Crohn’s disease is a chronic inflammatory disease of the digestive tract. Symptoms include abdominal pain and diarrhea, sometimes bloody, and weight loss. Crohn’s treatment consists of lifestyle changes, such as exercise and a healthy diet, as well as over-the-counter antidiarrhetics and prescription anti-inflammatory medication.
What Causes Crohn’s Disease?
Although there are many theories about what causes Crohn’s disease, none of them have been proven. There is a benefit, though, in understanding the possible causes of Crohn’s disease and how they interact with one another. Doing so can help one better understand the symptoms, diagnosis, and treatment of Crohn’s disease.
Scientists believe that Crohn’s disease is caused by a combination of these factors:
- Immune system problems
- Environmental factors
How might each of these factors contribute to Crohn’s disease? Read on to learn more.
How do immune system problems relate to Crohn’s disease?
Scientists have linked immune system problems to inflammatory bowel disease (IBD), including Crohn’s. Usually, cells of the immune system defend the body from harmful microbes — bacteria, viruses, fungi, and other foreign substances — that have entered it. The body doesn’t usually respond to all microbes, however. Many microbes are helpful, especially for digestion. And so the immune system leaves them alone.
If there is an invader that needs to be eliminated, your body’s defense reaction begins. This immune system response causes inflammation. Immune system cells, chemicals, and fluids flood to the site to overcome the offending substance. After the substance has been disabled or removed, the immune response ends. Inflammation subsides.
For some reason, though, people with Crohn’s disease have an immune system that reacts inappropriately. The immune system may be defending the body against helpful microbes by mistake. Or, for some other reason, the inflammatory response simply will not stop. Either way, over time, this chronic inflammation in the digestive system can result in ulcers and other injuries to the intestines.
Is genetics connected to Crohn’s disease?
Brothers, sisters, children, and parents of persons with IBD, including Crohn’s disease, are slightly more likely to develop the disease themselves. About 10% to 20% of people with Crohn’s disease have at least one other family member who also has the disease. The condition is more common in certain ethnic groups, such as Jews, and is more prevalent in Caucasians.
Is this tendency toward IBD and Crohn’s disease passed genetically? Scientists have identified a gene associated with Crohn’s disease. This gene helps the body decide how to react to certain microbes. If the gene has changed or mutated in some way, your body’s reaction to microbes may also be different from the normal reaction. Over time, IBD or Crohn’s disease may develop. People with Crohn’s disease have this mutated gene twice as often as people who do not have the disease.
Do environmental factors play a role in Crohn’s disease, too?
Environmental factors may help trigger Crohn’s disease. Also, it should be noted that because a potential trigger is linked or associated to a condition does not mean that it causes it. Associated environmental factors may include any of the following:
- Substances from something you’ve eaten
- Microbes such as bacteria or viruses
- Cigarette smoke
- Other substances that are yet unknown
Environmental factors may contribute to Crohn’s disease in one of these two ways:
- They may trigger an immune system response. Once started, the response cannot stop.
- They may directly damage the lining of the intestines. This may cause Crohn’s disease to begin or to speed up.
What can I do to control Crohn’s disease?
The factors involved in causing Crohn’s disease are complex. Scientists continue to seek more information about the causes — in hopes of finding better ways to diagnose, treat, and perhaps even cure this frustrating and painful disease. In the meantime, understanding current theories about the causes of Crohn’s disease can help you work with your doctor to explore how various treatments might work to control this condition.
Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of your digestive system, even your mouth.
The disease is typically diagnosed in adolescence and young adulthood, but it is becoming more common in children. Overall, about 700,000 people in the United States may have Crohn’s disease, though some of those cases are undiagnosed. While there is no cure for Crohn’s, it can be managed with medication, although surgery is often required.
Symptoms of Crohn’s include diarrhea, sometimes at night; abdominal pain; bowel obstruction (when something partially or fully blocks the intestines); weight loss; fever; night sweats; and fatigue. The pain tends to occur in the lower right part of yourabdomen or near your belly button. The pain might improve with a bowel movement. You may also see blood in your stool.
Many people live with Crohn’s for years before receiving the correct diagnosis.
Crohn’s can affect every part of the digestive system and can affect more than one part at the same time. Specifically:
- Ileocolitis. This is the most common form of the disease. It affects the ileum (the last part of the small intestine) and some portion of the large intestine, or colon, which goes from the end of the ileum to the anus. About half of people with Crohn’s will have disease in these parts of their digestive system.
- Crohn’s disease of the small intestine. The small intestine is affected in about 80 percent of people with Crohn’s. Sometimes this coexists with colon involvement (see above) or it can be the small intestine alone. The primary symptoms are weight loss and nutritional deficiencies because your intestine doesn’t absorb nutrients from food. Other symptoms include diarrhea, abdominal pain, lack of appetite and sometimes nausea and vomiting.
- Colonic Crohn’s disease. This form of the disease affects about 20 percent of patients and is limited to the colon. It is often confused with ulcerative colitis, another inflammatory bowel disease. Symptoms include bloody diarrhea with mucus; cramping abdominal pain; and an urgent need to have a bowel movement.
- Perianal disease. About a third of people with Crohn’s will develop perianal disease, in which the disease affects the anus and surrounding area. You may have abscesses or fistula on this part of your body, as well as skin tags, hemorrhoids, painful ulcers in the anus or rectum, and strictures, an abnormal narrowing of the rectum or anus. Symptoms include bright red blood in your stool or bleeding from your rectum, and pain, redness and/or discharge in the anal area. In some women, the fistulas may affect the vagina, and they could have the sensation of air or liquid coming out of the vagina.
Other less common manifestations of Crohn’s disease include symptoms in their mouth, esophagus or other digestive areas.
A major complication of Crohn’s is an obstruction in your small intestine or colon that prevents digested material from passing through. Symptoms of an obstruction include bloating after meals, cramping pain and loud growling from your stomach.
Another common complication is development of a fistula, literally a hole between two organs. Symptoms depend on where the fistula forms, but include vomiting, gas when you urinate (you’ll see bubbles in your urine), a grainy vaginal discharge and recurrenturinary tract infections. Fistulas can be managed with medication but sometimes require surgery to repair.
Sometimes the inflammation that underlies Crohn’s can affect other parts of your body, causing painful joints; ulcers in your mouth or on your skin; a tender, red rash on your shins; and eye inflammation. You also have a higher risk of blood clots, kidney stones, loss of bone density, anemia and vitamin B12 deficiency.
People with Crohn’s also have a higher risk of developing colon cancer and liver disease.
No one knows what causes Crohn’s, but experts suspect it is related to a combination of abnormalities, environmental factors, genetic causes and intestinal bacteria or viruses in the system. Researchers have identified several genes connected with the disease and know that it tends to run in families. The disease is most prevalent in people with Eastern European heritage, and there have been recently been an increased number of cases in African Americans.
The goal of treatment for Crohn’s is to prevent acute flares or exacerbations and keep you in remission. About 10 percent to 20 percent of people with Crohn’s have a remission after the initial diagnosis.
What Are the Symptoms of Crohn’s Disease?
Lots of people have stomachcramps with diarrhea or constipation. It’s uncomfortable, but you usually get over it and forget about it.
But when you have these symptoms often, and they’re severe, there’s a chance you could have Crohn’s disease. You’ll need to see your doctor to find out for sure.
As many as 700,000 Americans have the disease. Although there’s no cure, there are treatments to manage it.
You may have:
- Stomach pain
- Weight loss
- Bleeding from your rectum
- Sudden and frequent need to go to the bathroom
You might not have all these. The disease affects different people in different ways. The symptoms can be mild, or they can leave you very weak. At its worst, Crohn’s can cause severe complications.
The most serious cases of Crohn’s can cause:
- Painful tears called fissures in the lining of the anus, mostly during bowel movements
- Fistulas (passages that form between loops of the intestine, or between the intestines and the vagina, skin, or bladder)
- Thickening of intestine walls, which makes it hard for food and waste to move
- A partly or totally blocked intestine, for which you would need medical care right away
- Open sores called ulcers in the intestines, mouth, or anus
- Malnutrition, as your body is not able to absorb enough nutrients from food
- Pain, swelling, and burning in other parts of your body, such as your skin, eyes, or joints
Crohn’s disease is often confused with another condition called ulcerative colitis. The symptoms are similar, and both involve periods of active flare-ups, followed by times when you don’t have symptoms, which is called remission.
The only way to find out if you have Crohn’s or ulcerative colitis is to see your doctor for tests.
Diagnosing Crohn’s Disease
There isn’t any one test that can tell you whether or not you have Crohn’s disease. And Crohn’s disease has many possible symptoms that are the same as symptoms for other health problems. So, to make a diagnosis of Crohn’s disease, your doctor is likely to gather information from multiple sources. You’ll probably go through a combination of exams, lab tests, and imaging studies with these goals in mind:
- Rule out other health problems that have similar symptoms
- Make a clear diagnosis of Crohn’s disease
- Determine exactly which part of the digestive tract is affected
Diagnosing Crohn’s disease: Physical Exam and History
Your doctor will begin by gathering information about your health history and conducting a physical exam. Findings that may indicate further tests are needed include:
- Diarrhea, which may be bloody
- Family history of Crohn’s disease
- Pain and tenderness in the abdomen
Diagnosing Crohn’s Disease: Lab Tests
Your doctor may request lab tests in order to look for any problems that might be linked to Crohn’s disease. These tests check for signs of infection, inflammation, internal bleeding, and low levels of substances such as iron, protein, or minerals. Lab tests may include:
- Blood protein levels
- Blood sedimentation rates
- Body mineral levels
- Red blood cell counts
- Stool samples to check for blood or infectious microbes
- White blood cell counts
Diagnosing Crohn’s Disease: Imaging Studies and Endoscopy
Crohn’s disease may appear anywhere along the gastrointestinal tract, from the mouth to the rectum. X-rays and other images can help identify the severity and location of Crohn’s disease. These studies may include the following:
- Barium X-rays and other X-rays
- CT scans
- Colonoscopy or sigmoidoscopy
- Video capsule endoscopy
Diagnosing Crohn’s Disease: Barium X-rays and Other X-rays
A barium X-ray can show where and how severe Crohn’s disease is. It is especially helpful for finding any problems in parts of the small intestine that can’t be easily viewed by other techniques.
A chalky fluid containing barium is given by mouth or through the rectum. When barium fluid is given by mouth, it is called an upper GIseries. When barium fluid is placed in the rectum, it is called a barium enema. The barium fluid flows through the intestines, appearing white on X-ray film. This makes it easier to view problem areas. On a barium X-ray, your doctor may be able to see ulcers, narrowed areas of the intestine, abnormal connections between organs, known as fistulae, or other problems.
If barium X-rays show some sign of disease, your doctor may request other X-rays or imaging studies. These X-rays can help identify exactly how much of your digestive tract is affected by Crohn’s disease.
Diagnosing Crohn’s Disease: CT Scans
CT scanning uses computer-aided X-ray techniques to produce more detailed images of the abdomen and pelvis than can be seen in traditional X-rays. CT scans can help detect abscesses that might not show up on other X-rays. Abscesses are small pockets of infection.
Diagnosing Crohn’s Disease: Colonoscopy or Sigmoidoscopy
Colonoscopy and sigmoidoscopy allow the doctor to directly view the large intestine, which is the lower part of the digestive tract. These techniques can often provide the most accurate information about the intestines. They may be better at detecting small ulcers or inflammationthan other techniques. They can be used to assess the severity of any inflammation. Colonoscopy is the most important tool in diagnosing Crohn’s disease.
During these procedures, a flexible viewing tube is placed through the anusinto the large intestine. An image of the inside of the intestine is often projected onto a video monitor. A sigmoidoscopy involves examining the lowest part of the large intestine. A colonoscopy can provide a view of all of the large intestine and often the end of the small intestine, which is frequently affected by Crohn’s. In either case, the doctor can directly view the colon to check for signs of ulcers, inflammation, or bleeding. The doctor can also take small samples of tissue to examine under a microscope, known as a biopsy. This helps determine whether the tissue shows signs of Crohn’s disease or other problems.
Diagnosing Crohn’s Disease: Video Capsule Endoscopy
For video capsule endoscopy, you swallow a small capsule or pill that holds a miniature video camera. As it travels through the small intestine, it sends images of the lining to a receiver you wear on a belt around your waist. The images are downloaded and reviewed at a computer. The images can provide detailed information about early, mild problems associated with Crohn’s disease. This technique may be especially helpful if you have symptoms of Crohn’s disease but barium X-rays do not show evidence of the condition.
While video endoscopy can provide valuable information, there are times when it may be best to avoid it:
- If you have an obstruction in the small intestine, the capsule could get stuck and make the obstruction worse.
- If you have a narrowing in the small intestine, such as from Crohn’s disease, previous surgery, or previous radiation therapy, the capsule might become stuck.
- Some doctors worry that wireless transmissions from the capsule might interfere with implanted cardiac pacemakers or defibrillators.
Making a Diagnosis of Crohn’s Disease
- After the exams, lab tests, and imaging tests are done, your doctor will discuss the findings with you. If your doctor believes you have Crohn’s disease, then you can work together to develop a treatment plan to manage the symptoms and control the disease.
What to Expect If You Have Crohn’s Disease
You have Crohn’s disease. Maybe you’ve had it for a long time or maybe you’ve just been diagnosed. You’ve heard and read a lot about it, but you don’t really know what to expect.
The first thing to do is ask your doctor. He can help you understand your condition and provide answers to your questions. It’s a good idea to learn all you can about it.
What Happens To Your Body?
Crohn’s disease is a type of inflammatory bowel disease. That means that your body’s immune system attacks and damages your bowel or gastrointestinal system.
It’s a chronic, meaning long-term, condition that gets in the way of your body’s ability to take in important nutrients. It can also affect the way you digest food and get rid of waste.
Crohn’s can involve any part of your gut. But the ileum, the last part of your small intestine, is most commonly affected.
Because of inflammation, you might have some of these symptoms:
- Diarrhea or frequent, watery bowel movements
- Urgent bowel movements
- Trouble having bowel movements
- Bleeding from your rectum
- Pain or cramping in your abdomen or belly
- Weight loss
Other parts of your body, like your joints, skin, or eyes, can be affected too.
Symptoms can come and go. You may have periods of times when you feel fine. These times might be followed by flare-ups of the condition.
Remission also is possible. With Crohn’s, remission is sometimes thought to take place when symptoms go away and ulcers in the colon begin to heal.
What You Can Do
You should be able to do just about anything. But you may need to make some adjustments.
Each person is different. Your Crohn’s disease might:
- Affect a large part of your gastrointestinal system or only a small part.
- Be mild, moderate, or severe.
- Go long periods without symptoms or flare-ups.
- Be fairly easy to control or it may be very difficult.
- Go into remission.
Depending on the way Crohn’s affects you and your ability to manage it, you may have some challenges.
Your Symptoms. Although most people with Crohn’s are able to have active lives, symptoms and flare-ups may cause you to miss work, school, or other activities. To avoid that, stick with your treatment plan.
Your Day-to-Day Activities. You may want to plan your activities with your Crohn’s in mind. For example, know where the closest bathroom is.
Your Diet. Stay away from some foods if they make you feel worse. For instance, if milk products or greasy foods cause diarrhea, don’t eat them.
Your Mood. Crohn’s disease, like other chronic conditions, may affect your mood. You may feel more anxious or depressed at times. You may have pain, which also affects your emotions. If your condition starts to get to you, look into seeing a counselor and joining a support group.
If You’re Female, Crohn’s could affect your ability to get pregnant. If it isn’t well controlled, it may cause problems once you are pregnant. Your doctor may recommend a C-section if you have certain complications.
What Are The Risks?
With Crohn’s, you are slightly more likely to develop other health problems. Your doctor will watch you closely to help prevent them. They include:
Colon cancer, if Crohn’s disease affects your colon or large intestine.
Lymphoma. This is a cancer of the lymphatic system, the body’s disease-fighting cells and structures. It’s more likely if you take certain medicines for Crohn’s.
Primary sclerosing cholangitis. This is serious inflammation and scarring of the bile ducts, the tiny tubes that allow bile to pass through the gastrointestinal system.
Psoriatic arthritis . A form of arthritis that affects some people with psoriasis.
Knowing what to expect with Crohn’s can help you manage it. With the help of your doctor, you can work to avoid problems and possible complications.
To diagnose Crohn’s disease, your doctor will order a series of tests, ask you a lot of questions about your symptoms and examine you thoroughly. You should share any family history of gastrointestinal problems or inflammatory bowel diseases, including Crohn’s and ulcerative colitis, because Crohn’s is often hereditary.
Tests used to diagnose Crohn’s disease include:
- Blood tests. The doctor will likely order a complete blood count to check for anemia and high levels of white blood cells, which could signify infection and/or inflammation. Blood tests can also evaluate the health of your kidneys and liver and assess levels of inflammation.
- Colonoscopy. This procedure lets your doctor perform a detailed examination of the inside of your entire colon, including your rectum. A thin, lighted flexible tube with a small camera attached to the end is inserted through your anus to look for ulcerations and inflammation. If needed, the doctor can take tissue samples and correct certain problems using the same tube. You need to fast for at least 24 hours before a colonoscopy and take a special liquid to completely empty your bowel. The procedure is typically performed under sedation or anesthesia.
- Endoscopy. This procedure enables the doctor to see the upper digestive tract, including your esophagus, stomach and upper part of the small intestine (duodenum). The doctor inserts a small, flexible tube with a light and a lens on the end through your mouth. During the procedure, the doctor can take tissue samples and pictures. The procedure is done while you are anesthetized or heavily sedated, so you shouldn’t feel any pain or discomfort.
- Ultrasound. An ultrasound uses sound waves to provide an image of the inside of your abdominal area. You may have an external ultrasound or an endoscopic ultrasound, in which the ultrasound wand is inserted through the rectum, to look for any strictures. This may be used to look at the gall bladder, kidneys and pancreas.
- Imaging tests. In some instances, your doctor may order an MRI or a CT scan to look at the intestine and the complications such as abscesses or fistulas. An MRI uses magnets and a CT scan uses radiation to provide a three-dimensional image of your organs.
- Antibody tests. Because some immune system dysfunction is involved with Crohn’s, your doctor may order antibody tests to differentiate your disease from ulcerative colitis, another inflammatory bowel disease.
- Barium enema. In this procedure, a tube is inserted into your rectum and air and barium, a radio opaque liquid, are inserted into your bowel. X-rays are then taken to identify any abnormalities.
- Upper gastrointestinal series. An upper GI series requires you to drink a contrast agent. Then fluoroscopic imaging is used to examine your esophagus, stomach and duodenum.
- Small bowel follow-through. A small bowel follow looks at the distal portions of the small bowel, the jejunum and ileum. It helps evaluate abdominal pain and diarrhea. The small bowel series often is done immediately after an upper GI exam, though it may also be done separately. You will drink some contrast, and radiographs of you abdomen will be obtained every 20 or 30 minutes. The test can take several hours
- Capsule endoscopy. This procedure, also known as wireless capsule endoscopy or small bowel endoscopy, uses a tiny wireless camera to take pictures that help doctors see inside your small intestine. The camera fits inside a vitamin-sized capsule that you swallow. As the camera travels through your digestive tract, it takes pictures that are transmitted to a recorder. These pictures can reveal areas of inflammation in the small intestine that can help your doctor Crohn’s.
After diagnosing you, your doctor will stage your disease as a way of assessing its severity. Staging provides important information for developing a treatment plan.
Tips to Avoid Crohn’s Disease Symptoms
Getting a break from cramps, nausea, or diarrhea could almost make you forget you have Crohn’s. That’s the best time to take action to keep flares away.
Doctors don’t know why Crohn’s symptoms come and go. But they know that things like diet, smoking, and stress can make them worse.
Use these tips to keep flares at bay:
Become a Crohn’s Expert
Learn all you can: what causes it, your triggers, and which treatments work best. Keep up with news about Crohn’s and its treatments. Go to your doctor visits with questions prepared. Know how to spot the warning signs of a flare and what helps prevent it.
Stick With Your Crohn’s Drugs
Even if your symptoms are gone and you feel great, don’t stop taking your prescribed drugs unless your doctor tells you to.
People who don’t stick to their drug plan are more likely to get flares. Over time, that can cause medical problems. Repeated flares can lead to complications like narrowing of your intestines. Or you might get fistulas, which are tiny connections between the intestines and your skin or other organs.
If a drug causes side effects that bother you, don’t stop taking it. Talk to your doctor first. You might need to take a lower dose, switch to another drug, or get treated for the side effects.
When your Crohn’s disease flares, it can be hard for your small intestine to absorb nutrients. So when you don’t have symptoms, it’s especially important to eat healthy.
Keep a diary to learn if certain foods make your symptoms worse. For some people with Crohn’s, high-fat foods or fiber-rich fruits and vegetables (like beans and broccoli) cause problems. Let your doctor know about things you eat that seem to trigger your symptoms.
Your doctor and a diet expert can help you plan meals that include all the food groups. You might also need to take supplements of vitamins B12 and D, iron, or calcium, or a multivitamin.
If You Smoke, Stop
You already know that smoking is bad for you. Did you know that it worsens Crohn’s disease and makes it harder to control?
The more you smoke, the more likely you are to get flares. If you quit smoking, your chances drop to the same as a nonsmoker with Crohn’s.
Have you tried to quit smoking before, only to light up again? Hang in there. It can take a few tries to kick the habit for good. Tell your doctor that you’re working on it, and ask for her advice.
Avoid ‘NSAID’ Pain Drugs
NSAIDs are nonsteroidal, anti-inflammatory drugs. They include aspirin, ibuprofen, and naproxen.
They can trigger flares or cause symptoms like those of Crohn’s. Ask your doctor about other choices.
Tell Your Doctor How You’re Doing
Share any symptoms you have. They could be side effects of a drug or a sign of a medical problem caused by Crohn’s. Your doctor may want to do tests or adjust your treatment so you can feel better.
Take Care of Stress
Everyone has stress. On top of that, you have the stress that comes with Crohn’s disease.
Stress does not cause the illness, but it can make you feel worse. Get regular exercise and do things that help you relax, like yoga and meditation. You handle problems better when you’re rested, so make sleep a priority.
People who are both depressed and anxious are more likely to have flares. If you’re feeling down or upset about your health (or anything else), let your family and friends know how they can support you. Don’t hesitate to get help from your doctor or from a counselor who specializes in helping people with Crohn’s or other long-term conditions.
You may want to join a support group. You get a chance to talk to other people who know what you’re going through because they’ve been there, too.
Crohn’s disease, also known as ileitis or regional enteritis, is a chronic illness. In Crohn’s, the intestine, bowel, or other part of the digestive tract 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 usually affects the lower part of the small intestine, which is called the ileum, and the beginning of the colon. The disease, though, can occur in any part of the gastrointestinal system. Thus, the disorder may affect the large or small intestine, the stomach, the esophagus, or even the mouth. Crohn’s can occur at any age. It is most commonly diagnosed in people who are between the ages of 15 and 30.
What are the symptoms of Crohn’s disease?
The symptoms of Crohn’s disease depend on where in the bowel the disease occurs. They also depend on its severity. Symptoms can include:
The primary goal of Crohn’s treatment is to manage acute flares, bring you into remission and maintain remission over the long term without steroids.
A healthy diet and regular exercise can help keep the symptoms of Crohn’s in check. Work with your health care team to maintain a well-balanced diet that is low in saturated fats and high in foods containing omega-3 fatty acids. Because everyone with Crohn’s reacts to foods differently, there is no particular diet that has been proven effective. In general, follow a healthy, nutritious diet and avoid foods that seem to trigger symptoms or cause them to worsen.
Low-intensity workouts, such as walking, also have been shown to improve Crohn’s symptoms. Exercise reduces the stress that triggers flare-ups and can help prevent depression, which can occur in people with chronic conditions like Crohn’s.
Your health care team will work with you to improve any pain and will try to prevent surgery. Studies find that the disease tends to moderate after the first year of diagnosis, with about half of people with Crohn’s in remission at any given time.
Treatment depends on the severity of your disease, with four levels of severity possible:
- Asymptomatic remission, in which you have no symptoms after medical or surgical treatment. However, if you have to take steroids to remain symptom free, you’re not considered to be in remission.
- Mild-to-moderate Crohn’s, in which you can eat normally without major gastrointestinal problems or weight loss but still have some mild symptoms.
- Moderate-to-severeCrohn’s, in which you have symptoms such as fever, weight loss, abdominal pain and tenderness, nausea and vomiting and loss of appetite.
- Severe fulminant disease, in which you have significant symptoms even while on steroids or biologic drugs or when you have an abscess, obstruction or other severe symptoms.
Treatment is often given in a “step-up” manner starting with drugs like 5-aminosalicylic acid (5-ASA) and antibiotics that have few side effects but also fewer beneficial effects, moving on to steroids, immune modulators and biologic drugs.
However, there’s some evidence that using a more aggressive approach earlier with immune modulators and biologic drugs leads to a faster remission, higher remission rate and improved healing of the intestinal lining than conventional therapy.
The bottom line is that you and your health care team must work together to find the right treatment approach for you, balancing the benefits of the drugs against their side effects, your preference for oral, injected or infused medications and the affects of the treatment and the disease on your quality of life.
Medications used to treat Crohn’s Disease
Aminosalicylates (5-ASA). These drugs reduce inflammation and provide some antioxidant benefits in the small bowel and colon. They are not specifically approved by the United States Food and Drug Administration (FDA) for the treatment of Crohn’s, but they can help decrease inflammation in the lining of the GI tract. Therefore, they are sometimes prescribed as maintenance therapy to maintain remission. These drugs include oral mesalamine (Asacol, Pentasa), sulfasalazine (Azulfidine), olsalazine (Dipentum) and balsalazide (Colazal). and rectal 5-ASA medications (Canasa and Rowasa). These drugs are most effective in the colon and don’t work as well if Crohn’s disease is limited to the small intestine. Side effects of these medications include headaches, nausea, fever, rash, hair loss and a risk of kidney and liver damage. Rarely they can cause Crohn’s to flare.
Biologic therapies. These drugs are typically given by IV infusion or subcutaneous injection. They work by preventing immune system processes that lead to inflammation and are primarily used in the short-term for a flare or when fistulizing disease hasn’t improved with other drugs. The major side effects are an increased risk of infection, lymphoma and the development of antibodies to the drug that make it ineffective. The medications used are infliximab (Remicade), adalimumab (Humira), certolizumab and pegol (Cimzia). Natalizumab (Tysabri) is used when none of these have worked.
Antibiotics. Antibiotics are used to treat mild-to-moderate Crohn’s and fistulizing or perianal disease. They are prescribed primarily to change the bacterial balance in your intestines, which can improve the abnormal immune response underlying Crohn’s. The most commonly used antibiotics are metronidazole (Flagyl) and ciprofloxacin (Cipro). Side effects are rare but include nausea and abdominal pain.
Antispasmodic/anticholinergic agents. These drugs are prescribed to help with abdominal cramping and pain. They should not be used if there is any possibility you have a bowel obstruction. They include propantheline (Pro-Banthine), dicyclomine (Bentyl) and hyoscyamine (Levsin). The major side effects are constipation, dry mouth, dry skin and reduced sweating.
Antidiarrheal agents. These drugs include loperamide (Imodium), diphenoxylate and atropine (Lomotil) and tincture of opium, all designed to improve diarrhea. Side effects include blurred vision, dry mouth, sedation, nausea, vomiting and abdominal discomfort. You shouldn’t take these drugs during a flare because they could cause a serious condition called toxic megacolon.
Probiotics. Probiotics are natural microorganisms that help maintain a favorable balance of good and bad bacteria in your gut. There is some evidence that they can help prevent inflammation and recurrences in people with inflammatory bowel disease.
Corticosteroids. These drugs include prednisone (Deltasone, Orasone), budesonide (Entocort EC) and hydrocortisone (Cortenema, Anusol-HC). They reduce inflammation and are used during a disease flare to return you to remission. They are not used as maintenance therapy because of the risk of serious side effects, which include osteoporosis, delayed wound healing and muscle weakness.
Immune modulators. These drugs, 6-mercaptopurine (Purinethol), azathioprine (Imuran) and methotrexate (Trexall, Rheumatrex), suppress the immune system and enable you to be weaned off corticosteroids. They are also used to treat fistulas. Side effects include an increased risk of infection with azathioprine, and nausea and vomiting with 6-mercaptopurine. Side effects with methotrexate include inflammation of the mouth, gums and tongue, excess uric acid in the blood, diarrhea, loss of appetite, low white blood cell counts and kidney disease.
Tacrolimus (Prograf) is another immune modulator sometimes used in people with Crohn’s. This drug interrupts certain immune system processes that contribute to the disease. Because of the risk of significant side effects, however, it is mainly used when other treatments fail. Side effects may include diarrhea, headache, insomnia, abdominal pain, tremor, high blood pressure, nausea and high blood sugar, among others.
Your health care professional will also prescribe nutritional supplements if the disease affects your weight or restricts a child’s growth. During an attack, you may need to be fed intravenously to give your intestine time to rest and heal.
Many people with Crohn’s will need surgery at some point, usually to remove a severely damaged part of the intestine. Surgery is often recommended when symptoms continue despite high doses of steroids; when complications like abscesses, fistulas and obstructions occur; and when there is significant bleeding or the colon or small intestine is perforated.
The surgeon removes the part of your intestine that is damaged. The most common surgery in Crohn’s disease is removal of the end of the small intestine because of a stricture causing a blockage. The two healthy ends of the intestine are reattached. Sometimes, part of the colon needs to be removed and the remaining ends connected. If the colon is severely diseased and/or damaged, it may have to be completely removed, a procedure called a colectomy. In that instance, the surgeon creates an opening to the outside of your body near your abdomen called a stoma. Waste exits through the stoma into a pouch that you empty as needed. Very few people need this to be done.
Surgery may also be recommended for a condition called toxic megacolon, when the colon widens very quickly, usually because of serious infection and/or inflammation. Symptoms include abdominal pain, bloating and tenderness, fever and rapid heart rate. You can go into shock and, unless the condition is treated immediately, could die.
In many instances, the surgeon may be able to operate laparoscopically through small incisions, rather than opening your entire abdomen. There is some evidence that laparoscopic surgery has a lower rate of infection and a lower risk of reoperations than abdominal surgery. Not all surgeons do this. Colorectal surgeons, who specialize in colon surgeries, are more likely to have the training and experience for laparoscopic surgeries.
The most common complication from surgery for Crohn’s is the development of adhesions. Adhesions occur when bands of scar tissue in the abdominal cavity get “stuck” to pelvic or abdominal organs, similar to how plastic wrap clings to itself. In some instances, the surgeon may need to go back in to remove the adhesions.
Surgery is not a cure but can relieve complications such as blockage. Surgery is typically used only when complications occur or your symptoms don’t respond to any medications in the Crohn’s arsenal. Most people need to stay on medication after surgery to prevent the disease from returning.
There is no way to prevent Crohn’s because the cause is not known, but there are treatments to prevent acute flares and maintain remission of Crohn’s. Medication is the best way to do this, but learning to manage stress and reduce the stress in your life may also help. Stress-management techniques include deep, slow breathing when you’re stressed, visualization exercises and meditation.
Exercise and other physical activity can help with stress management, as can simply taking care of yourself with enough sleep and a healthy diet.
Facts to Know
- Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the digestive system.
- Crohn’s is typically diagnosed when people are adolescents or in their early 20s, although more children are being diagnosed.
- Crohn’s is a chronic disease with no cure. It is managed with medication and surgery.
- Symptoms of Crohn’s include diarrhea, fever, abdominal pain, night sweats, weight loss and fatigue.
- The disease affects the small intestine and colon in most people with Crohn’s.
- Complications of Crohn’s include obstructions, fistula, abscesses and perianal disease.
- The inflammation associated with Crohn’s can affect other parts of your body, causing painful joints, mouth or skin ulcers, rashes and eye inflammation.
- Diagnosing Crohn’s involves a thorough medical examination, blood tests, imaging studies such as ultrasound, MRI or CT, endoscopy, colonoscopy and barium X-rays.
- Numerous medications are used to treat Crohn’s, including aminosalicylates, biologic therapies, antibiotics, antispasmodic/anticholinergic agents, antidiarrheal agents, bile acid sequestrants, probiotics, corticosteroids and immune modulators.
- About three out of four people with Crohn’s will need surgery to remove some small intestine or a piece of colon. Surgery is not a cure.
- What causes Crohn’s disease?We don’t know what causes Crohn’s, but experts suspect it is related to a combination of abnormalities, environmental factors, genetic causes and intestinal bacteria or viruses in the system. Researchers have identified several genes connected with the disease so far and know that it tends to run in families.
- What are the symptoms of Crohn’s disease?Symptoms of Crohn’s include diarrhea, abdominal pain; bowel obstruction (when something partially or fully blocks the intestines), weight loss, fever, night sweats and fatigue. The pain tends to occur in the lower right part of your abdomen or near your belly button. The pain might improve with a bowel movement. You may also see blood in your stool.
- How can I be sure I get the right diagnosis?To diagnose Crohn’s disease, your doctor will order a series of tests, ask you a lot of questions about your symptoms and thoroughly examine you. You should share any family history of gastrointestinal problems or irritable bowel diseases, including Crohn’s and ulcerative colitis, since Crohn’s is often hereditary. Tests that may be used to diagnose Crohn’s disease include blood tests, endoscopy, colonoscopy, ultrasound, imaging tests, antibody tests and a barium enema.
- Is there a cure for Crohn’s disease?Although there is no cure for Crohn’s, it can be managed with medication and sometimes surgery.
- What medications are used to treat Crohn’s disease?Medications used to treat Crohn’s disease include aminosalicylates (5-ASA) to reduce inflammation and provide some antioxidant benefits in the small bowel; antibiotics; biologic therapies to tamp down the immune system; supportive medications like antispasmodic/anticholinergic agents to help with abdominal cramping and pain; antidiarrheal agents; bile acid sequestrants to help you absorb bile acids properly; probiotics to help maintain a favorable balance of good and bad bacteria in your gut; corticosteroids to reduce inflammation; and immune modulators to suppress the immune system.
- How will I know what medication is best for me?You and your doctor will work together to find the right medications for your disease based on your symptoms.
- How will I know when I need surgery?Many people with Crohn’s will need surgery at some point, usually to remove a severely damaged part of the intestine. Surgery is often recommended when symptoms continue despite high doses of steroids; when complications like abscesses, fistulas and obstructions occur; and when there is significant bleeding or the colon has become perforated.
- What are the risks of surgery?The most common complication from surgery for Crohn’s is the development of adhesions. Adhesions occur when bands of scar tissue in the abdominal cavity get “stuck” to pelvic or abdominal organs, similar to how plastic wrap clings to itself. In some instances, the surgeon may need to remove the adhesions.
- Is there any way to prevent recurrences?The goal of treatment is to prevent recurrences. You and your health care team can work together to find the best combination of lifestyle and medical therapies to reduce or prevent the risk of recurrence.
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