Crohn’s disease is a chronic, recurrent inflammatory disease of the intestinal tract. The intestinal tract has four major parts: the esophagus, or food tube; the stomach, where food is churned and digested; the long, small bowel, where nutrients, calories, and vitamins are absorbed; and the colon and rectum, where water is absorbed and stool is stored. The two primary sites for Crohn’s disease are the ileum, which is the last portion of the small bowel (ileitis, regional enteritis), and the colon (Crohn’s colitis). The condition begins as small, microscopic nests of inflammation which persist and smolder. The lining of the bowel can then become ulcerated and the bowel wall thickened. Eventually, the bowel may become narrowed or obstructed and surgery would be needed.
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Because Crohn’s disease can affect any part of the intestine, symptoms may vary greatly from patient to patient. Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating. Not all patients experience all of these symptoms, and some may experience none of them. Other symptoms may include anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).
Common Crohn’s symptoms:
- Cramping – abdominal pain
- Weight loss
- Anal pain or drainage
- Skin lesions
- Rectal abscess
- Joint pain
There are five subtypes of Crohn’s disease, distinguished by the gastrointestinal area in which the disease occurs. While Crohn’s disease lesions can appear anywhere in the digestive tract, lesions rarely occur in the mouth, esophagus, and stomach unless there are also lesions in the lower parts of the tract (intestines).
Gastroduodenal CD – Gastroduodenal Crohn’s disease affects the stomach and the duodenum. Symptoms of gastroduodenal CD include loss of appetite, weight loss, nausea, pain in the upper middle of the abdomen, and vomiting.
Jejunoileitis – Jejunoileitis is Crohn’s disease of the jejunum. Symptoms include mild to intense abdominal pain and cramps after meals, diarrhea, and malnutrition caused by malabsorption of nutrients.
Ileitis – Ileitis affects the ileum. Symptoms include diarrhea and cramping or pain in the right lower quadrant and periumbilical area, especially after meals. Malabsorption of vitamin B12 can lead to tingling in the fingers or toes. Folate deficiency can hinder the development of red blood cells, putting the patient at higher risk of developing anemia. Fistulas can develop, as can inflammatory masses.
Ileocolitis – Ileocolitis is the most common type of Crohn’s disease. It affects the ileum and the colon. Often, the diseased area of the colon is continuous with the diseased ileum, and therefore involves the ileocecal valve between the ileum and the colon. In some cases, however, areas of the colon not contiguous with the ileum are involved. Symptoms of ileocolitis are essentially the same as those present in ileitis. Weight loss is also common.
Crohn’s Colitis (Granulomatous Colitis ) – Crohn’s colitis affects the colon. It is distinguished from ulcerative colitis in two ways. First, there are often areas of healthy tissue between areas of diseased tissue; ulcerative colitis is always continuous. Second, while ulcerative colitis always affects the rectum and areas of the colon beyond the rectum, Crohn’s colitis can spare the rectum, appearing only in the colon.
Researchers have not yet identified the cause of Crohn’s disease, so it is described as an “idiopathic” disease. It is known that inflammation is part of the body’s immune response, and an immune response is usually triggered by something. But to date no specific “trigger” has been found to cause the inflammatory response seen in Crohn’s disease.
There is some evidence that Crohn’s disease has a genetic component. While there is no simple correlation from parent(s) to offspring, the disease tends to “run” in families. As many as 20 to 25 percent of patients with Crohn’s disease have a relative with CD or ulcerative colitis. There is also a higher incidence among certain ethnic groups.
In addition, some possible environmental factors have been linked to initial episodes or relapses. Crohn’s disease appears to be a disease that primarily affects those living in Western, industrialized societies. Whether this is due to some condition of the environment in which people live or their diet has not been determined.
People with Crohn’s disease are seen regularly by a specialist team who manage their treatment. Although there is no cure for Crohn’s disease, symptoms can be improved with dietary changes, drugs or surgery, or a combination of these.
Drug treatment is effective for many patients and the disease may respond quickly to medication.
Medicines that reduce inflammation, such as steroids (eg prednisolone) and aminosalicylates (eg sulfasalazine).
Medicines that suppress the immune system (eg azathioprine) may be needed for more serious bouts of the illness. A new drug called infliximab may be used to treat severe Crohn’s disease that does not respond to other drugs.
Anti-diarrhoea medicines, antibiotics and painkillers may be useful during flare-ups.
An elemental diet may be recommended when the disease is active. An elemental diet is a liquid diet, made up of simple forms of protein, carbohydrates and fats. These can be absorbed without further digestion, and can cause a remission of the illness.
When there are complications, other special diets may be advised. For example, if there is narrowing of the bowel, a low residue diet (low in fibre) may be recommended. When food is not being absorbed well, a low fat diet may be recommended.
Short periods of parenteral feeding (through a route other than the mouth, usually by injection into a vein) in hospital may be needed for people with major complications.
For the rest of the time, it is important for people with Crohn’s disease to eat a balanced diet with a high fibre content.
Vitamin and iron supplements are often necessary as these nutrients may not be properly absorbed from the bowel.
Many people with Crohn’s disease require surgical treatment at some time to treat complications such as anal abscesses, or fistulae, to remove areas of narrowed, non-functioning bowel, or when drugs are not controlling the disease.
Surgery aims to remove the least amount of bowel possible and the operation trying to expand narrowed segments, rather than just remove them.
Sometimes an ileostomy is needed. This is when the small bowel is separated from the large bowel and the end of the small intestine is brought out at the skin surface. The faeces are collected in a specially designed bag that fits securely over the skin site. This is not necessarily a permanent procedure but may be used to rest the large bowel while it is intensively treated. The small and large bowel can then be rejoined. A long period of remission can follow.
Women may be less fertile during periods of active disease and at these times may also have an increased risk of miscarriage, but otherwise there is no connection between the disease and problems with pregnancy.