Crohn's disease is a chronic illness in which the intestine
(bowel) becomes inflamed and ulcerated (marked with sores). Along with
ulcerative colitis, Crohn’s disease is part of a group of diseases known as
inflammatory bowel disease (IBD).
Crohn’s disease most commonly affects the lower part of the
small intestine (ileum), although it can occur in any part of the large or small
intestine, stomach, esophagus or even the mouth. It can occur at any age, but it
is most common between the ages of 15 and 30.
Crohn's disease can disrupt the normal function of the bowel in a number of ways. The tissue may:
- Swell, thicken, or form scar tissue leading to blockage of the passageway inside the bowel
- Develop ulcers that can involve the deep layers of the bowel wall
- Lose its ability to absorb nutrients from digested foods (malabsorption)
- Develop abnormal passageways (fistulas) from one part of the bowel to
another part of the bowel, or from the bowel to nearby tissues such as the bladder or vagina.
Symptoms of Crohn’s disease
People with Crohn's disease experience periods of severe
symptoms followed by periods of remission that can last for weeks or years.
Unfortunately there is no way to determine when a remission will occur or when
symptoms will return. The symptoms of Crohn's disease depend on where the
disease occurs in the bowel and its severity. In general, symptoms at times
include:
- Chronic diarrhea
- Rectal bleeding
- Weight loss
- Fever
- Abdominal pain and tenderness (often on the right side of the lower
abdomen)
- Feeling of a mass or fullness in the lower, right abdomen
- Delayed development and stunted growth (in children)
Other symptoms can develop, depending on complications related
to the disease. For example, a person with a fistula (abnormal passageway) in
the rectal area may have pain and discharge around the rectum. Other
complications from Crohn’s disease include:
- Arthritis
- Kidney stones
- Gallstones
- Inflammation of the eyes and mouth
- Skin rashes or ulcers
- Liver disease
Causes of Crohn’s disease
The cause of Crohn's disease is unknown. It is likely that
Crohn's disease is at least partially an inherited disease that causes an
abnormal response of the immune system in the gastrointestinal tract. Recently,
the first gene associated with Crohn’s disease was identified. This gene is
called the NOD2 or CARD15 gene. Abnormalities in the gene are found in up to 20%
of patients with Crohn’s disease. People who have a relative with Crohn’s
disease are 10 times more likely to develop the disease themselves. If the
affected relative is a sibling, the risk jumps to 30 times more likely to
develop Crohn’s disease. Jewish people of European descent also have a greater
risk for developing the disease.
Diagnosing Crohn’s
A number of tests are used to distinguish Crohn's disease from
other gastrointestinal conditions. First, your physician will review your
medical history. This information is helpful because Crohn's disease is more
common in people who have a first-degree relative (mother, father, sister or
brother) with IBD. After the physical examination is complete, the following
tests may be ordered:
- Endoscopy (such as colonoscopy or sigmoidoscopy):
During this procedure, a flexible, lighted tube (called an
endoscope) is inserted into the rectum and used to view the inside of the
rectum and colon. (Colonoscopy shows a greater portion of the colon than
sigmoidoscopy.) A small sample of tissue may also be taken for testing
(biopsy).
- Blood tests:When testing the blood, the doctor will look for signs of
anemia, or a high white blood cell count, which will indicate inflammation
or infection somewhere in the body.
- Barium X-ray (barium enema or small bowel series): During these
procedures, X-rays are taken of either the upper or lower intestine. Barium
coats the lining of the small intestine and colon, and shows up white on an
X-ray. This characteristic enables doctors to view any abnormalities.
- CT scan: X-ray of the abdomen that highlights the extent and
severity of bowel inflammation, as well as identifying lesions in other organs.
Treating and managing Crohn’s
Treatment for Crohn's disease is determined by the severity and
location of the disease. Because the disease can sometimes go into remission on
its own, it is not always possible to determine whether a specific treatment has
been effective. When Crohn’s disease is active, treatment is aimed at
controlling inflammation, correcting nutritional deficiencies and relieving
symptoms such as pain, diarrhea and fever.
Medications are generally the first step in treating Crohn’s
disease. Some of these medications include anti-inflammatories, antibiotics,
corticosteroids, antidiarrheals and immune suppressing medications. For those
patients experiencing nutritional deficiencies, supplements are often
prescribed.
Even though it cannot cure Crohn’s disease, surgery is sometimes
needed for patients whose symptoms do not respond to medications. Surgery can be
performed to correct perforations, blockages or bleeding in the intestine.
Unfortunately, Crohn’s disease often returns to the area next to where the
inflamed part was removed. It is therefore important that you discuss with your
doctor all possible options before deciding upon surgery.
In managing Crohn’s disease it is very important to maintain a
healthy lifestyle, even when the disease goes into remission for long periods of
time. This can be accomplished by exercising regularly and eating a healthy
diet. Abstaining from smoking can also help prevent symptoms from recurring.
Studies have shown that smokers are at a higher risk of developing Crohn’s
disease than non-smokers and the smokers with Crohn’s disease tend to have a
more severe course than non-smokers with Crohn’s disease. People with Crohn’s
disease are usually able to lead healthy and active lifestyles.
Like many other disorders, understanding and education about
Crohn’s disease is the most important tool with which to manage and prevent
complications. The following organizations can provide more information about
Crohn’s disease:
Crohn’s and Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016
800.932.2423
National Institute of Diabetes and Digestive and Kidney Diseases
2 Information Way
Bethesda, MD 20892
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/13/2008...#9357
