About Crohn’s Disease (Inflammatory Bowel Disease, IBD)
Crohn’s disease is a chronic inflammatory bowel disease (IBD) that affects the gastrointestinal (GI) tract (digestive system). Crohn’s disease can affect any one or more areas oft he GI tract, which spans from the mouth to the anus. Crohn’s disease can penetrate through the entirety of the multitude of layers in the bowel wall. Additionally, the disease can also affect multiple areas of the GI tract at once, while leaving some adjoining areas unaffected, or skipping regions between affected areas altogether. Most often, Crohn’s disease is found to affect the terminal ileum (last section of the small intestine) and/or the colon (first part of the large intestine). Although Crohn’s disease is chronic, individuals may experience remission wherein symptoms are not present for periods of time, this is termed a period of remission. When symptoms present themselves again, it is called a relapse or a flare-up.
Why it is problematic
The inflammation caused by Crohn’s disease creates potentially painful ulcers within the GI tract. If ulcers grow very deep throughout the layers within the intestinal walls they may create a hole (perforation), which allows the infection to travel to other parts of the body, including the organs and the skin. These passageways are called fistulas. Fistulas provide a route for the spread of infection, which may include a spread to other areas of the GI tract or to nearby areas including the skin, vagina or bladder although they occur most frequently around the anus.
In moderate to severe cases of the disease, inflammation may cause the intestines to thicken, preventing the passage of digested food. This condition is called stricture. When inflammation caused by Crohn’s disease has subsided, sometimes scar tissue remains in the location of the swelling. Excess scar tissue can also lead to blockage in the intestines. Blockage in the GI tract due to from inflammation, scarring, or both, prevents the proper absorption of nutrients in food. This condition is called malabsorption. Malabsorption contributes to nutrient deficiencies (malnutrition). Malnutrition is the cause and contributor to a slew of dangerous health complications.
There are a variety of psychological and emotional implications that accompany Crohn’s disease and other gastrointestinal conditions. Patients commonly report feelings of anxiety, depression and isolation as a result of the symptoms present in the disease.
Very commonly, individuals with Crohn’s disease require surgery to address intestinal blockage, fistulas and/or abscesses. Statistics report that between 7-9 out of 10 patients with Crohn’s disease will need surgery at some point. Additionally, Crohn’s disease slightly increases the risk of an individual developing colon cancer.
Causes and Risk Factors
The precise cause of Crohn’s disease is currently unknown. Scientific evidence suggests that a number of factors could contribute to the development of, or aggravate the intensity of Crohn’s disease. These factors include:
Genetic predisposition is associated with Crohn’s disease. Individuals have a 25% increased risk of developing Crohn’s if someone in the immediate family also has the disease. Researchers have identified over 100 genes associated with Crohn’s disease, although there is no single genetic test that can confirm a Crohn’s disease diagnosis.
Immune factors are believed to play a role in the development of Crohn’s disease. The body’s immune system is designed to recognize and manage foreign organisms in the body. The body, especially the GI tract, hosts a plethora of bacteria. Some bacteria in the digestive system are considered “good bacteria” that can assist in regulating the delicate balance of gut flora. On the other hand, some bacteria are harmful to the body. A properly functioning immune system can recognize the difference between “good” and “bad” bacteria, however; the immune system of those with Crohn’s disease cannot. The absence of “good” bacteria within the GI tract is the most prominent cause of harmful inflammation.
Bacterial associations are linked to Crohn’s disease. Some studies have found that traces or markers indicating a former infection of the mycobacterium avium, subspecies paratuberculosis (MAP) bacteria is more commonly found in the systems of Crohn’s patients as compared to control subjects. MAP is a harmful bacterium that causes Johne’s disease in farm animals like cows, goats and sheep. Johne’s disease affects these farm animals in a similar way that Crohn’s disease affects humans. MAP is present in affected animal’s feces, milk, and surrounding soil and water sources. Pasteurization isn’t completely effective in eliminating MAP from milk. Much debate remains about the role of MAP in Crohn’s disease. Most commonly, MAP is believed to trigger flare-ups in predisposed individuals, rather than cause Crohn’s disease. Researchers continue to investigate the role of MAP as well as other bacteria in Crohn’s disease.
Smoking isn't believed to be a cause of Crohn’s disease, but those that smoke tend to report more intense symptoms during a flare up.
Environmental factors are observed as risk factors for Crohn’s disease. Certain geographical locations, primarily regions in the Western world, have a higher prevalence of the disease. As a result, attribution to genetics, diet, lifestyle factors and sanitation are made.
Symptoms of Crohn’s disease vary significantly from person to person and are cyclic in that they follow undefined periods of time of remission and relapse. Because Crohn’s disease is chronic, an individual may go long periods of time without symptoms or with very mild symptoms. During relapse or a flare-up symptoms may include:
• Persistent diarrhea
• Abdominal pain and cramping, often worse after eating
• Unintended weight loss
• Blood or mucus in stool
• Fever (+100º F)
• Joint pain
• Mouth ulcers
• Night sweats
• Feeling of fullness
• Female sexual dysfunction
• Loss of normal menstrual cycle (amenorrhea, oligomenorrhea)
• Skin problems or abscesses
• Eye inflammation
• Kidney stones
• Delayed development or stunted growth (children)
• Liver disease
The most common symptom of Crohn’s disease is persistent diarrhea. Diarrhea is defined as loose or watery stool occurring three or more times per day. Adults should contact a doctor if diarrhea persists for longer than 48 hours and 24 hours for children.
Unpleasant digestive symptoms are a common symptom in many different conditions or diseases. As a result, a physician must work to isolate the root cause of your symptoms in order to make an accurate diagnosis. If someone in your immediate family suffers from Crohn’s disease, be sure to communicate this to your doctor, as this increases your risk. Several types of diagnostic tools may be employed to reach a Crohn’s diagnosis.
Blood tests such as a complete blood count (CBC) test are sometimes used to assess the general health. Other blood tests, particularly those that help determine malnutrition or anemia may also be used.
Colonoscopy is the most common diagnostic tool used to detect Crohn’s disease. This procedure involves a long flexible tube (endoscope) with a lighted camera affixed to the end. The endoscope is inserted into the rectum and maneuvered in to the colon. The camera records the process and transfers images on to a screen so that a physician may make a more precise analysis of the condition of the GI tract. If a biopsy is required, surgical tools are attached to the endoscope to collect small tissue samples.
Capsule endoscopy is a relatively new option for hailing internal diagnostic imaging results. In this procedure, a pill-sized camera is swallowed to collect images as it travels down the GI tract. These images are transferred from the camera to a recording device affixed to the patient’s belt or carried by the patient in a small shoulder bag. After a couple of days, the disposable capsule is naturally expelled through the stool.
Diagnostic Imaging Tests such as an Ultrasound, CT scan and X-ray are noninvasive techniques physicians may use in conjunction with other methods to analyze the condition of the GI tract. Contrast dye (barium) is used to target and highlight specific regions of the body for a stronger analysis. In the pursuit of a Crohn’s disease diagnosis, the intestines are highlighted for examination. Highlighting the intestines can provide a more detailed look at this specific region of the body and thus aid in an accurate assessment of the progression of the disease.
Stool samples may be requested for diagnostic analysis. Examining stool can rule out a bacterial or parasitic infection. A common symptom of Crohn’s disease is the presence of blood or mucus in the stool.
There is currently no cure for Crohn’s disease. Instead, physicians aim to target and alleviate problematic symptoms and prolong remission times. This is achieved in a number of ways:
Anti-inflammatory medications such as corticosteroids are used to control inflammation present in the disease. These medications may be in pill form or administered via weekly injections. Corticosteroids side effects are common and may include: vulnerability to infection, facial swelling and weight gain. Milder steroids with fewer side effects are available although they yield less effective results.
Liquid diets such as the elemental or polymeric diets are sometimes recommended as treatment for Crohn’s disease. These diets are intended to allow the GI tract to rest. These liquid diets provide pre digested nutrients to patients without putting strain on the GI tract by reducing fecal bulk and possibly altering gut flora. Evidence has shown that the elemental diet can reduce activity in gastrointestinal fistulae.
Immunosuppressant medication is used in the event of severe recurrent flare-ups (more than twice per year). Side effects of these medications are closely monitored via routine blood tests because they can create a slew of independent complications. Some immunosuppressant are considered safe for use during pregnancy and some are not. Certain immunosuppressive drugs can cause birth defects up to six months after cessation from the drug. Be sure to speak with a doctor if you or your partner are pregnant, wish to become pregnant, or are not taking precautions to prevent pregnancy.
Biological therapies are used in cases of especially severe cases of Crohn’s disease. These therapies are a unique form of anti-inflammatory medications made from genetically engineered living organisms that specifically target the enzymes and proteins causing inflammation in the GI tract. Biological therapies or Biologics suppress the immune system. Studies suggest that biologics are quite effective in the treatment of Crohn’s disease by reducing the frequency of flare-ups and Crohn’s disease related GI surgery. Biologics are still a relatively new player in the field of Crohn’s disease management and scientists continue to investigate the therapeutic benefits.
Surgery is a likely treatment for Crohn’s disease, with approximately 70-90% of patients requiring surgery at some point. Blockage in the intestines due to inflammation or scars from inflammation that has healed is the primary cause of surgery. A resection surgery is sometimes performed to remove a blocked area of the intestine to reconnect healthy areas. Other times a procedure to temporarily redirect gastrointestinal waste away from the colon (ileostomy) is used. The ileum is disconnected from the colon and redirected through a hole in the abdomen. An external device collects the redirected waste.
Crohn’s disease can occur at any age but is appears most frequently between the ages of 15 and 35. Crohn’s disease is most prevalent in the Western world and affects approximately 700,000 individuals in the U.S alone. Those of European or European Jewish descent have the highest incidence of Crohn’s disease. Reported cases of the disease in those of African descent are on the rise. Crohn’s disease affects men and women equally.