Crohn's Disease

Symptoms, Doctors, Treatments, Advances & More

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that causes the digestive tract to become inflamed and is characterized by severe diarrhea and abdominal pain. The areas of the digestive tract affected by Crohn’s disease are different depending on the person; however, it most commonly affects the small intestine and colon. Crohn’s disease is progressive and has several subtypes that are categorized by the area of the digestive tract affected. The incidence of Crohn’s disease in the U.S. and the world has been increasing; however, the reasons why are unknown. Crohn’s disease is considered to be an autoimmune disorder caused by the body’s immune system attacking normal cells and develops more frequently in people who are between the ages of 15 and 40 (but can appear earlier), who have a family history of inflammatory bowel disease, who are of Eastern European Jewish (Ashkenazi) descent, or those who smoke.

There are several alternative names for Crohn’s disease, such as Crohn’s enteritis, granulomatous colitis, granulomatous enteritis, IBD, ileitis, ileocolitis, inflammatory bowel disease (IBD), and regional enteritis.

While the cause of Crohn’s disease is unknown, researchers believe that it may be genetic because it tends to run in families and more frequently affects people of Eastern European (Ashkenazi) Jewish descent. Crohn’s disease is also considered to be an autoimmune disorder, where a virus or bacteria may trigger the immune system to attack the normal cells of the digestive tract. Further risk factors can increase the chances of developing Crohn’s disease, such as being under the age of 30, having a family history of inflammatory bowel disease (IBD), smoking, using non-steroidal anti-inflammatory medications, such as ibuprofen (Advil or Motrin), naproxen sodium (Aleve), diclofenac sodium (Voltaren), and others which can inflame the intestinal tract, using antibiotics or birth control pills, eating a diet high in fat or processed foods, or living in an urban or industrialized area.

Symptoms of Crohn’s disease can vary depending on which part of the intestinal tract is affected (most commonly the small intestine and colon) and can range from mild to severe. Symptoms of Crohn’s disease most often develop gradually; however, they can also occur suddenly. The disease may also have periods of remission when no symptoms are occurring, followed by flare-ups. When Crohn’s disease is active, symptoms may include fatigue, reduced appetite, weight loss, nausea, diarrhea, abdominal pain, mouth sores, fever, blood in the stool, anemia, and pain or drainage around the anus due to the development of anal fistula (abnormal opening). Severe Crohn’s disease can affect other areas of the body, causing inflammation of the skin, eyes, joints, liver, or bile ducts, as well as delayed sexual development and growth in children.

While there is no cure for Crohn’s disease, several treatments can help to reduce symptoms and increase the possibility of long-term remission. Treatment for Crohn’s disease is individualized, depending on each patient’s symptoms and the areas of the digestive tract and/or other parts of the body affected. Treatments for Crohn’s disease may include anti-inflammatory drugs, immune system suppressors, antibiotics, pain relievers, anti-diarrheal medications, iron supplementation, Vitamin B12 injections, calcium and Vitamin D supplements, nutritional therapy, and surgery. Anti-inflammatory drugs – Anti-inflammatory drugs are often the first-line treatment for Crohn’s disease and include corticosteroids, such as prednisone and budesonide (Entocort EC), which can reduce inflammation and induce remission, and oral 5-aminosalicylates, such as sulfasalazine (Azulfidine) and mesalamine (Asacol HD, Delzicol, and others). Immune system suppressors – Immune system suppressors can reduce inflammation by targeting the immune system, are often used in combination, and include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), methotrexate (Trexall), natalizumabe (Tysabri), vedolizumab (Entyvio), and ustekinumab (Stelara). Antibiotics – Antibiotics can help to heal abscesses and fistulas (abnormal openings) caused by Crohn’s disease and include ciprofloxacin (Cipro) and metronidazole (Flagyl). Pain relievers – Acetaminophen (Tylenol) may be prescribed for mild pain caused by Crohn’s disease; however, other pain relievers, such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), must be avoided as they can worsen the disease. Anti-diarrheal drugs– Fiber-based supplements, such as psyllium powder (Metamucil) or methylcellulose (Citrucel), can help relieve mild diarrhea associated with Crohn’s disease. Loperamide (Imodium A-D) may be recommended for more severe diarrhea and should be used with caution under the care of a doctor. Iron supplements, Vitamin B injections, Calcium and Vitamin D supplements – Iron supplements may be prescribed for anemia related to Crohn’s disease, while Vitamin B12 shots may be necessary to counteract Vitamin B12 deficiency caused by Crohn’s disease. Calcium and Vitamin D supplements may be also be necessary to decrease the risk of osteoporosis associated with Crohn’s disease and its treatment. Nutrition therapy – Some patients with Crohn’s disease may need a special diet which is temporarily administered through a feeding tube (enteral nutrition) to allow the bowel to rest and to reduce inflammation. A low-fiber diet may also be prescribed to reduce the risk of bowel obstruction. Surgery – More than half of patients with Crohn’s disease may require surgery to remove damaged areas of the digestive tract, or to drain abscesses or repair fistulas (abnormal openings). Specific types of surgery may include small bowel resection (removal of part of the small intestine) via laparoscopy or open surgery, subtotal colectomy (removal of part of the large colon), proctocolectomy (removal of entire colon and rectum), and ileostomy, which is a permanent opening in the abdomen (stoma) with the application of a pouch to collect stool.

There are several online, local, national, and international support groups for Crohn’s disease, including the following: Crohn’s and Colitis Foundation - https://site.crohnscolitisfoundation.org/living-with-crohns-colitis/find-a-support-group/ Gastro Health Crohn’s and Colitis Support Group - https://gastrohealth.com/join-gastro-healths-crohns-colitis-support-group/ Smart Patients Inflammatory Bowel Disease Support Group - https://www.smartpatients.com/forums/ibd

The outcomes (prognosis) for Crohn’s disease vary by individual as the disease usually starts gradually, and then worsens over time and is characterized by long periods of no symptoms (remissions) followed by flare-ups. While Crohn’s disease is a progressive, lifelong disease after it begins, it can be both managed and improved with treatment.

Possible complications of Crohn’s disease may include bowel obstruction (blockage of intestine or colon), ulcers along the digestive tract, including the mouth, anus, and genital region, fistulas (abnormal openings into intestinal or anal wall), anal fissures, intestinal and anal abscesses, malnutrition, anemia, skin disorders, osteoporosis, arthritis, gallbladder or liver disease, and colon cancer. Treatment-related complications of medications for Crohn’s disease may also occur, such as an increased risk of infection or osteoporosis (bone thinning), for which treatment is an essential part of care.

If you experience any of the signs and symptoms of Crohn’s disease, such as a persistent change in bowel habits, chronic diarrhea, unexplained weight loss, fever, abdominal pain, vomiting, blood in the stool (black, tarry stools), or heavy bleeding from the rectum, contact your doctor as soon as possible.

While there is no known way to prevent Crohn’s disease, smoking can increase the chance of developing the disease and should be avoided. Since having Crohn’s disease can increase the risk of developing colon cancer, speak with your doctor about regular colon cancer screening, such as a periodic colonoscopy exam.