Crohn’s disease

What is Crohn’s Disease?

Before gathering information about Crohn’s Disease, knowing about your gastrointestinal tract is a prerequisite. The GI (Gastrointestinal) tract comprises of your mouth, esophagus, stomach, small intestine, large intestine (colon), rectum, and anus. Any inflammation of the GI tract leads to a medical condition known as inflammatory bowel disease (IBD).

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Crohn’s Disease is a type of Inflammatory Bowel Disease that causes irritation and swelling in various parts of the GI tract, mostly in the lower portion of the small intestine (the ileum). It is commonly known as regional enteritis due to the fact that it always affects a particular region of the GI tract.

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Crohn’s Disease is a long-lasting condition which persists for a lifetime. There are no particular curative techniques to heal the disease completely, however, timely treatment and medications often soothe the symptoms to a great extent.

Crohn’s disease vs Ulcerative colitis

IBD is the key term under which both Crohn’s Disease and Ulcerative Colitis falls. Usually, people confuse the symptoms of Crohn’s disease with ulcerative colitis and go for a wrong treatment technique.

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  • The distinctive feature of Crohn’s disease and ulcerative colitis is the region of malaises in the GI tract. Ulcerative colitis usually targets colon, starting from the rectum, however, Crohn’s Disease typically targets the lower portion of small intestine (ileum).
  • In Crohn’s the inflammation occurs in all the layers of intestines while, in Ulcerative Colitis, the inflammation is localized to the innermost lining of the intestinal wall.
  • On the other hand, rectal bleeding is more prominent in Ulcerative Colitis than in Crohn’s Disease.
  • People with Ulcerative Colitis will suffer from intermittent pain along with the bowel movements while the victims of Crohn’s Disease are subjected to continuous pain in the abdominal region.
  • Crohn’s disease is also marked by perianal problems like fistulas, anal sores, and skin tags while these issues being uncommon in Ulcerative Colitis.

How many are affected? Prevalence in the United States

201 people out of every 100,000 Adults in the United States are suffering from Crohn’s Disease.

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  • If the population is kept under consideration, the number clearly indicates that around 700,000 US citizens are having the disease, according to the Crohn’s & Colitis Foundation of America.
  • However, it is mostly diagnosed between the age group of 15-35, but it can be detected at any age.
  • Crohn’s disease affects both Men and women in the same way.
  • Caucasians and people of Ashkenazi Jewish descent are more prone to be affected by Crohn’s Disease than people of other races or ethnicities.

Causes & Risk Factors of Crohn’s Disease

Many theories have been devised so as to speculate the causes of Crohn’s Disease, but none of them has been proven scientifically. Experts consider that a combination of genetic and environmental factors adds to a person’s risk for the disease.

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Some risk factors and possible causes for Crohn’s disease include:

Genetics: Genetics seems to be an evident factor in the disease, however, the association of this factor with the disease is not specific. It is probable that more than one gene is responsible for IBD and having the gene related to IBD doesn’t guarantee the occurrence of the disease. The gene which are found responsible is actually susceptibility gene, which increases the chances of getting Crohn’s Disease. The first gene to be discovered in association with Crohn’s is a mutation of NOD2/CARD15 gene. Nearly equal to 20 percent of IBD patients in America and Europe might possibly be having mutation in the above-mentioned gene, says Crohn’s and Colitis Foundation of America.

Family History: Studies have revealed that 5 percent to 20 percent of people suffering from Crohn’s have a first-degree relative who have been diagnosed with the disease itself. Children born to the parents having IBD are more prone to develop Crohn’s disease during their lifespan.

Geographic Factors: Studies suggest that people living in higher latitudes have higher possibilities of developing Crohn’s while the people living in lower latitudes have lower chances of developing it. Also, the Crohn’s Disease is found more prominent in Developed countries than in developing and underdeveloped countries.

Smoking: Active smokers are twice as vulnerable as those who doesn’t smoke. (source, CCFA)

Antibiotics: it substantially increases the risks of IBD
Anti-inflammatory drugs: drugs like aspirin, ibuprofen and naproxen might increase the risk of IBD and cause flares.

Appendicitis: People who have undergone appendectomy are less likely to get ulcerative colitis, but are more prone to develop Crohn’s disease.

Immune system: it has been speculated that immune system anomalies have also contributed to the development of Crohn’s disease in people. Our immune system doesn’t defend to the healthy microbes which are helpful for digestion. The people who have Crohn’s, have an immune system which responds inaptly and defends the body against the healthy microbes instead. This inflammatory reaction in the stomach can result in ulcers and other injuries in the intestine. Along with the healthy microbe, the immune system also attacks the digestive tract.

Crohn’s Disease Symptoms- How to know if you are having Crohn’s Disease?

In some people who have developed Crohn’s disease get only the last part of their small intestine affected. While in others, the disease is restrained to the colon (part of the large intestine). Mostly, last part of the small intestine and the colon are affected by Crohn’s disease.

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Signs and symptoms of Crohn’s disease can range from trivial to severe. They usually advance little by little, but sometimes it appears suddenly, without a warning. You may also go through times when you’ll have no signs or symptoms (remission).

While the disease is inactive state, signs and symptoms include:

Diarrhea: it is a common problem for those with Crohn’s. Intensified Intestinal Cramping can lead to loose stools.

Fever and Fatigue: A mild fever accompanies Crohn’s mainly due to inflammation of digestive tract. You might also feel tired and lethargic.

Abdominal cramps: Inflammation and irritation of digestive tract can create difficulty for the normal content of your diet to pass through you GI tract and may lead to severe pain and cramping. The pain may sometimes include nausea and vomiting.

Blood in the fecal matter: You might also experience some blood along with your stool, also you might also undergo bleeding which cannot be seen by you (Occult Blood)

Mouth sores: Persistent ulcers in mouth clearly indicates irritated GI tract.

Reduced appetite and weight loss: Irritated and inflamed wall of your GI tract might also reduce your desire to eat anything to a great extent. Also, the ability to digest the food and assimilation is also hampered due to Crohn’s.

Perianal disease: constant pain and drainage in and around the anal region due to inflammation that is carried out to skin from the tunnel.

Inflammation of skin, eyes and joints: Tenderness and redness in skin and eyes are also noticeable during Crohn’s Disease.

If all of these symptoms persists in your body, consult the doctor immediately.

Crohn’s Disease Diagnosis

Before carrying out any test, the doctor will rule out the possibilities of another disease that might be causing your symptoms. No single test can determine the presence of Crohn’s disease in a person. A combination of endoscopy with biopsies and radiological tests are used to confirm Crohn’s.

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Following Blood Tests are carried out to help diagnose Crohn’s Disease:

Blood test for anemia and other infections: The doctor might check your blood for any abnormality in the number of red blood cells, lack of which causes a health condition known as Anemia. Along with the red blood cells, the blood is checked for any infection in the body.

Fecal Occult Blood Test: Sometimes, blood is present in the stools but can’t be seen with the naked eyes. A sample of stools is examined for the presence of hidden blood in it.

After positive reports of the blood test, the following procedures are carried out:

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Colonoscopy: A thin flexible lighted tube with an attached camera is used to view the entire length of the colon. During the procedure, the doctor also removes a small patch of tissues for laboratory analysis. The laboratory analysis confirms the diagnosis of the patient. If the clusters of inflammatory cells called granulomas are found in the specimen, Crohn’s Disease can be confirmed.

Flexible sigmoidoscopy: a slender, bendable, lighted tube is used to examine the sigmoid which is the last section of your colon.

Computerized tomography (CT): a CT scan can also be performed which is a special X-ray technique that offers more elaborate details than a standard X-ray does. This test involves examination of the entire bowel as well as at tissues outside the bowel. While CT enterography is a special class of CT scan that provides enhanced images of the small bowel. This test has successfully substituted barium X-rays in many medical centers.

Magnetic resonance imaging (MRI): A magnetic field and radio waves are used by an MRI scanner to generate thorough images of organs and tissues. It is mainly useful for examining a fistula around the anal area (pelvic MRI) or the small intestine (MR Enterography).

Capsule endoscopy: during this test, a capsule that has a camera in it is asked to swallow by you. The camera takes pictures, which are communicated to a computer you wear on your belt. The images are then recorded, shown on a monitor and checked for signs of Crohn’s disease. The capsule cum camera passes out of your body painlessly in your stool. However, you may still require endoscopy with biopsy to confirm the diagnosis of Crohn’s disease.

Double-balloon endoscopy: Standard endoscopes fail to look into the small bowel, so this type of endoscopy is used. This technique is adopted when capsule endoscopy displays abnormalities, but the diagnosis is can’t be fully confirmed by this technique.

Small bowel imaging: Small parts of the colon where normal colonoscopy can’t be reached are examined by small bowel imaging. You are made to drink a liquid containing barium and doctors take X-ray, CT or MRI images of your small intestine.

Types of CD

If you’re diagnosed with Crohn’s Disease, it becomes imperative for you to understand which part of GI tract has been taken hold of this deadly disease.

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The following are the types of Crohn’s disease along with their symptoms:

Ileocolitis: It is the most common type of CD. It affects the last part of small intestine (ileum) and the large intestine (colon). Symptoms of this disease include diarrhea and cramping in the right lower part or the middle of the abdomen.

Ileitis affects only the ileum. Symptoms resemble those of Ileocolitis. However, in severe cases, complications like fistulas or inflammatory sore in a right lower quadrant of the abdomen can be seen.

Gastroduodenal Crohn’s disease: It affects the beginning of the small intestine (duodenum) and the stomach. Symptoms include loss of appetite, weight loss, nausea, and vomiting.

Jejunoileitis: This type of CD is marked by inflammation in the upper half of the small intestine (the jejunum). Symptoms include mild to extreme abdominal pain and cramps after having meals, as well as diarrhea.
Fistulas are seen in prolonged forms.

Crohn’s (granulomatous) colitis: It affects the colon only. Warning signs include diarrhea, rectal bleeding, and malady around the anus (blister, fistulas, and ulcers). Skin lesions and joint pains are more prominent in this form of Crohn’s than in others.

CD complications

Crohn’s disease is a wide term in its own. It never comes unaccompanied. More than one complication usually follows the trail of CD.

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Inflammation: Scarring and narrowing of bowel walls can cause due to inflammation.

Bowel obstruction: The thickness of the intestinal wall is also hampered by Crohn’s disease. Over time, the wideness of the bowel can be diminished which causes pain and irritation during the bowel movements.

Ulcers: Prolonged inflammation can lead to open sores anywhere in the digestive tract including your genital area.

Fistulas: Sometimes the ulcers can spread throughout the intestinal wall creating a fistula- an abnormal connection between different parts of the body. Fistula can even rise between your skin and the intestine. In adverse conditions, these fistulas grow into abscesses which are a life threatening situation if not treated.

Anal fissure: A small rip in the tissues that lines the anus can occur. It is often followed by painful bowel movements and might end up into the perianal fistula.

Malnutrition: Crohnic diarrhea, cramps, and vomiting make it difficult to eat or drink anything. As a result, the body doesn’t get enough nutrients for its proper functioning. Anemia often follows Crohn’s disease.

Colon Cancer: Having Crohn’s disease increases your chances of developing colon cancer. Consult your doctor to get yourself tested.

Side effects of the medication: Certain medicines taken to relieve the symptoms of CD are often accompanied by small risks of developing cancers such as lymphoma and skin cancers. Corticosteroids can be related to the risk of osteoporosis.

CD treatments- surgeries and medication

There is no certain cure for Crohn’s Disease, however, medications and surgeries are opted to ease down the symptoms. People with CD can lead a normal and happy life if right treatment is given to them. The major purpose of the treatment of CD is to stop the inflammation of the GI tract. The two main type of treatments given to CD patient is Medication and Surgery.

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Medication

Medicines are usually preferred to counteract the symptoms of CD. Right medications can reduce or control the inflammation in the intestines and will help to:

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  • Get rid of the symptoms
  • Stimulate restoration of the damaged tissue
  • Set the disease in remission and stop it from flaring back
  • Postpone and eliminate the need for surgery

Medications are offered to the patients according to the severity of the symptoms.

  • Mild symptoms are treated with an antidiarrheal medicine such as loperamide (Imodium). This prescription slows down or stops the excruciating spasms in your intestines that cause uneasiness.
  • For mild to moderate symptoms, the doctor will rather prescribe aminosalicylates, antibiotics and other medicines to bring down the inflammation.
  • Severe symptoms, on the other hand, are treated with corticosteroids, immunomodulatory medicines, or biologics.

Other medications prescribed to ease the symptoms are:

Antibiotics: If aminosalicylates are not able to work efficiently on the symptoms, the doctor will recommend you a course of antibiotics. Antibiotic lessen the bacteria in the intestines which further reduces the inflammation.

Steroids: Deltasone (prednisone) or Entocort EC (budesonide) will be recommended if both aminosalicylates and antibiotics fail to work. However, it is advisable to take steroids only for the short duration of time.

Immunomodulator: if severe symptoms are seen then your doctor will prescribe you immunomodulators. Common immunomodulators are:

  • Imuran (azathioprine)
  • Purinethol (6-mercaptopurine)
  • Trexall (methotrexate)

Biologic response modifiers (biologics): They are often taken in combination with other medicines or are given intravenously through injections. Commonly used biologics are:

  • Remicade (infliximab)
  • Humira (adalimumab)
  • Cimzia (certolizumab pegol)

Other medicines: in addition to the above-mentioned medicines, other medicines can also be used to relieve the signs and symptoms. Some alternate medicines are:

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1. Anti-diarrheal: fiber supplements like psyllium powder (Metamucil) or methylcellulose (Citrucel) can be used to harden the stools.

2. Pain relievers: For mild pains, the doctor might recommend you cetaminophen but common pain relievers like ibuprofen, naproxen sodium, etc. are not advisable as they might only worsen your symptoms and disease as well.

3. Iron supplements: Crohnic intestinal bleeding might cause iron deficiency anemia. So taking iron as a supplement is a must for CD patients.

4. Vitamin B-12 shots: Crohn’s disease is said to cause vitamin B-12 deficiency. Vitamin B-12 prevents anemia and promotes normal growth and development.

5. Calcium and vitamin D supplement: Steroids used to ease the symptoms can increase your chances to get osteoporosis so you may need to take calcium and vitamin D supplement.

Alternate medicines for CD: very little is known about the utility of the alternative medicine for the treatment of Crohn’s disease. Some of the commonly used alternative medicines are:

1. Herbal and nutritional supplements: FDA has not yet approved the use of alternate medicines for the treatment, as it might cause some side effects and dangerous interactions. Consult your doctor before taking any supplement.

2. Probiotics: No evidence has been produced to prove the utility of probiotics in the treatment of CD.

3. Fish Oil: People tried using fish oil to ease the symptoms, however, the research totally dismissed the use of fish oil for CD.

4. Acupuncture: People went for acupuncture and hypnosis to control the symptoms of CD, but neither of them is well studied for the same.

5. Prebiotics: Prebiotics are natural components of plants that help increase healthy bacteria in the intestines. Studies have still hadn’t shown any positive side of prebiotic use.

Surgery

If any of the above-mentioned medication fails to bring down the symptoms of the disease, your doctor might recommend you surgery. Research says that about 80% of people who have Crohn’s disease will need to undergo surgery at one point of their life. Commonly preferred surgeries are:

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Colectomy: the surgeon will take out a small part of your colon and reconnect the remnants.

Strictureplasty: IF the parts of bowel get blocked, a procedure called strictureplasty is carried out to reopen the blocked areas of the bowel.

Intestinal Transplant This is seldom used in Crohn’s disease. In this procedure, the inflamed small intestine is removed and replaced with a healthy intestine of the person who has recently died.

Bowel Resection: The unhealthy portion of the bowel is removed and the healthy ends are sewn together

Proctocolectomy and ileostomy: The large intestine and the rectum is removed and the anus is sewn together, leaving the lower part of the small intestine intact. A small opening called stoma is made in the lower belly which is then connected to the ileum. The stool is exited from this opening into a small pouch called ostomy which is attached to the skin around the stoma.

CD best Hospitals in U.S

For the treatment and better recovery of your disease, it is suggested to visit these best healthcare service in the United States. These hospitals and health care centers have been ranked best according to the US News, based on the number of success stories and a number of patients treated.

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1. Mayo Clinic

Rochester, MN
Bed Count: 1132

2. Cleveland Clinic

Cleveland, OH
Bed Count: 1268

3. Massachusetts General Hospital

Boston, MA
Bed Count: 947

4. UCLA Medical Center

Los Angeles, CA
Bed Count: 466

5. Johns Hopkins Hospital

Baltimore, MD
Bed Count: 951

6. Cedars-Sinai Medical Center

Los Angeles, CA
Bed Count: 865

7. UPMC-University of Pittsburgh Medical Center

Pittsburgh, PA
Bed Count: 1528

8. Mount Sinai Hospital

New York, NY
Bed Count: 1048

9. Mayo Clinic

Phoenix, AZ
Bed Count: 268

10. Houston Methodist Hospital

Houston, TX
Bed Count: 839

Crohn’s Disease and Pregnancy

Women with Crohn’s disease might develop complications in getting pregnant during the flare up periods or during the time when the disease is active. However, for most of the women, the fertility is restored to normal during the remission period. The risk of miscarriage, stillbirth, and developmental defects gets higher when the disease is active.

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CCFA advises women to wait for at least 6 months after their last flare-up before trying to conceive a baby.

Crohn’s Disease Diet

Diagnosis of Crohn’s disease might require little changes to your diet as some food might elevate the symptoms of the disease. CD straightaway targets the digestive system and affects the body’s ability to digest to digest and derive the nutrients from it.

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The following strategies can help you deal with dietary issues related to Crohn’s Disease:

Reduce the portion size: give up the habit of taking large sized meals three times a day. Instead, break up the meals into small portions and try grazing throughout the day.

Avoid high fiber food: high fiber food is recommended to everyone, but people with Crohn’s Disorder can find food high fiber like nuts, popcorns, beans and vegetable skins highly bloating during the flare up periods. Go for cooked, pureed and peeled vegetables instead.

Avoid fatty and greasy food: Fatty foods are difficult to digest and worsen the symptoms especially when you have inflamed small intestine.

Limit Dairy Products Consumption: People with CD find it hard to digest lactose, the sugar found in milk and other dairy products. So it is highly advisable to refrain from dairy goods as much as you can.

Limit the caffeine intake: Caffeine content in tea coffee or soda can fuel the bowel irritation and worsen the flare-up.

And the last but definitely not the least, don’t lose hope!

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