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Family Medical Care

Crohn’s Disease

OVERVIEW
Crohn’s disease is an inflammatory bowel disease (IBD), characterized by ulcers, diarrhea, abdominal pain, weight loss, fatigue, and fever. Some patients also have manifestations of the disease outside of the digestive tract, including skin rash, joint pain, eye redness, and liver problems. Crohn’s disease is an autoimmune disease in which the body’s immune system inappropriately attacks its own cells in the digestive tract, leading to inflammation, but the initial cause of the disease is unknown. While there is no cure, there are several treatments that can help keep the disease in control. Patients will usually have flares and remissions, alternating between symptomatic and asymptomatic periods. Crohn’s is a lifelong disease, but treatments can help keep the disease in remission.
Untreated, Crohn’s disease can be painful and debilitating, as well as potentially leading to life - threatening complications. It is, therefore, important to properly manage the disease.

RISK FACTORS AND CAUSES
Although it is known that Crohn’s is an autoimmune disease, the initial cause is unknown. The prevailing theory is that there is genetic predisposition that puts a person at risk for the disease, and after the person at risk encounters a trigger (likely an illness or something in the environment), the immune system is inappropriately activated to attack its own cells in the digestive tract.
Risk factors for Crohn’s disease include age <30, white ethnicity, Eastern European Ashkenazi Jewish descent, family history, cigarette smoking, and living in an urban area or industrialized nation.

SYMPTOMS
The most common symptoms include abdominal pain, diarrhea, fatigue, and weight loss due to inability to absorb nutrients. Other symptoms can include constipation, mouth sores, skin problems, eye inflammation, bloody stools, and anal problems, such as fistulas and abscesses. In addition, complications such as bowel obstruction, bleeding ulcers, fistulas, malnutrition, increased risk of colon cancer, arthritis, osteoporosis, clubbing of the fingernails, kidney stones and gallstones may occur. Symptoms can range from mild to severe and can develop gradually or appear suddenly. The disease can also enter remission, when you stop experiencing symptoms.

DIAGNOSIS
Your doctor will only make a diagnosis of Crohn’s disease after ruling out other conditions, such as irritable bowel syndrome, diverticulitis, and colon cancer. In addition to asking about the symptoms above, your doctor may order some tests. These may include blood tests to check for anemia, signs of infection, and presence of certain antibodies, a fecal occult blood test to check for blood in your stool, colonoscopy or flexible sigmoidoscopy to confirm the diagnosis in a lab, upper GI series, CT or MRI scan to evaluate the extent of the disease, capsule endoscopy (capsule with a camera that takes pictures of your digestive tract), regular or double balloon endoscopy, and a barium enema followed by x-ray. Since there is no single diagnostic test for Crohn’s disease, your doctor may order several different tests in order to make a diagnosis.

TREATMENT
Different patients will respond to treatments differently so treatment of Crohn’s disease will vary by patient. The most commonly used medications are the following:
  • 5-aminosalicylates (5-ASA): A class of drugs used to reduce inflammation in the digestive tract. Mesalamine (sold as Asacol and Pentasa) is the most commonly used.
  • Antibiotics: These can reduce the number of bacteria in your digestive tract, which can help to reduce inflammation.
  • Steroids: These drugs are usually used if you don’t respond to 5-ASA or antibiotics and only for a short period of time. Prednisone and budesonide are the most commonly used steroids.
  • Immunomodulators: These drugs help reduce inflammation and are used if none of the above are sufficient. The most commonly used include azathioprine, 6-mercaptopurine, and methotrexate.
  • Biologic response modifiers: These drugs work by preventing inflammation and are often used in combination with some of the treatments above. All are given as an injection, and the most commonly used are Infliximab (Remicade), Adalimumab (Humira), and Certolizumab pegol (Cimzia).
Your doctor may also prescribe other medications to help with the symptoms, such as anti-diarrheals, laxatives, pain relievers, iron supplements, nutrition and vitamin supplements. Lifestyle changes may help as well, which include eating a healthy diet, limiting stress, avoiding foods that worsen your symptoms, getting regular exercise, quitting smoking, and avoiding non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (sold as Advil) and naproxen (sold as Aleve). If medications don’t work or if the side effects are too unbearable, surgery may be recommended. About 80% of patients with Crohn’s disease will need surgery at some point in their lives. While surgery does not cure the disease, it can help you feel better and live a more active life. Unfortunately, the disease will likely return after surgery so you will need to continue taking medications. Up to 85%-90% of patients don’t have symptoms of Crohn’s disease the year after surgery, but only 20% don’t have any symptoms 15 years after surgery. The most common surgeries performed are those to remove parts of the colon that have a lot of inflammation and to open up blockages that may have developed.
Because Crohn’s disease puts you at an increased risk for colon cancer, colonoscopy screenings may need to be done more frequently, so be sure to ask your doctor if you need more frequent cancer screenings.

PREVENTION
While there is no way to prevent Crohn’s disease, certain steps can reduce the severity of the disease like taking medications, quitting smoking, avoiding NSAIDs, eating a healthy diet, getting regular exercise, and avoiding antibiotics unless prescribed by your physician.

ADDITIONAL INFORMATION
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