| I
was diagnosed with Crohn's disease in September,
2000. Crohn's disease
causes inflammation most commonly in the small intestine. It
usually occurs in the lower part of the small
intestine, called the ileum, but it can affect
any part of the digestive tract, from the mouth
to the anus. The inflammation extends deep into
the lining of the affected organ. The
inflammation can cause pain and can make the
intestines empty frequently, resulting in
diarrhea.
Crohn's disease is an
inflammatory bowel disease (IBD), the overall
name for diseases that cause inflammation in the
intestines. Crohn's disease can be hard to
diagnose because its symptoms are similar to
other intestinal disorders such as irritable
bowel syndrome and to another type of IBD called
ulcerative colitis. Ulcerative colitis causes
inflammation and ulcers in the top layer of the
lining of the large intestine.
What causes Crohn's disease?
|
There are many theories about
what causes Crohn's disease, but
none have been proven. One idea
is that the body's immune system
reacts to a virus or a bacterium
by causing inflammation in the
intestine. Additionally, people
with Crohn's disease tend to
have abnormalities of the immune
system, but doctors do not know
whether these abnormalities are
a cause or result of the
disease. Crohn's disease is not
caused by emotional distress,
but many patients report that
stress contributes to their
symptoms. |
|
What are the
symptoms of Crohn's disease?
The most
common symptoms of Crohn's disease are abdominal
pain and diarrhea. Rectal bleeding, weight loss,
and fever may also occur. Bleeding may be
serious and ongoing, leading to anemia. Children
with Crohn's disease may suffer delayed
development and stunted growth.
How is Crohn's disease diagnosed?
|
A overall physical exam and a
series of tests are normally
required to diagnose Crohn's
disease. Blood tests may be
done to check for anemia, which
could indicate bleeding in the
intestines. Blood tests may also
uncover a high white blood cell
count, which is a sign of
inflammation somewhere in the
body. They are also used
to look for genetic markers of
Crohn's disease. In
addition, by testing a stool sample,
the doctor can tell if there is
bleeding or infection in the
intestines.
The doctor may
do an upper gastrointestinal
(GI) series to look at the small
intestine. For this test, the
patient drinks barium, a chalky
solution that coats the lining
of the small intestine, before x
rays are taken. The barium shows
up white on x-ray film, showing
inflammation or other problems
in the intestine.
There are also
other, newer, forms of looking
inside the body for signs of
Crohn's. In the past
several years, video capsules
the size of pills have become
increasingly popular.
These capsules contain tiny
cameras. The patient
swallows the capsule, which can
take continuous digital images
of the gastrointestinal tract
for the life of the
self-contained battery, worn on
a pack around the waist.
Other imaging techniques, such
as CT scans and MRIs, are used
as well.
The doctor may
also do a colonoscopy. For this
test, the doctor inserts an
endoscope--a long tube linked to
a computer and TV monitor--into
the intestine to see the inside
of it. The doctor will be able
to see any inflammation or
bleeding. During the exam, the
doctor may do a biopsy, which
involves taking a sample of
tissue from the lining of the
intestine to view with a
microscope. Children are
normally sedated for this test,
but adults may have the option
to stay awake.
What are the complications
of Crohn's disease?
|
One common
complication is
blockage of the
intestine.
Blockage occurs
because Crohn's
tends to thicken
the intestinal
wall with
swelling and
scar tissue,
narrowing the
intestine.
Crohn's disease
may also cause
sores, or
ulcers, that
make holes
through the
affected area
into surrounding
tissues such as
the bladder or
even skin. The
holes are called
fistulas and can
become infected
just like a cut
on the outside
of your body
could.
Sometimes
fistulas can be
treated with
medicine, but in
some cases they
may require
surgery.
Nutritional
problems are
common, too.
Deficiencies of
protein,
calorie, and
vitamins are
often seen in
Crohn's disease.
These losses may
be caused by
inadequate
dietary intake
or poor
absorption
(malabsorption).
Other
complications
found with
Crohn's disease
include
arthritis, skin
problems,
inflammation in
the eyes or
mouth (although
this is more
common with
ulcerative
colitis), kidney
stones,
gallstones, and
sometimes
cancers of
affected organs.
Some of these
problems resolve
during treatment
for disease in
the digestive
system, but some
must be treated
separately.
What is
the treatment
for Crohn's
disease?
| Treatment for Crohn's disease depends on the location and severity of disease, other related problems, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like cramping, diarrhea, and bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. As of today, treatment can help control the disease, but there is no cure.
Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not always possible.
Medicines
| Most people are first treated with drugs containing mesalamine, a drug that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, widely known as ASA agents, such as Asacol, Rowasa, or Pentasa. (Note they all have -asa- somewhere in their name.) Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.
Some patients take steroids to control inflammation. These drugs are often the most effective for Crohn's disease, but they can cause serious side effects, including greater susceptibility to infection and weight gain.
Drugs that suppress the immune system are also used to treat Crohn's disease. The most commonly prescribed are 6-mercaptopurine (6-MP) and a related drug, azathioprine. Immunosuppressive medicines work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person's resistance to infection. When people are treated with a combination of steroids and immunosuppressive drugs, the dose of steriods can sometimes eventually be lowered.
The FDA has approved the drug infliximab ( Remicade) for the treatment of moderate to severe Crohn's disease that does not respond to standard therapies. It was previously used as a medicine for arthritis patients. Infliximab, the first treatment approved specifically for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a protein produced by the immune system that may cause the inflammation found in Crohn's disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thus preventing inflammation. Remicade is still fairly new on the market for Crohn's use.
Antibiotics are used to treat bacterial problems in the small intestine caused by stricture, fistulas, surgery, etc. For this common problem, the doctor may prescribe an antibiotic.
Nutritional Help
Doctors may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.
Surgery
| Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Many Crohn's disease patients require surgery, either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine.
Some people who have Crohn's disease in the large intestine need to have their entire colon removed in an operation called colectomy. A small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin's surface. This opening, called a stoma, is where waste exits the body. The stoma is about the size of a quarter and is usually located in the right lower part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. The majority of colectomy patients go on to live normal, active lives. Sometimes only the diseased section of intestine is removed and no stoma is needed. In this operation, the intestine is cut above and below the diseased area and reconnected.
How does diet help Crohn's disease?
| No special diet has been proven effective for preventing or treating this disease. However, some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. People are encouraged to eat well and avoid any foods that seem to worsen symptoms.
What sort of new drugs are being researched?
Anti-TNF. Research has shown that cells affected by Crohn's disease contain a protein produced by the immune system called tumor necrosis factor (TNF). TNF may be responsible for the inflammation of Crohn's disease. Anti-TNF is a substance that finds TNF in the bloodstream, binds to it, and removes it before it can reach the intestines and cause inflammation.
Interleukin 10. Interleukin 10 (IL-10) is a drug that suppresses inflammation.
Antibiotics. Antibiotics are used to treat the bacterial infections that often go along with Crohn's disease, but some research suggests that they might also be useful as a primary treatment for Crohn's disease.
Budesonide. This is a new steroid that appears to be as effective as other steroids but causes fewer side effects.
Methotrexate and cyclosporine. These are immunosuppressive drugs that may be useful in treating Crohn's disease. One potential benefit of methotrexate and cyclosporine is that they appear to work faster than traditional immunosuppressive drugs. Side effects can be more serious than more commonly used drugs, though, so they are still being researched.
Where can I get more information?
First, talk to a doctor. As helpful as any information you'll find on your own may be, speaking with a medical professional is the best way to learn about your specific case.
These resources are also available:
Crohn's & Colitis Foundation of America (CCFA)
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Phone: 1-800-932-2423
Internet: www.ccfa.org
Pediatric Crohn's & Colitis Association
P.O. Box 188
Newton, MA 02468
Phone: (617) 489-5854
Internet: http://pcca.hypermart.net
Extra Tidbits:
Click here to see what areas of the intestine Crohn's disease affects.
How do steroids help patients with Crohn's disease?
View an excerpt from Congressional Record in support of the IBD Act.
Please Note:
The content of this page is not intended in any way to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider. The content of this page is not intended to be relied on for medical diagnosis or treatment. Do not disregard professional medical advice or delay in seeking it because of anything you have read on this page. If you believe you have symptoms of IBD or another digestive illness, contact your physician or qualified health provider as soon as possible. |
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