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Crohn’s Disease – Symptoms and Treatments

What is Crohn’s disease?

Crohn’s disease is a chronic disease of the intestinal tract. It involves inflammation of the wall of the intestines and can be present anywhere from the mouth to the anus. It most commonly affects the latter part of the small bowel, the ileum, and the large bowel, or colon. It affects approximately 1,000,000 people in the U.S. It usually begins during the teenage years, but can also begin after 40 years of age, and tends to run in families.

The cause is unknown. One theory is that it may be caused by an interaction between a virus or bacterium in the GI tract and the body’s own immune system which then triggers the development of the inflammation. It is not caused by food or emotional stress and cannot be transmitted from person to person.

Crohn’s Disease Symptoms

The symptoms include crampy abdominal pain and diarrhea that is often bloody. The pain and diarrhea typically follow a meal. Teens with Crohn’s disease may have growth failure and delayed sexual development that may precede the symptoms of abdominal pain and diarrhea by a couple of years. Children with Crohn’s disease often have severe weight loss, fever, and decreased energy. They appear pale and malnourished.

Because the inflammation extends through the entire thickness of the intestinal wall, people with Crohn’s can develop intestinal fistulas (a tunnel from one portion of the intestine to another or from one portion of the intestine to a nearby organ such as the bladder). These fistulas can become infected and lead to abscess+formation. Another complication is intestinal blockage where intestinal contents are unable to pass through the GI tract. This is a severe complication and will manifest with abdominal pain, distention and vomiting.

Other non-GI physical manifestations commonly associated with Crohn’s disease include oral aphthous ulcers, arthritis, skin abnormalities (erythema nodosum), eye abnormalities (episcleritis), kidney stones, and gallstones.

How is it diagnosed?

A thorough history and physical examination usually will point to the diagnosis of Crohn’s disease. Other entities that have similar symptoms include irritable bowel syndrome, ulcerative colitis, and infectious gastroenteritis. Blood tests will be done to check for anemia and to look for blood indicators of an inflammatory process (sedimentation rate). Stool tests will be done to look for blood as well as for infection. The definitive diagnosis will be made by radiologic studies. Tests that may be performed include an upper gastrointestinal contrast examination (upper GI) with a small bowel follow-through; a barium enema; and colonoscopy with a biopsy of the intestinal wall. An upper GI involves drinking barium, which is a chalky liquid that will coat the lining of the intestine and be visible on x-rays. A small bowel follow-through means that the barium from the upper GI is followed by x-ray as it travels through the small bowel. A colonoscopy involves insertion of a long, flexible, lighted tube through the anus into the colon, with a camera attached to the end of the tube to allow the physician to view the lining of the colon close-up. These above radiologic studies will show the classic inflammatory pattern of Crohn’s disease, thereby confirming the diagnosis.

Treatment for Crohn’s disease

The treatment of Crohn’s disease for children and adults is managed by a gastroenterologist (a GI specialist). The aim of treatment is to control inflammation, improve nutritional status, and to alleviate the symptoms of pain and diarrhea. Some people will have long periods of time when they are free of symptoms. The disease usually recurs, but without any known precipitants.

The reduced appetite, poor nutrient absorption, and diarrhea cause loss of vital fluids and nutrients. Restoration and maintenance of fluids and nutrition is vital to the treatment of Crohn’s. Nutritional therapy has been found to be effective as a primary treatment. Nutrition given via a vein (parenteral nutrition) has been shown to not only restore fluid and nutrient balance but also to help quiet active disease. In children who have had significant weight loss prior to diagnosis, their physician may chose to give nutrients via a nasogastric (NG) tube for catch-up weight gain and growth. It is also important to note that individual patients may find that soft, bland foods may cause less abdominal discomfort than spicy and high-fiber foods when their disease is active.

Medications are used to help suppress the inflammatory process, allow healing of fistulas, and relieve symptoms of abdominal pain and diarrhea. Several groups of drugs are used and follow below.

1.     Aminosalicylates (aspirin-like drugs), which include sulfasalazine

2.     Corticosteroids: prednisone

3.     Immunosuppressive medications: azathioprine, 6-MP, cyclosporin, tacrolimus

4.     Antibiotics: metronidazole, ciprofloxacin, and clarithromycin

5.     Newest: FDA approved in 1998: infliximab (brand name: Remicade) for moderate to severe disease

6.     Investigational: monoclonal antibodies and interleukin-10 are showing promising results

Surgical therapy is reserved for very specific indications. It may be required in cases where symptoms are not relieved by medications, intractable bleeding, or to correct complications such as intestinal blockage, abscesses or fistulas.

Social support is also integral to treatment. Psychosocial issues for children with Crohn’s disease include a sense of being different, body image concerns, and dealing the inability, in some cases, to participate in athletic activities. There are peer support groups for children with Crohn’s disease.