Crohn’S Disease

Overview, Causes, & Risk Factors

Crohn’s disease causes chronic inflammation of the gastrointestinal tract. Itis one form of a condition known as inflammatory bowel disease.

What is going on in the body?

The cause of Crohn’s disease is unknown. It is thought to be an autoimmune disorder. This means thatthe body’s immune system attacks itself. The immune attack resultsin chronic inflammation of the gastrointestinal tract and other parts of thebody.

What are the causes and risks of the disease?

The cause of Crohn’s disease is not known, but it is thought to be anautoimmune disorder.Inherited factors also may play a role, since 20% to 25% of the peoplewho have Crohn’s disease have a close relative with this disease or a similardisease. Crohn’s disease is more common among whites than blacks. Men andwomen are affected equally. The disease usually starts between 15 and 35years of age.

New research findings suggest that autoimmune disordersmay be triggered by a transfer of cells between the fetus and the mother duringpregnancy. The studyinvolved women with scleroderma, an autoimmune disorder involving the skin. These womenhave more fetal cells in their blood decades after a pregnancy than women whodon’t have scleroderma. While further research is needed to substantiate thesefindings, the study does offer an explanation for the much higher incidence ofautoimmune disorders in women than in men.

Symptoms & Signs

What are the signs and symptoms of the disease?

The first symptom of Crohn’s disease is pain in the abdomen ator below the navel. Diarrhea often accompanies the pain, which usually followsa meal.

Crohn’s disease may cause a wide variety of symptoms, such as:

  • abdominal distressand cramping
  • anemia, or low redbloodcell counts
  • arthritis, withjoint pain andswelling
  • diarrhea
  • fatigue
  • fever
  • liver damage
  • loss of appetite
  • malnutrition, asa result ofdamage of the intestines
  • rectal bleeding
  • skin rashes
  • visual impairments
  • weight loss
  • Diagnosis & Tests

    How is the disease diagnosed?

    Crohn’s disease is diagnosed through medical history, physical examination, andlaboratory tests. There is no one test or feature of the disease that confirmsthe diagnosis. Sigmoidoscopy is a procedure to examine the rectumand part of the large intestine. It involves passing a small telescope throughthe anus so that the rectum and large intestine can be seen directly. Thisprocedure is very important if a person has long-term diarrhea or bloody diarrhea.

    A blood test called a complete blood count, or CBC, may show anemia, a low level of red blood cells. Lab studies may also showabnormal liver function and low levels of certain vitamins and minerals. Theremay also be evidence of poor food absorption.

    Another common test is the barium enema. In this test, a contrast agentcalled barium is injected into the intestine and X-rays are taken. Sometimesthe diagnosis is made during surgery that is performed to find the cause ofsevere abdominal pain.

    Prevention & Expectations

    What can be done to prevent the disease?

    There are no effective ways to prevent Crohn’s disease. An individual may beable to reduce flare-ups by managing stress and eating a soft, blanddiet.

    What are the long-term effects of the disease?

    The course of Crohn’s disease varies. Because it has a tendency to come and go,itincludes periods without any symptoms. Both gastrointestinal and arthritissymptoms of Crohn’s disease tend to recur.

    Chronic bowel problems include the development of fistulas. A fistula is anabnormal passage or duct formed by the disease. It can connect two differentareas of bowel or connect the bowel to the outer skin. Other long-term effectsinclude anal fissures, which are small tears, and pockets of pus near therectum. A bowelobstructionor a hole or perforation in the intestines is also possible.

    Mostly due tosepsis, an infection in the bloodstream, 5% to 10% of Crohn’s patients will die fromthe disease. There is a slightly increased risk ofcolorectal cancer inpeoplewho have Crohn’s disease.

    What are the risks to others?

    Crohn’s disease is not contagious and poses no risk to others. There is sometendency for the disease to run in families.

    Treatment & Monitoring

    What are the treatments for the disease?

    Medications used to treat Crohn’s disease include the following:

  • aminosalicylates, such as sulfasalazine and mesalamine
  • corticosteroids, such as prednisone and methylprednisolone
  • medications that alter the body’s immune response, such as azathioprine,6MP, and methotrexate
  • antibiotics, such as metronidazole, ampicillin, and ciprofloxacin, forinfections
  • Some persons need extra vitamins, minerals, and salts. A healthy diet isessential for maintaining body weight. A soft, bland diet may be bettertolerated than a diet with spicy foods. Milk products may be restricted if theperson has lactoseintolerance. In severe cases, a person may need to be fed throughan intravenous tube to improve his or her nutritional status.

    Seventy percent of the people with Crohn’s disease will have surgery at leastonce. A recent study showed that the surgery significantly improves the qualityof life in individuals with Crohn’s disease. Surgery may be done for one ormore of the following effects of the disorder:

  • A section of the intestines that is severely damaged or obstructed may beremoved with a procedure called a resection and anastamosis. The damagedportion is cut out, and the bowel is sewn back together.
  • If the rectum is diseased, an ileostomy may be done. This procedure involves taking a portion ofthe bowel to the outside through a hole in the abdomen and attaching adrainage bag.
  • An incision and drainage may be done to drain abscesses, or pus pockets,near the rectum.
  • A fistula repair may be done to close abnormal openings caused by thedisease.
  • What are the side effects of the treatments?

    Many of the medications used to treat Crohn’s disease can cause stomach upset,allergic reactions, and an increased susceptibility to infection. Personstaking metronidazole may have severe vomiting and abdominal pain if they drinkalcohol. Surgery maycause bleeding, infection, or allergic reaction to anesthesia.

    What happens after treatment for the disease?

    Crohn’s disease is a long-term disease with occasional flare-ups. There can beperiods without any symptoms. However, the symptoms usually reappear.

    How is the disease monitored?

    There is no specific test for monitoring Crohn’s disease. Affected persons needto monitor their symptoms carefully. Any new or worsening symptoms should bereported to the healthcare provider.

    Article type: xmedgeneral