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Crohn's Disease: Symptoms, Diagnosis & Treatment

Biodigital human digestive system
The digestive system includes the esophagus, stomach, liver, pancreas, gallbladder, small intestine and large intestine.
Credit: The BioDigital HumanTM developed by NYU School of Medicine and BioDigital Systems LLC

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that involves inflammation in all or part of the digestive tract. Parts of the digestive system become swollen and develop deep sores or ulcers. Though Crohn’s can develop anywhere in the digestive tract from the mouth to the anus, it most often affects the last part of the small intestine and the first part of the large intestine.

Crohn’s disease has no known definitive cause. Doctors theorize that the body’s immune system has an abnormally strong response to the good bacteria in the intestine, which the immune system normally ignores. Those with a Jewish background may have a higher chance of developing Crohn’s disease, while African Americans have a decreased risk. Smoking is another risk factor. But it affects men and women equally, runs in families, and most commonly starts in people between the ages of 13 and 30.

Symptoms

The symptoms of Crohn’s disease tend to focus on the digestive area. Abdominal pain and diarrhea, often with blood and sometimes up to 20 times a day, are common in Crohn’s patients. Because the body is struggling to properly digest food, and abdominal pain can lessen the appetite, weight loss is another common sign of Crohn’s disease. Other symptoms include mouth sores, bowel blockages and anal tears/fissures. These symptoms can lead to complications like anemia, osteoporosis, restless leg syndrome, arthritis, and skin problems.

In Crohn’s disease, the intestinal wall is thickened and inflamed by swelling and scar tissue, narrowing the passageway for food that is being digested. When the intestine has narrowed, this is referred to as a stricture. One drastic symptom of Crohn’s disease is a fistula — ulcers develop so deep that they create openings and tunnels to other organs. For example, an ulcer might develop and connect the intestines to the bladder, which can cause serious infection.

Symptoms often flare up thanks to infections, hormonal changes and smoking. Some patients go for a long time without symptoms (known as remission) then suffer the occasional flare up, while other patients have ongoing severe symptoms. Crohn’s disease can also worsen and progress, so it’s important to be aware of this. Call your doctor immediately if you feel faint or your pulse is abnormal, you have severe abdominal pain, fever or shaking chills, or persistent vomiting.

Diagnosis & treatment

There are a number of ways to diagnose Crohn’s disease. Your doctor will first analyze your symptoms and do a physical exam before ordering tests. Tests that diagnose Crohn’s disease include:

  • Barium X-rays of the colon or small intestine
  • Colonoscopy or sigmoidoscopy
  • Biopsy
  • Stool analysis

Crohn’s disease isn’t curable, but the symptoms can be managed and treated to make sure that the patient has as normal a life as possible. Because patients have a wide range of symptoms, from mild to severe, there are varying ways of dealing with Crohn’s disease. Exercising, a healthy diet, and avoiding smoking can help alleviate many of the symptoms.

The most common treatment for Crohn’s disease is over-the-counter and prescription medicines. Patients can use over-the-counter medicines to treat diarrhea and other mild symptoms, but prescription medications will be needed to control inflammation in the intestines and keep the disease from causing other symptoms. Medications can help heal damaged tissue and postpone the need for surgery.

Some of these drugs include:

  • Anti-TNF alpha therapies, likeinfliximab, adlimumab,and certolizumab
  • Antibiotics to reduce bacterial growth caused by strictures or fistula
  • Corticosteroids

Roughly 65 to 75 percent of Crohn’s disease patients will need surgery at some point, either to relieve symptoms or correct problems like strictures, fistulae or intestinal bleeding. Though surgery can relieve some of the symptoms, it cannot cure Crohn’s disease, as the disease occurs in patches across the entire digestive system. While parts of the system can be removed, the Crohn’s disease could simply appear in a different part of the system.

Types of surgery include:

  • Strictureplasty — the strictured/narrowed area is widened without any intestinal removal
  • Bowel resection — the damaged part of the small or large intestine is removed and the healthy ends surgically attached
  • Large intestine removal — as the name implies, the large intestine is removed and an external pouch is attached for the collection of waste draining out of the body. The patient must empty the pouch several times a day for the rest of their lives

Coping with Crohn’s disease can be stressful, as it affects every part of a patient’s life. It’s important to have a good support system in family and friends. There are also support networks out there for people suffering from Crohn’s disease and other inflammatory bowel diseases, and their loved ones. Some Crohn’s disease sufferers seek counseling and therapy to help cope. Alternative treatments could also help your well-being. Though they aren’t proven to treat Crohn’s disease, they could alleviate symptoms and lower stress. These treatments include herbal supplements, acupuncture, and massage.

Because Crohn’s disease makes it hard for your body to absorb nutrients from food, patients need to focus on a healthy meal plan that is high-calorie and high-protein to ensure that you’re getting the right nutrients. Try eating regular meals plus two or three snacks a day.

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