Crohn’s Disease

Background

Crohn’s disease is an inflammatory bowel disease, which is the general name for diseases that cause swelling in the intestines. In Crohn’s disease, any area of the gastrointestinal (GI) tract can be affected. Common areas are the end of the small bowel and the beginning of the large bowel. All layers of the intestine may be involved, and often there can be normal, healthy sections found between areas of diseased bowel.

Crohn’s affects both men and women equally, and about 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease. Often this may be a brother, sister or sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but is often diagnosed in people between the ages of 20 and 30. People of Jewish heritage also have an increased risk of developing Crohn’s disease.

Causes

There are different theories about what causes Crohn’s disease. The most common theory is that the body mistakes bacteria, food and other substances as being foreign to the body. This results in the immune system attacking the invaders. White blood cells are drawn to the lining of the intestines to attack the invaders. This results in chronic inflammation in the intestines that leads to ulcerations and bowel injury.

It is uncertain whether the inflammation that occurs in Crohn’s disease is a cause of the disease or a result. The inflammation seen in people with Crohn’s disease can result from different factors such as the genes a person may have inherited from their parents, problems with the immune system or environmental factors. The inflammation can develop because the person’s body is reacting to the foreign substances in the environment, or the foreign substances themselves may be the cause for the inflammation.

Symptoms

Symptoms of Crohn’s disease can include:

  • Persistent diarrhea (loose, watery or frequent bowel movements)
  • Cramping, abdominal pain
  • Fever
  • Rectal bleeding, if serious can lead to anemia
  • Weight loss
  • Tiredness

The disease is not always limited to the GI tract and can also affect the joints, eyes, skin and liver.

Diagnosis

Doctors will perform a thorough physical exam and order a series of tests that are required to diagnose Crohn’s disease:

Blood test
This test will check the number of red and white blood cells in a person’s body. When the red blood cells are low, a person may have anemia, which may occur if there is bleeding in the intestine. If the white blood cell count is high, this is a sign of inflammation somewhere in the body.
Stool sample
The doctor will be able to tell if there is bleeding or infection in the intestines.
Upper GI series
A person drinks barium, a chalky solution that coats the lining of the small intestine, and x-rays are taken. This will show if there is any inflammation or changes in the intestine. If the test does show a person has Crohn’s disease, the doctor often will order more x-rays to see how much of the GI tract is affected.
Sigmoidoscopy
This test will show any inflammation or bleeding that may be in the lining of the lower part of the large intestine.
Colonoscopy
The doctor will order this test to examine the entire large intestine for any inflammation or bleeding.
Biopsy
A sample of tissue is taken from the lining of the intestine and examined with a microscope.

Treatment

Specialty drug list

The goals of treatment for Crohn’s disease are to control inflammation, correct any nutritional deficiencies and relieve any symptoms like abdominal pain, diarrhea and rectal bleeding. Treatment can help control the disease by lowering the number of times a person experiences a recurrence. However, there is no cure. The treatment also depends on the location and severity of the disease, complications and the person’s response to previous medical treatment. Options for treatment include drugs, nutrition supplements, surgery or a combination of these options.

The five groups of drugs used to treat Crohn’s disease today are anti-inflammatory drugs containing mesalamine (sulfasalazine, 5-ASA agents), steroids (prednisone), immune system suppressors (azathioprine, 6-MP, and methotrexate), antibiotics (metronidazole, ampicillin, ciprofloxin and others) and biologic therapy (infliximab). Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point, when medications can no longer control the symptoms.

Side Effects

Treatment can cause side effects, but it is important that a person never change their dosage or stop taking their medication without talking to their doctor or pharmacist.

Common side effects for the different treatment options for Crohn’s disease include:

Anti-inflammatory drugs
Nausea, vomiting, heartburn, diarrhea and headache
Steroids
Weight gain, increased appetite, anxiety, nervousness and increased risk of developing an infection
Immune system suppressors
Nausea, vomiting, diarrhea and increased risk of developing an infection
Antibiotics
Nausea, vomiting, headache, constipation, diarrhea and dizziness
Biologic therapy
Cough, nausea, vomiting, rash, weakness, upper respiratory tract infections, urinary tract infections and back pain

Resources

There are many resources and organizations available to help, providing support, advocacy and information:

Crohn’s and Colitis Foundation of America

Reach Out for Youth with Ileitis and Colitis Inc.

United Ostomy Associations of America Inc.

References

Centers for Disease Control and Prevention. http://www.cdc.gov/ibd. Accessed November 30, 2011.

National Institutes of Health. NIDDK. Handout on Crohn’s Disease. NIH Publication No. 06-3410. February 2006.