Crohn's Disease

Also called Crohn's Colitis

Crohn's colitis is an inflammatory bowel condition that affects any part of the digestive tract, from the mouth to the anus. The exact cause of the condition is unknown but it may be hereditary or related to problems with immunity and the immune response. Crohn's disease is an autoimmune disorder, where antibodies and immune cells confuse foreigners with the normal body tissue and attack normal body tissue of the intestinal tissue. Crohn's disease patients have chronic gastrointestinal inflammation that can be patchy or can cover large areas of the intestines, stomach, esophagus, mouth and colon. The intestinal wall thickens due to inflammation and this can be seen on x-ray.

There are five types of Crohn's disease. The most common is ileocolitis which involves the large bowel and distal intestinal area. Ileitis is inflammation of the ileum. There is gastroduodenal Crohn's disease, which affects the stomach and the duodenum. Jejunoileitis is inflammation of the small intestines in a complete or patchy way; Crohn's colitis affects just the large intestines.

Crohn's disease affects those at any age but is more common between the ages of 15-35. The major risk factors include having a family history of the disease, being of Jewish descent, or having a smoking history.

The major symptoms of Crohn's disease depend on where in the gastrointestinal tract the disease has taken hold. Some symptoms include crampy abdominal pain, fatigue, fever, loss of appetite, pain on passing the stool, weight loss, and frequent diarrhea. Less common symptoms include inflammation of the eye, constipation, fistulas near the rectum, pain in the joints, liver inflammation, rectal bleeding, mouth ulcers, swollen gums and skin rashes.

Exams and tests done to find the diagnosis of Crohn's disease include a physical exam that shows tenderness of the abdomen, abdominal masses, rash of the skin, mouth ulcers or swollen joints. Doctors can do a barium enema, which can show changes in Crohn's disease, colonoscopy to take samples of the colon, a CT scan of the abdomen, endoscopy or capsule endoscopy, which will show the entire digestive tract, MRI of the abdomen, or a sigmoidoscopy. An upper GI x-ray series can show Crohn's disease of the stomach, esophagus and upper small intestines. A stool culture can tell if there is another cause of the diarrheal symptoms and will be negative in Crohn's disease.

Treatment of Crohn's disease includes altering the diet so that you eat healthy calories with vitamins and protein. You need to consider eating foods that don't make gas and diarrhea worse. You need to eat small amounts of food, drink a lot of water and avoid food that is high in fiber such as bran, nuts, beans, nuts, popcorn and seeds. You need to avoid fatty foods or fried foods as well as butter, heavy cream and margarine. Limit dairy products if you can't seem to digest them well. Avoid alcohol intake and stay away from caffeine. Raw fruits and vegetables can contribute to blockage of the intestines.

Doctors may recommend iron supplements to counteract anemia, vitamin D and calcium for strong bones, and vitamin B12 to counteract anemia.

Medications are also prescribed, including medications to block antidiarrheal medications. Other medications include aminosalicylates that control inflammation of the colon and intestines. Corticosteroids are used to treat moderate inflammation. Immunomodulators like azathioprine can quiet the response of the immune system; antibiotics are used to treat rectal fistulas or abscesses in the intestinal tract. There are newer medications called biological therapies that treat Crohn's disease. They include Remicade and Humira, among others.

Surgery is a last resort for the treatment of Crohn's disease. The surgery is often a bowel resection that removes damaged portions of intestines. Surgery can be used to drain an abscess and an anastomosis can be done to connect the ends of the colon or intestine that are healthy.

Complications of Crohn's disease include hemorrhage of the colon, fistulas, narrowing of the intestines and infections or abscesses of the colon area. In some serious cases of Crohn's disease, the colon needs to be removed in its entirety and you may also need a total proctocolectomy with an ileostomy.