• Positive stool guaiac
• A stool culture may be done to rule out other possible causes of the symptoms.

This disease may also alter the results of the following tests:

• Fecal fat
• Liver function tests
• Albumin

Treatment

Your health care provider may prescribe medications such as 5-aminosalicylate to control the inflammatory process. If this is not effective or if the case is severe, treatment may require corticosteroids and immunomodulators such as azathioprine or 6-mercaptopurine.

If you have abscesses or fistulas, your health care provider may prescribe antibiotics. Infliximab (an antibody to an immune chemical called TNF-alpha, which promotes inflammation) can be effective for patients with fistulous disease and those with moderate to severe disease.

If medical therapy is not effective, you may need surgery (see bowel resection) to remove a diseased or strictured segment of the bowel or to drain an abscess. However, unlike ulcerative colitis, surgical removal of a diseased portion of the intestine does not cure the condition.

No specific diet has been shown to improve or worsen the bowel inflammation in Crohn's disease. An adequate intake of calories, vitamins, and protein is important.

Foods that worsen diarrhea should be avoided -- specific food problems may vary from person to person. People who have blockage of the intestines may need to avoid raw fruits and vegetables. Some people have difficulty digesting lactose (milk sugar) and need to avoid milk products.

What are the benefits of surgery?

Your symptoms should improve. Your doctor may also be able to reduce or stop your medication.

Are there any alternatives to surgery?

Crohn’s disease can be treated using medication, such as mesalazine, steroids, azathioprine and infliximab. These have side effects and your doctor will discuss them with you.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes an hour to 90 minutes.

Your surgeon will make a cut on your abdomen and remove the diseased part of your small bowel. They will often also need to remove a part of your large bowel.

Your surgeon will usually join the ends of your bowel back together. If they are unable to join the ends of your bowel, they will make a colostomy or ileostomy.

What complications can happen?

General complications

• pain
• bleeding
• infection of the surgical site (wound)
• unsightly scarring
• developing a hernia
• blood clots
• chest infection
• difficulty passing urine

Specific complications

• anastomotic leak
• continued bowel paralysis
• damage to other structures inside your abdomen
• injury to your bowel
• tissues can join together in an abnormal way
• death

How soon will I recover?

You should be able to go home after 5 to 10 days. It may take up to 3 months for you to recover fully. Most people feel much better after the diseased part of their bowel has been removed. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Crohn’s disease sometimes comes back and affects another part of your bowel.

Summary

Crohn’s disease causes inflammation of your bowel. Surgery is usually recommended if medication fails to improve your symptoms.

Expectations (prognosis)

This is a chronic disease characterized by periods of improvement followed by deterioration and increased symptoms. There is an increased risk of small bowel or colorectal carcinoma associated with this condition.

Complications

• Fistulas in the following areas:
• Bladder
• Vagina
• Skin
• Bowel obstructions
• Abscess
• Nutritional deficiencies (particularly vitamin B12 deficiency)
• Complications of corticosteroid therapy
• Inflammation of the joints
• Erythema nodosum
• Pyoderma gangrenosum
• Lesions in the eye
• Impaired growth and sexual development in children

External links

General Information

• Crohn's Disease US National Institute of Diabetes and Digestive and Kidney Diseases
• Crohn's Disease MayoClinic.com
• Crohn's Disease WebMed
• Crohn's Disease Clinical and Alternative Treatment
• IBD Directory - Listings for Crohn's and colitis resources
• Crohn's Disease HealthAtoZ
• Crohns Disease Resource Site
• How the disease came to be known as Crohn's disease
• Jigsaw Health IBD

Organizations

• National Association of Colitis and Crohn's Disease
• Crohn's and Colitis Foundation of America
• Crohn's and Colitis Foundation of Canada
• Australian Crohn's and Colitis Association

Communities

• TeenCrohns.co.nr A community for teenagers with Crohn's Disease
• Teens with Crohn's Disease Support for teenagers with Crohn's Disease
• CrohnsZone.org UK based Crohn's and colitis support network
• Paratuberculosis Awareness and Research Association, inc. subscribes to the view that Crohn's is caused by infectious agents
• Israeli online community about Crohn's Disease
• French online community about Crohn's Disease
• IBD Sucks - an online forum for people with Colitis, Crohn's, and IBS

Crohn's disease Resources
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