What is Crohns Disease?
Crohn’s disease is classified as a very rare condition with approximately 200,000 new cases diagnosed in the US each year. Also known as ileitis, it is a chronic disease that causes inflammation of the lining of the digestive tract. Along with ulcerative colitis, Crohn’s is categorized as an inflammatory bowel disease.
What causes Crohns Disease?
While the exact cause of Crohn’s disease is not yet known, it is believed that a bacterium or virus which attacks the immune system may be the trigger. Although most people with Crohn’s don’t have a family history of the disease, it can run in families, so genetics may be a contributing factor.
While Crohn’s can affect anyone, the majority of Crohn’s disease patients are diagnosed before the age of 30. Certain habits, such as smoking, eating a high-fat diet, or heavy use of non-steroidal anti-inflammatory medicines can make the symptoms of Crohn’s disease worse.
Symptoms of Crohn’s Disease
Symptoms of Crohn’s disease are similar to those of other less serious conditions such as Irritable Bowel Syndrome (IBS). Only a gastroenterologist or other qualified health professional can diagnose Crohn’s. Symptoms of Crohn’s disease can vary according to which part of the digestive tract is most affected. However, general symptoms include abdominal pain and cramping, diarrhea, a low-grade fever, and fatigue. Blood may be present in the stool, and there may be loss of appetite and weight loss. Canker-like sores may appear in the mouth, and inflammation of the skin, eyes, or joints may occur.
To diagnose Crohn’s, doctors perform a physical exam and do routine blood tests. These may include tests for anemia and also a fecal occult blood test to identify any blood in the stool. X-rays of the gastrointestinal tract are also useful in making the diagnosis. Sometimes, the patient may be asked to take barium before the X-rays are done. This provides more detail on the X-ray.
The next set of tests includes colonoscopies, endoscopies, and flexible sigmoidoscopies. These procedures are done while the patient is under light sedation. They use a lighted camera mounted on a thin tube to allow doctors to see areas of inflammation in different areas of the gastrointestinal tract. They may also take a biopsy (tissue sample) during the procedure.
Advanced imaging tests can be particularly helpful in the diagnosis of Crohn’s. CT (computerized tomography) scans and especially CT enterography, can provide highly-detailed images of the small bowel. CT enterography is now preferred over barium X-rays for this purpose. MRI (magnetic resonance imaging) scans are also good for evaluating the small bowel, and MRI enterography can sometimes be used in place of CT enterography.
Crohns Disease Cure
Once a diagnosis is made, prescription drugs are the main treatment option for managing Crohn’s disease. The goal of using medication is to reduce the inflammation that causes the symptoms and reduce the risk of complications from the disease. Sometimes, the right combination of medication allows patients to enter remission which may last for years. When starting medication for Crohn’s, doctors often use one of two common approaches. They may start with milder drugs during the first phase of treatment and build up to more powerful drugs, or they may start with more aggressive drug treatment and then taper to milder drugs. Every Crohn’s patient is different, and finding the right drugs for each patient can take time.
Anti-inflammatory drugs are typically started first. Corticosteroids help reduce inflammation throughout the body, but they aren’t meant for long-term use and can have side effects including diabetes, high blood pressure, and an increased risk of infection. Another class of anti-inflammatories called oral 5-aminosalicylates were frequently used in the past but are now regarded as having only a limited benefit. They are only helpful for those patients whose colons are affected, not for those who have small intestine involvement.
After anti-inflammatories, drugs that suppress the immune system are often started. Usually, a combination of these works better than taking just one medication. Azathioprine and mercaptopurine are among the most common immune-suppressing drugs taken by Crohn’s disease patients. Both require regular blood testing to check infection resistance levels. Side effects can include nausea and vomiting. Skin cancers, lymphoma, and bone marrow suppression have been reported.
Adalimumbab (Humira) and infliximab (Remicade) can help both children and adults with moderate to severe symptoms. These drugs are known as TNF inhibitors or “biologics,” and they have been able to help patients achieve remission. Patients should be tested for tuberculosis and hepatitis B before starting these drugs. As with the anti-inflammatory medications, side effects of TNF inhibitors can include skin cancer and lymphoma.
Methotrexate, a medicine for treating cancer, psoriasis, and rheumatoid arthritis, can be used for Crohn’s patients who can’t get symptom relief with other drugs. Common side effects include fatigue and nausea, but some cancers have been reported, and it can sometimes lead to pneumonia, so it requires close monitoring.
If none of these drugs helps, cyclosporine can be used in the short-term, though it has been known to cause liver damage. Natalizumab and vedolizumab are newer drugs that may help, too. Antibiotics are sometimes used as a treatment option for reducing harmful bacteria that may cause inflammation.
Switching to a low-fiber (low-residue) diet can help ease the symptoms of Crohn’s by reducing the frequency of stools. Dairy foods can cause inflammation, so doctors recommend that Crohn’s patients avoid dairy products. Eating foods high in fat can worsen symptoms, so a low-fat diet is recommended. Spicy foods, alcohol, and caffeine can irritate the gastrointestinal tract, so it’s wise to avoid them, too. Broccoli and other foods in the cabbage family can sometimes cause pain for those with Crohn’s.
Rarely, some patients whose disease is at a severe stage may need nutrition via a feeding tube. As a last resort, surgery can be used to increase the size of parts of the small intestine that have been narrowed by the disease or to remove a damaged portion of the digestive tract. While surgery doesn’t cure Crohn’s, 50% of Crohn’s patients may need surgery at some point.
While Crohn’s disease is a chronic condition, treatment advances are being made, and there is every hope that a cure will be found. Until then, patience and persistence can help those with Crohn’s disease find treatment options that help them manage their symptoms and may even help them enter remission.