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Crohn's Disease by Rosalyn Carson-DeWitt, MD

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Definition

Crohn's is a severe, chronic inflammatory bowel disease. It causes inflammation, ulcers , and bleeding in the digestive tract. It usually affects the end portion of the small intestine called the ileum. However, any part of the digestive tract can be affected, from the mouth to the anus.

Small Intestine

Causes

The cause of Crohn's disease is not known. Inflammatory bowel diseases (ulcerative colitis and Crohn's disease) seem to run in some families. Some researchers think that it is due to a reaction to a virus or bacteria. The immune system overreacts and causes damage to the intestines.

Risk Factors

Factors increase your chance of getting Crohn's include:

Family members with inflammatory bowel disease
Jewish heritage

Symptoms

Symptoms include:

Diarrhea
Abdominal cramps and pain
Rectal bleeding
Anemia
Weight loss
Fatigue, weakness
Nausea
Fever
Mouth sores
Sores, abscesses in the anal area

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

Blood tests
Stool examination
Barium swallow —a series of x-rays of structures inside the throat that are taken after drinking a barium-containing liquid
Barium enema x-ray —insertion of fluid into the rectum that makes your colon show up on an x-ray
Flexible sigmoidoscopy —a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon
Colonoscopy —a thin, lighted tube inserted through the rectum and into the colon to examine the lining of the colon
Biopsy —removal of a sample of colon tissue for testing (may be performed as part of a flexible sigmoidoscopy or colonoscopy)

If you are diagnosed with Crohn's disease, follow your doctor's instructions.

Treatment

Treatment may include:

Avoiding Foods That Provoke Symptoms

These foods are different for each person. They may include:

Dairy foods (due to lactose intolerance)
Highly seasoned foods
High-fiber foods

Aminosalicylate Medications

Anti-inflammatory Medications

Immune Modifiers

Azathioprine
6-mercaptopurine
Methotrexate

TNF-Inhibitors

FDA Public Health Advisory for TNF-Inhibitors

Children and teens who take TNF-inhibitors may be at an increased risk of Hodgkin’s and non-Hodgkin’s lymphoma and other types of cancer.*¹ For more information, please visit: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm175843.htm

Antibiotic Medications

Surgery

Very severe Crohn's may not improve with medicines. You may be advised to have the severely diseased section of your intestine removed. The two remaining healthier ends of the intestine are then joined together. You are still at high risk for recurrence of the disease elsewhere.

Surgery may also be done if you have an obstruction or fistulas.

Untreated Crohn's disease may lead to:

Fistulas—abnormal connections between the intestine and other organs or tissues, such as the bladder, vagina, or skin
Intestinal obstruction
Arthritis
Eye inflammation
Liver disease
Kidney stones
Gallstones
Skin rashes
Osteoporosis

If you are diagnosed with Crohn's disease, follow your doctor's instructions .

Prevention

There are no guidelines for preventing Crohn's disease because the cause is unknown.

RESOURCES:

American Gastroenterological Association http://www.gastro.org/
Crohn's and Colitis Foundation of America http://www.ccfa.org/

CANADIAN RESOURCES:

Crohn's and Colitis Foundation of Canada http://www.ccfc.ca/
Health Canada http://www.hc-sc.gc.ca/

References:

Crohn's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/ . Accessed July 20, 2008.
Disease information. Crohn's and Colitis Foundation of America website. Available at: http://www.ccfa.org/info/?LMI=4 . Accessed July 20, 2008.
Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis, MO: Mosby; 2005.
Ferri F, ed. Ferri’s Clinical Advisor 2010. Philadelphia, PA: Mosby Elsevier; 2009.
Goroll AH, Mulley AG. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.
Inflammatory bowel disease. American Gastroenterological Society website. Available at: http://www.gastro.org/wmspage.cfm?parm1=851 . Accessed July 20, 2008.
*¹10/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: FDA approves new drug to treat psoriasis. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183851.htm. Published September 25, 2009. Accessed October 2, 2009.

Last reviewed November 2009 by Rosalyn Carson-DeWitt, MD

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