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Crohn's disease is a
lifelong
inflammatory bowel disease (IBD). Parts of the
digestive system get swollen and have deep sores
called
ulcers. Crohn's disease usually is found in the last
part of the small intestine and the first part of the large intestine. But it
can develop anywhere in the digestive tract, from the mouth to the anus.
What causes Crohn's disease?
Doctors don't know
what causes Crohn's disease. You may get it when the body's
immune system has an abnormal response to normal
bacteria in your intestine. Other kinds of bacteria and viruses may also play a
role in causing the disease.
Crohn's disease can run in families.
Your chances of getting it are higher if a close family member has it. People
of Eastern European (Ashkenazi) Jewish background may have a higher
chance of getting Crohn's disease. Smoking also puts you at a higher risk for
the disease.
What are the symptoms?
The main symptoms of
Crohn's disease are belly pain and diarrhea (sometimes with blood). Some people
may have diarrhea 10 to 20 times a day. Losing weight without trying is another
common sign. Less common symptoms include mouth sores, bowel blockages, anal
tears (fissures), and openings (fistulas) between organs.
Infections,
hormonal changes, and smoking can cause your symptoms to flare up. You
may have only mild symptoms or go for long periods of time without any
symptoms. A few people have ongoing, severe symptoms.
It's
important to be aware of signs that Crohn's disease may be getting worse. Call
your doctor right away if you have any of these signs:
You feel faint or have a fast and weak
pulse.
You have severe belly pain.
You have a fever or
shaking chills.
You are vomiting again and again.
How is Crohn's disease diagnosed?
Your doctor will
ask you about your symptoms and do a physical exam. You may also have X-rays
and lab tests to find out if you have Crohn's.
Tests that may be
done to diagnose Crohn's disease include:
Barium X-rays of the small intestine or
colon.
Colonoscopy or flexible sigmoidoscopy.
In these tests, the doctor uses a thin, lighted tube to look inside the colon.
Biopsy. The doctor takes a sample of tissue and tests
it to find out if you have Crohn's or another disease, such as
cancer.
Stool analysis. This is a test to look for blood and signs
of infection in a sample of your stool.
One or more imaging tests, such as a CT scan or MRI.
How is it treated?
Your treatment will depend on
the type of symptoms you have and how bad they are.
There are a few steps you can take
to help yourself feel better. Take your medicine just as your doctor tells you
to. Exercise, and eat healthy meals. Don't smoke. Smoking makes Crohn's disease
worse.
The most
common treatment for Crohn's disease is medicine. Mild symptoms of Crohn's
disease may be treated with over-the-counter medicines to stop diarrhea. But
talk with your doctor before you take them, because they may cause side effects.
You may also use prescription medicines. They help control
inflammation in the intestines and keep the disease from causing symptoms.
(When you don't have symptoms, you are in
remission.) These medicines also help heal damaged
tissue and can postpone the need for surgery.
Crohn's disease makes it hard for your body to absorb
nutrients from food. A meal plan that focuses on high-calorie, high-protein
foods can help you get the nutrients you need. Eating this way may be easier if
you have regular meals plus two or three snacks each day.
How do you cope with Crohn's disease?
Having
Crohn's disease can be stressful. The disease affects every part of your life.
Seek support from family and friends to help you cope. Get counseling if you
need it.
Many people with inflammatory bowel diseases look to
alternative treatments to improve their well-being.
These treatments haven't been proved effective for Crohn's disease, but they
may help you cope. They include massage, supplements such as vitamins D and
B12, and herbs like ginseng.
The cause of
Crohn's disease is unknown. This disease may result from an
abnormal response by the body's
immune system to normal intestinal bacteria.footnote 1 Disease-causing bacteria and viruses also may play a role.
Crohn's disease can run in families, so
some people may be more likely than others to develop the condition when
exposed to something that triggers an immune reaction. Environmental factors
may also play a role in causing this disease.
Symptoms
The main symptoms of
Crohn's disease include:
Belly pain. The pain often is described as
cramping and intermittent, and the belly may be sore when touched. Belly
pain may turn to a dull, constant ache as the condition gets worse.
Diarrhea. Some people may have diarrhea 10 to 20 times
a day. They may wake up at night and need to go to the bathroom. Crohn's
disease may cause blood in stools, but not always.
Loss of
appetite.
Fever. In severe cases, fever or other symptoms that
affect the entire body may develop. A high fever may mean that you have an infection, such as an
abscess.
Weight loss. Ongoing symptoms,
such as diarrhea, can lead to weight loss.
Too few red blood cells
(anemia). Some people with Crohn's disease develop
anemia because of low iron levels caused by bloody stools or the intestinal
inflammation itself.
Small tears in the anus (anal fissures) that may go away, but come back again.
Because Crohn's disease involves the immune system, you also
may have symptoms outside the digestive tract . These may include
joint pain, eye problems, a skin rash, or liver disease.
Crohn's disease
is an ongoing (chronic) condition that may flare up throughout your life. It affects different people in different ways. Some people
may have only mild symptoms. Others may have severe symptoms or
complications that, in rare cases, may be life-threatening.
Crohn's disease may be defined by the part of the
digestive tract involved, such as the rectum and anus (perianal disease) or the
area where the small intestine joins the large intestine (ileocecal disease).
Some people may have features of both Crohn's disease and
ulcerative colitis, the other major type of
inflammatory bowel disease (IBD).
Complications
Because Crohn's disease can cause inflammation in parts
of the intestines that absorb nutrients from food, it can cause deficiencies in
vitamin B12, folic acid, or other nutrients. The disease can increase the risk
of
gallstones,
kidney stones, and certain uncommon forms of
anemia.
In long-term Crohn's disease,
scar tissue may replace some of the inflamed or ulcerated intestines. This scar tissue can form
blockages (bowel obstructions) or narrowed areas (strictures) that can prevent
stool from passing through the intestines. Blockages in the intestines also can
be caused by inflammation and swelling, which may improve with medicines.
Sometimes blockages can only be treated with surgery.
If sores
break through the wall of the intestines, abnormal connections or openings
(fistulas) may form. Fistulas can form between two parts of the
intestines, between the intestines and other organs (such as the bladder or
vagina), or between the intestines and the skin. In rare cases, this can lead
to infection of the abdominal wall.
Cancer risk
Crohn's disease of the colon
and rectum that has been present for 8 years or longer increases the
risk of cancer . With regular screening, some cancers can be
found early and treated successfully.
Inflammatory bowel disease also increases the risk of melanoma, a serious type of skin cancer. Your doctor may recommend regular screening by a dermatologist.footnote 2
Pregnancy
Most women who have
Crohn's disease can have a normal pregnancy and deliver a healthy baby. The best idea is to wait until the disease is in remission before becoming pregnant. Women who become pregnant when their disease is under control are more likely to avoid flare-ups during pregnancy.
Some medicines used to treat the disease
can be used during pregnancy. It's a good idea to talk with your doctor about which medicines are okay. But sometimes severe Crohn's disease can
harm your baby more than medicines to keep it under control.
What Increases Your Risk
Things that may increase your
risk of getting
Crohn's disease include:
Having a family history of Crohn's disease.
Your risk increases if an immediate family member (a parent, brother,
or sister) has the disease.
Having Ashkenazi Jewish
ancestry.
Smoking cigarettes.
Things that may cause Crohn's disease symptoms to flare up
include:
Medicines.
Infections.
Hormonal
changes.
Lifestyle changes.
Smoking.
When To Call a Doctor
Call a doctor right away if you have been diagnosed with
Crohn's disease and you have one or more of the
following:
Evidence of pus draining from the area
around the anus, or pain and swelling in the anal area
Repeated
vomiting
Not passing any stools or gas
If you have any of these symptoms and you have been
diagnosed with Crohn's disease, your condition may have become much
worse. Some of these symptoms also may be signs of
toxic megacolon. This is a rare complication of Crohn's
disease that requires emergency treatment. Untreated toxic megacolon can cause
the colon to leak or rupture, which can be fatal.
People who have
Crohn's disease usually know their normal pattern of symptoms. Call your doctor
if there is a change in your usual symptoms or if:
Your symptoms become significantly worse than
usual.
You have diarrhea that lasts for more than 2
weeks.
You have lost weight.
Who to see
The following doctors can diagnose most cases of Crohn's disease:
Crohn's disease
is diagnosed through a
medical history and physical exam, imaging tests to
look at the intestines, and lab tests.
It may go undiagnosed for years, because
symptoms usually develop gradually and it doesn't always affect the same part of the intestine.
Other diseases can have the same symptoms as Crohn's disease. But doctors can diagnose Crohn's by doing a test that looks at the inside of the intestine.
Diagnostic tests
Colonoscopy or flexible sigmoidoscopy : Colonoscopy is often the preferred test because it can be used to examine the entire colon.
Sigmoidoscopy reaches only the lowest
part of the colon.
Abdominal X-ray : This test can show possible obstructions in the
belly.
Magnetic resonance imaging (MRI) : MRI
uses a magnetic field and pulses of radio wave energy to provide pictures of
organs and structures inside the body.
Other tests may be done to confirm or evaluate the disease.
Biopsy: This test is done on a sample of tissue collected during sigmoidoscopy or colonoscopy. A biopsy also may be done to find out
if a tumor is present. Bowel biopsies are painless (other than the possible discomfort
of the scope procedure). They remove only a tiny piece of tissue.
Stool analysis : This may be done to look for blood, signs of bacterial infection, malabsorption, parasites, or
the presence of white blood cells. It can help tell the difference between Crohn's
disease and
irritable bowel syndrome (IBS), which can have similar symptoms.
Video capsule endoscopy (VCE) : This test takes pictures of the digestive tract using a tiny camera that you swallow. The images are recorded by a device that you wear on your belt. The test allows your doctor to see the small intestine, which is hard to see with other
tests.
Small bowel enteroscopy: This test uses a long, lighted flexible
tube with a tiny camera that sends pictures of the small intestine to a video
screen. This helps the doctor look at the small intestine. The doctor can also
take small samples of the tissue.
Blood tests to find antibodies: These tests can sometimes help the doctor tell if you have Crohn's disease or ulcerative colitis. These tests include anti-neutrophil cytoplasmic antibody with perinuclear staining (pANCA), anti-Saccharomyces cerevisiae antibody (ASCA), and outer membrane porin C (Omp C).
Treatment Overview
The main treatment for
Crohn's disease is medicine to stop the inflammation
in the intestine and medicine to prevent flare-ups and keep you in
remission. A few people have severe, long-lasting
symptoms or complications that may require a stronger medicine, a combination
of medicines, or surgery. The type of treatment you need depends on the type of symptoms you have and how bad they are.
Managing symptoms
Mild symptoms may respond to an
antidiarrheal medicine such as loperamide (Imodium, for example). This medicine slows or stops the painful spasms in your intestines
that cause symptoms.
Severe symptoms may be treated
with corticosteroids, immunomodulator medicines, or biologics.
With severe symptoms, the first step is to control the disease. When your
symptoms are gone, your doctor will plan your treatment to keep you symptom-free (in remission).
After symptoms are controlled, your treatment will focus on medicine or a combination of medicines that keeps
Crohn's disease in remission.
Your doctor will want to see you about every 6 months if your
condition is stable. You'll be seen more often if you have flare-ups. You may have
lab tests every 2 to 3 months.
Severe disease
Some severe cases of Crohn's disease need to be treated in the hospital. In the hospital, you may get
supplemental nutrition through a tube placed in your
nose and down into the stomach (enteral nutrition). Or your bowel
may need to rest, and you will be fed liquid nutrients in a vein (total
parenteral nutrition, TPN). See Other Treatment .
Surgery may be needed if no
medicine is effective or if you have complications. See Surgery .
Prevention
Crohn's disease
cannot be prevented, because the cause is unknown. But you can take steps to
reduce the severity of the disease. For help, see Home Treatment .
Home Treatment
If
Crohn's disease doesn't cause symptoms, no treatment
is needed. Mild symptoms may be treated with antidiarrheal medicines or changes in
diet and nutrition.
In general, doctors recommend that you do not use
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen or naproxen. These medicines may cause flare-ups
of Crohn's disease. But some people may be more
likely to have flare-ups from NSAIDs than others. Talk to your doctor about
whether to avoid these medicines.
You can also help yourself by:
Not smoking. Smoking makes
Crohn's disease worse.
Eating a healthy diet.
Not using
antibiotics unless they have been prescribed for you by a
doctor.
Getting regular exercise.
Support and counseling
Crohn's disease can
affect every aspect of your life. It may make you feel isolated or depressed.
But you can take steps to improve your outlook and coping skills. You may want
to seek professional counseling and social support from family, friends, or
clergy.
Helping your child
Children who have Crohn's disease may feel self-conscious
if they don't grow as fast as other children their age. Encourage your child
to take medicine as prescribed. Offer help with the treatment so that your
child can feel better, start growing again, and lead a more normal life.
Children tend to have a harder time managing the disease than adults, so your
support is especially important.
Medications
Medicines usually are the treatment of
choice for
Crohn's disease. They can control or prevent
inflammation in the intestines and help to:
Relieve symptoms.
Promote healing
of damaged tissues.
Put the disease into
remission and keep it from flaring up
again.
Postpone the need for surgery.
Medicine choices
The choice of medicine usually depends on how severe the disease is, what part of the intestine is affected, and whether
complications are present. Medicines for Crohn's disease include:
Antibiotics (such as ciprofloxacin or metronidazole). These may be tried to treat the disease itself or to treat infections that can occur with Crohn's disease. They are also used to treat fistulas and abscesses.
Corticosteroids (such as budesonide or prednisone). These may be given for a few weeks or months to control swelling.
These steroid medicines usually stop symptoms and put
the disease in remission. But they are not used as long-term treatment to keep
symptoms from coming back.
Nonbiologics, such as
azathioprine and methotrexate. You may take these if other medicines don't work, if your symptoms come back when you stop
taking steroid medicines, or if your symptoms come back often, even with
treatment.
Biologics, such as infliximab or adalimumab. Your doctor may have you try these medicines if other medicines for Crohn's disease haven't worked for you. In some cases, biologics are tried before some of the other medicines listed above.
They are also used to treat fistulas.
Aminosalicylates, such as mesalamine or sulfasalazine. Your doctor may recommend these medicines during a flare-up or at other times.
Cyclosporine and intravenous (IV) corticosteroids, which may
be needed for severe cases.
Surgery
Surgery for Crohn's disease may be done if:
No medicine can control your symptoms.
You have serious side effects from medicines.
Your symptoms can only be controlled with long-term use of corticosteroids.
You have complications.
Surgery is rarely done, and it's not a cure. When surgery for Crohn's is needed , as little of the intestine as possible is removed to keep the intestines working normally. The disease tends to return to other areas of the intestines after surgery.
Surgery may improve a child's well-being and quality of life and
restore normal growth and sexual development.
Types of surgery
Bowel Resection. The diseased portion of the intestine is removed,
and the healthy ends of the intestine are reattached.
Strictureplasty. The surgeon makes a lengthwise cut in the
intestine and then sews the opening together in the opposite direction. This
makes the intestine wider and helps with obstruction of the bowels. This is
sometimes done at the same time as resection or when a person has had resection
in the past. Strictureplasty is used when the doctor is trying to save as much
of the intestine as possible.
Proctocolectomy and ileostomy. The surgeon removes the
large intestine and rectum, leaving the lower end of the small intestine (the
ileum). The anus is sewn closed, and a small opening called a stoma is made in
the skin of the lower belly. The ileum is connected to the stoma, creating an
opening to the outside of the body. Stool empties from this opening into a small plastic
pouch called an ostomy bag that is applied to the skin around the stoma.
Intestinal transplant. This is rarely used for Crohn's disease. In this complex procedure, the small intestine is removed and replaced
with the small intestine of a person who has recently died and donated his or
her organs.
What to think about
It may take time to adjust to living with an ostomy . It may help to know that most people are able to adapt and resume all of their usual activities. Talk with your doctor about support groups in your area for people with ostomies.
Other treatments for Crohn's disease include balloon dilation, supplemental nutrition, and complementary therapies.
Balloon dilation
Balloon dilation isn't surgery. It may be done if you want to delay surgery, or if you have had surgery before and your doctor wants to save as much of the intestine as possible.
During the procedure, the doctor moves an
endoscope through your intestine from your anus. The
endoscope is a long, thin tube that has a video camera on the end. An uninflated balloon is placed across the narrowed part of the intestine. When the balloon is inflated, it makes
that part of the intestine wider.
The balloon is deflated and then removed.
Not as much is known about the
long-term success of balloon dilation compared to surgery.
Supplemental nutrition
Some people who have
Crohn's disease need additional nutrition because
severe disease prevents their small intestine from absorbing nutrients.
Supplemental liquid feedings may be done through a tube placed in the nose and
down into the stomach (enteral nutrition) or through a vein (total parenteral
nutrition, or TPN). Enteral nutrition or TPN may be needed when:
Crohn's disease isn't controlled with standard
treatment.
Short bowel syndrome occurs. This
happens when so much of the small intestine has been surgically removed or is
affected by the disease that you can't properly digest food and absorb enough
nutrients.
Bowel blockage occurs.
Supplemental feeding can restore good nutrition to children
who are growing more slowly than normal. It also can build strength if you need
surgery or have been weakened because of severe diarrhea and poor
nutrition.
Supplemental nutrition allows the intestines to
rest and heal. But it's common for symptoms to return when TPN is stopped and you
go back to a regular diet. TPN doesn't change the long-term outcome of Crohn's
disease.
Complementary medicine
Many people with inflammatory bowel disease consider nontraditional or complementary medicine in addition to prescription medicines. They may turn to these alternatives because there is no cure for Crohn's disease. People may also use complementary medicine for help with:
The difficult side effects from standard medicines.
The emotional strain of dealing with a chronic illness.
The negative impact of severe disease on daily life.
These therapies have not been proved effective for Crohn's disease, but they may improve your well-being. Therapies include:
Special diets or nutritional supplements, such as probiotics , evening primrose, and fish oils.
Vitamin supplements, such as vitamins D and B12.
Herbs, such as ginseng.
Massage.
Stimulation of the feet, hands, and ears to try to affect parts of the body (reflexology).
Other Places To Get Help
Organizations
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
www.digestive.niddk.nih.gov
North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: GI Kids
Sands BE, Siegel CA (2010). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1941-1973. Philadelphia: Saunders Elsevier.
Singh S, et al. (2014). Inflammatory bowel disease is associated with an increased risk of melanoma: A systematic review and meta-analysis. Clinical Gastroenterology Hepatology, 12(2): 210-218. DOI: 10.1016/j.cgh.2013.04.033. Accessed March 25, 2015.
Other Works Consulted
American Gastroenterological Association (2006). American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology, 130(3): 935-939. Also available online: http://download.journals.elsevierhealth.com/pdfs/journals/0016-5085/PIIS0016508506000734.pdf.
American Gastroenterological Association (2010). AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology, 138(2): 738-745. Available online: http://www.gastro.org/practice/medical-position-statements.
Strong SA, et al. (2007). Practice parameters for the surgical management of Crohn's disease. Diseases of the Colon and Rectum, 50(11): 1735-1746.
Credits
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Specialist Medical ReviewerArvydas D. Vanagunas, MD - Gastroenterology
Sands BE, Siegel CA (2010). Crohn's disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1941-1973. Philadelphia: Saunders Elsevier.
Singh S, et al. (2014). Inflammatory bowel disease is associated with an increased risk of melanoma: A systematic review and meta-analysis. Clinical Gastroenterology Hepatology, 12(2): 210-218. DOI: 10.1016/j.cgh.2013.04.033. Accessed March 25, 2015.
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