Crohn’s disease is an inflammatory bowel disease (IBD). IBD should not be confused with Irritable Bowel Syndrome (IBS), which is a less serious–although chronic–condition. There are two main types of IBD, Crohn’s disease and ulcerative colitis (UC). UC only affects the large intestine while Crohn’s disease can be found anywhere along the digestive tract from the mouth to the anus. Approximately 700,000 people in the United States are living with Crohn’s disease. This disease can appear at any time; however, it usually begins between the ages of 15 and 35. Being aware of the symptoms can make a huge difference so you can receive proper diagnosis early, and learn how to manage the disease.
Symptoms of Crohn’s Disease
With Crohn’s disease, people will either find that it affects the last segment of the small intestine or others find it only affects the colon. Symptoms can be mild or completely severe, but they usually appear gradually. For some people, though, symptoms can come on without any warning. Crohn’s disease patients can go into remission and not have any symptoms during that time, but when the disease is active, symptoms may include:
- mouth sores
- blood in stool
- abdominal cramping and pain
- weight loss and reduced appetite
- drainage or pain near or around the anus from inflammation from a tunnel into the skin (a fistula)
Severe cases of Crohn’s usually include:
- inflammation of the liver or bile ducts
- inflammation of the joints, eyes, and skin
- delayed sexual development or growth for children
What Causes Crohn’s Disease?
The ultimate cause of Crohn’s disease is still not known. At one time, stress and diet were suspect; however, doctors now know those two factors can worsen symptoms but aren’t a cause for Crohn’s. Factors like heredity or an autoimmune response are most likely the cause of Crohn’s disease.
An autoimmune response is when a person’s immune system turns against its own body and attacks systems within the body. Some researchers believe that a bacterium or virus could trigger an immune system problem that can lead to Crohn’s disease. As your immune system begins to fight off an invading microorganism, there is an abnormal immune response that will cause the immune system to start attacking the cells in the digestive tract as well.
Heredity plays another role with Crohn’s because your risk increases if more people in your family have this disease; genetics also appear to play a role. This is just a theory though since many people with Crohn’s don’t have a family history of this particular disease, which could be simply because the family members never got officially diagnosed.
The underlying factors that cause Crohn’s are still just an assumption by doctors until more research is conducted. Age does play into it though as more people are diagnosed before age 30. Smoking is also a risk, along with a diet high in fat.
Diagnosis of Crohn’s Disease
Since there is not a go-to test to diagnose Crohn’s disease, other potential causes will be ruled out first. Multiple types of testing may be needed to assist with an accurate diagnosis of Crohn’s such as:
- Fecal occult blood test: At times, a stool sample is needed to check for hidden blood in the stool.
- Tests for infection or anemia: A blood test to rule out anemia is necessary. Blood tests for possible infection will also be needed.
Aside from blood work, some procedures may be needed as well:
- Computerized Tomography (CT): This is a special type of X-ray technique that gives better overall detail than standard X-rays. With this test, the entire bowel and tissues on the outside of the bowel can be seen.
- Colonoscopy: A colonoscopy allows a doctor to see the entire colon, along with the end of your ileum by using a lighted flexible and thin tube that has a camera attached. During this procedure, small pieces of tissue will be taken as a sample for laboratory analysis to help provide an accurate diagnosis. If there is a group or a mass of inflammatory cells (granulomas) present, this helps confirm that the issue is Crohn’s.
- Capsule Endoscopy: With this capsule endoscopy test, you will need to swallow a capsule, which has a tiny camera inside. The camera will take photos of your small intestine. As it passes through your small intestine, the pictures will be sent to a recorder that will be worn on your belt. Next, the images will download to a computer and be displayed on the screen to confirm signs of Crohn’s disease. The camera will leave your body through a bowel movement, pain-free.
- Magnetic Resonance Imaging (MRI): An MRI uses radio waves and magnetic fields to form detailed images of the tissues and organs. An MRI is useful for evaluating the small intestine or a fistula around the anal area.
- Balloon-assisted Enteroscopy: With this test, a device called an overtube and a scope will be used. Your doctor will be able to look into your small bowel where a standard endoscope won’t reach. When a capsule endoscopy leads to abnormal findings but a diagnosis is still questionable, this test is useful.
How to Manage Crohn’s Disease
Once you are diagnosed with Crohn’s disease, there’s not a go-to treatment that will work for each person. Each person’s body is different and will react differently to all sorts of management. Working with a professional is beneficial as you may need to try a range of things to find what works best for you.
- Anti-inflammatory Drugs: This is usually the beginning step for treating or managing inflammatory bowel disease, and often helps with Crohn’s. Corticosteroids like budesonide and prednisone can help to reduce inflammation. Another type is Oral 5-aminosalicylates, which has a limited benefit but may work for some people.
- Antibiotics: Taking antibiotics can assist with reducing the amount of drainage and can also heal abscesses and fistulas for those with Crohn’s. Some research is still underway to prove that antibiotics can help to reduce the harmful intestinal bacteria that can lead to inflammation. The most common antibiotics for this disease are Flagyl and Cipro.
- Immune System Suppressors: This type of medication can help with reducing inflammation and targeting your immune system at the same time. A combination like this can be helpful for some people, rather than just one medication alone. Some of the immunosuppressant medications are Azasan, Imuran, Purinethol, Purixan, Remicade, Humira, Cimzia, Trexall, Tysabri, Entyvio, and Stelara. You might consider infusion therapy, which is treatment given intravenously. Here at Cary Gastroenterology Associates, we offer infusion therapy of the medications Remidcade, Entyvioa, and Stelara.
- Nutrition Therapy: Depending on your particular case, you may benefit from a personalized diet that will be given through a feeding tube or injected into a vein to help treat the condition. This can help to improve your nutrition and let your bowel rest. Allowing the bowel to rest reduces inflammation short-term. Another thing your doctor may suggest is a diet low in fiber to reduce your risk of internal blockage if you have a narrow bowel.
- Surgery: The last resort is surgery. If your body doesn’t respond to drug therapy, lifestyle changes, or other methods, surgery may be your only option. Approximately half of the people with Crohn’s will go through a minimum of one surgery. Keep in mind, though, surgery doesn’t cure Crohn’s.
Working with a medical professional will set you out on the right path so you can better manage your disease. Crohn’s can be very serious; all doctors’ orders should be followed exactly and follow-up appointments need to be kept. The presence of Crohn’s disease does increase the patient’s lifelong risk for developing colon cancer, so your doctor will discuss the appropriate screening schedule. If you suspect Crohn’s or it runs in your family, you may want to rule it out.
You don’t have to live with the symptoms when there are modifications and management options out there. Schedule an appointment with Cary Gastroenterology Associates to see how we can help.