Crohn's Disease
What Causes
Crohn's Disease?
What Are the Symptoms?
How Is Crohn's Disease Diagnosed?
What Are the Complications of Crohn's Disease?
What Is the Treatment for Crohn's Disease?
Research
Can Diet Control Crohn's Disease?
Is Pregnancey Safe for Women with Crohn's Disease?
Resources
Video References
 Crohn's
disease causes inflammation in the small intestine. Crohn's disease 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 general name for diseases that cause inflammation in the intestines.
Crohn's disease can be difficult 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. Crohn's disease affects men and women equally and seems to
run in some families. About 20 percent of people with Crohn's disease
have a blood relative with some form of IBD, most often a brother or sister
and sometimes a parent or child. Crohn's disease may also be called ileitis
or enteritis.
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What
Causes Crohn's Disease?
Theories about what causes Crohn's disease abound, but none has been proven.
The most popular theory is that the body's immune system reacts to a virus
or a bacterium by causing ongoing inflammation in the intestine. 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.
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What
Are the Symptoms?
The most common symptoms of Crohn's disease are abdominal pain, often
in the lower right area, and diarrhea. Rectal bleeding, weight loss, and
fever may also occur. Bleeding may be serious and persistent, leading
to anemia. Children with Crohn's disease may suffer delayed development
and stunted growth.
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How
Is Crohn's Disease Diagnosed?
A thorough physical exam and a series of tests may be 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. 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, revealing
inflammation or other abnormalities in the intestine. The doctor may also
do a colonoscopy. For this test, the doctor inserts an endoscope--a long,
flexible, lighted tube linked to a computer and TV monitor--into the anus
to see the inside of the large intestine. 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. If these tests show Crohn's disease, more x-rays
of both the upper and lower digestive tract may be necessary to see how
much is affected by the disease.
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What
Are the Complications of Crohn's Disease?
The most common complication is blockage of the intestine. Blockage occurs
because the disease tends to thicken the intestinal wall with swelling
and scar tissue, narrowing the passage. Crohn's disease may also cause
sores, or ulcers, that tunnel through the affected area into surrounding
tissues such as the bladder, vagina, or skin. The areas around the anus
and rectum are often involved. The tunnels, called fistulas, are a common
complication and often become infected. Sometimes fistulas can be treated
with medicine, but in some cases they may require surgery. Nutritional
complications are common in Crohn's disease. Deficiencies of proteins,
calories, and vitamins are well documented in Crohn's disease. These deficiencies
may be caused by inadequate dietary intake, intestinal loss of protein,
or poor absorption (malabsorption). Other complications associated with
Crohn's disease include arthritis, skin problems, inflammation in the
eyes or mouth, kidney stones, gallstones, or other diseases of the liver
and biliary system. Some of these problems resolve during treatment for
disease in the digestive system, but some must be treated separately.
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What
Is the Treatment for Crohn's Disease?
Treatment for Crohn's disease depends on the location and severity of
disease, complications, and response to previous treatment. The goals
of treatment are to control inflammation, correct nutritional deficiencies,
and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding.
Treatment may include drugs, nutrition supplements, surgery, or a combination
of these options. At this time, 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 possible.
Someone with Crohn's disease may need medical care for
a long time, with regular doctor visits to monitor the condition.
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Drug Therapy
Most people are first treated with drugs containing mesalamine, a substance
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, generally known as
5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects
of mesalamine preparations include nausea, vomiting, heartburn, diarrhea,
and headache.
Some patients take corticosteroids to control inflammation.
These drugs are the most effective for active Crohn's disease, but they
can cause serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to
treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine and
a related drug, azathioprine. Immunosuppressive agents 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 patients are treated with a combination
of corticosteroids and immunosuppressive drugs, the dose of corticosteriods
can eventually be lowered. Some studies suggest that immunosuppressive
drugs may enhance the effectiveness of corticosteroids.
The U.S. Food and Drug Administration has approved the
drug infliximab (brand name, Remicade) for the treatment of moderate to
severe Crohn's disease that does not respond to standard therapies (mesalamine
substances, corticosteroids, immunosuppressive agents) and for the treatment
of open, draining fistulas. 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
associated with Crohn's disease. Anti-TNF removes TNF from the bloodstream
before it reaches the intestines, thereby preventing inflammation. Investigators
will continue to study patients taking infliximab to determine its long-term
safety and efficacy.
Antibiotics are used to treat bacterial overgrowth in
the small intestine caused by stricture, fistulas, or prior surgery. For
this common problem, the doctor may prescribe one or more of the following
antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or
metronidazole.
Diarrhea and crampy abdominal pain are often relieved
when the inflammation subsides, but additional medication may also be
necessary. Several antidiarrheal agents could be used, including diphenoxylate,
loperamide, and codeine. Patients who are dehydrated because of diarrhea
will be treated with fluids and electrolytes.
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product or company. Brand names appearing in this publication are
used only because they are considered essential in the context of
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Nutrition Supplementation
The doctor may recommend nutritional supplements, especially for children
whose growth has been slowed. Special high-calorie liquid formulas are
sometimes used for this purpose. 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.
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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.
Because Crohn's disease often recurs after surgery, people
considering it should carefully weigh its benefits and risks compared
with other treatments. Surgery may not be appropriate for everyone. People
faced with this decision should get as much information as possible from
doctors, nurses who work with colon surgery patients (enterostomal therapists),
and other patients. Patient advocacy organizations can suggest support
groups and other information resources. (See Resources for the names of
such organizations.)
People with Crohn's disease may feel well and be free
of symptoms for substantial spans of time when their disease is not active.
Despite the need to take medication for long periods of time and occasional
hospitalizations, most people with Crohn's disease are able to hold jobs,
raise families, and function successfully at home and in society.
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Research
Researchers continue to look for more effective treatments.
Examples of investigational treatments include
Anti-TNF. Research has shown that cells affected
by Crohn's disease contain a cytokine, 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. In studies, anti-TNF seems particularly
helpful in closing fistulas.
Interleukin 10. Interleukin 10 (IL-10) is a cytokine
that suppresses inflammation. Researchers are now studying the effectiveness
of synthetic IL-10 in treating Crohn's disease.
Antibiotics. Antibiotics are now used to treat
the bacterial infections that often accompany Crohn's disease, but some
research suggests that they might also be useful as a primary treatment
for active Crohn's disease.
Budesonide. Researchers recently identified a new
corticosteroid called budesonide that appears to be as effective as other
corticosteroids 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.
Zinc. Free radicals--molecules produced during
fat metabolism, stress, and infection, among other things--may contribute
to inflammation in Crohn's disease. Free radicals sometimes cause cell
damage when they interact with other molecules in the body. The mineral
zinc removes free radicals from the bloodstream. Studies are under way
to determine whether zinc supplementation might reduce inflammation.
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Can
Diet Control Crohn's Disease?
No special diet has been proven effective for preventing or treating this
disease. Some people find their symptoms are made worse by milk, alcohol,
hot spices, or fiber. People are encouraged to follow a nutritious diet
and avoid any foods that seem to worsen symptoms. But there are no consistent
rules.
People should take vitamin supplements only on their doctor's
advice.
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Is
Pregnancy Safe for Women with Crohn's Disease?
Research has shown that the course of pregnancy and delivery is usually
not impaired in women with Crohn's disease. Even so, women with Crohn's
disease should discuss the matter with their doctors before pregnancy.
Most children born to women with Crohn's disease are unaffected. Children
who do get the disease are sometimes more severely affected than adults,
with slowed growth and delayed sexual development in some cases.
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Resources
Crohn's & Colitis Foundation of America, Inc.
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Tel: (800) 932-2423 or (212) 685-3440
E-mail: info@ccfa.org
Home Page: http://www.ccfa.org
Pediatric Crohn's & Colitis Association, Inc.
P.O. Box 188 Newton,
MA 02468
Tel: (617) 489-5854
Home Page: http://pcca.hypermart.net
Reach Out for Youth with Ileitis and Colitis, Inc.
15 Chemung Place
Jericho, NY 11753
Tel: (516) 822-8010
United Ostomy Association, Inc.
19772 MacArthur Blvd. #200
Irvine, CA 92612-2405
Tel: (800) 826-0826 or (949) 660-8624
Fax: (949) 660-9262
Home Page: http://www.uoa.org
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Video
References
Video: Crohn's
Disease Tutorial - The National Library of Medicine
http://www.nlm.nih.gov/medlineplus/tutorials/crohnsdisease/htm/index.htm
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