What is Crohn’s Disease?

Crohn’s disease is a chronic inflammatory condition of the digestive tract. It is one of the two types of inflammatory bowel disease (IBD), the other being ulcerative colitis. The disease is named after Dr. Burrill B. Crohn.

1. Symptoms of Crohn’s Disease

The most common symptoms of Crohn’s disease are:

Diarrhea
Abdominal pain
Blood in the stool
Fever
Mouth sores
Unexplained weight loss
Fatigue
Anal Pain
Anal discharge

In Crohn’s disease, symptoms are intermittant. Sometimes, they are very severe (this is called a “flare-up”). At other times, you may be completely symptom-free, in “clinical remission”.

2. Causes of Crohn’s Disease

Crohn’s disease is an autoimmune disease, in which your body’s immune system recognizes the lining of your digestive tract as a foreign body and attacks it, causing inflammation. This inflammation results in ulcers and bleeding. The exact cause that triggers our immune system to attack our own cells is mostly unknown. Crohn disease usually affects the last part of the small intestine (called the “ileum”) and some of the large intestine (colon) but it can affect the entire digestive tract, from the mouth to the anus

3. Risk Factors of Crohn’s Disease

Risk factors for Crohn’s disease include:

Age – most patients are younger, between 20 and 30 years old.
Ethnicity – the disease is more common in whites and people of Eastern European and Ashkenazi Jewish descent.
A family history of Crohn’s disease.
Cigarette smoking.
Nonsteroidal anti-inflammatory medication use such as ibuprofen, diclofenac sodium, and naproxen.

4. Complications of Crohn’s Disease

Crohn’s disease may lead to one or more of the following complications:

Bowel obstruction that may require surgery to remove the obstructed portion of the bowel.
Ulcers – chronic inflammation can lead to ulcers anywhere in your digestive tract, from your mouth to anus.
Fistulas – sometimes ulcers can extend completely through the intestinal wall creating a fistula, which is an abnormal connection
between different body parts.
Anal fissures.
Bowel strictures.
Malnutrition.
Colon cancer.
Medication side effects.

5. Diagnosis of Crohn’s Disease

Your doctor will first take a detailed history and perform the relevant physical examination. Since multiple other conditions can produce the same symptoms as Crohn’s disease, your doctor will suggest various medical tests to confirm the diagnosis. Tests may include:

Stool tests: Used to exclude infection or to detect inflammation (fecal calprotectin).
Blood tests: May detect the presence of inflammation, abnormal antibodies, anemia, or nutritional and vitamin deficiencies.
Colonoscopy and upper endoscopy: Used to look at the lining of your digestive tract with a scope or a tube with a camera and a light at the end. A sample of tissue can be obtained through these scopes (biopsy) for microscopic examination.
Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to evaluate the intestinal tract and surrounding structures.

6. Treatment of Crohn’s Disease

There is no complete cure for Crohn’s disease but multiple medicines are available that help to reduce the symptoms of Crohn’s disease. The groups of medicine commonly used to treat Crohn’s disease are:

Corticosteroids (examples prednisone and budesonide).
5-aminosalicylates (example sulfasalazine).
Azathioprine.
Infliximab.
Methotrexate.
Natalizumab.
Vedolizumab.
Ustekinumab
Almost all of these medicines work by reducing inflammation and the body’s immune response. Every person has a different response to their medicines. Your doctor will advise for these medicines depending upon your general health and symptom severity. Your doctor may also sometimes prescribe antibiotics during flare up or with anal discharge. You might have to try a few different medicines before you find the one that works best for you.
Surgical Management of Crohn’s Disease
Awareness of the diet and a focus on nutrition may help to reduce the symptoms of Crohn’s disease by restoring nutrients that have been lost, and by encouraging the healing process. Restricting dairy products, and foods high in fiber and fat, may help to prevent flare-ups of the disease. Quitting smoking and reducing stress are also helpful. Surgical options include:
Removing the diseased part of the colon.
Re-opening parts of the colon that have become blocked.
Closing fistulas and draining abscesses.

7. Diet and Exercise

Although there is no clear evidence that foods actually cause inflammatory bowel disease, certain foods may aggravate your symptoms of Crohn’s disease. Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat the symptoms of your Crohn’s disease. This not only improves your overall nutrition but also allows your bowel to rest. Bowel rest can reduce inflammation in the short term. Your doctor may also recommend:

Limiting dairy products.
Trying low-fat foods.
Limiting fiber.
Avoiding spicy foods, alcohol, and caffeine.
Eating smaller meals.
Drinking plenty of liquids.
Considering multivitamins.
Managing stress and anxiety.
Increasing physical activity.
Yoga.

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