An overview of Crohn’s Disease

Crohn's disease is a type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.

Crohn’s disease most commonly occurs in the small intestine and the colon. It can affect any part of your gastrointestinal (GI) tract, from the mouth to the anus. It can involve some parts of the GI tract and skip other parts.

There are five types of Crohn’s disease. Each affects a different part of the GI tract:

Ileocolitis : This is the most common type, and it affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen.

Ileitis : This only affects the small intestine. The symptoms are the same as those of ileocolitis, but a person with a severe case could develop fistulas or an inflammatory abscess.

Gastroduodenal Crohn’s disease : This affects the stomach and the beginning of the small intestine. Symptoms may include nausea, vomiting, loss of appetite, and unexplained weight loss.

Jejunoileitis : This causes spots of inflammation in the upper area of the small intestine, called the jejunum. Symptoms include abdominal cramping after meals, diarrhea, and in severe cases, fistulas.

Crohn’s colitis : This only affects the large intestine, or colon. Symptoms may include diarrhea, rectal bleeding, and damage around the anus, such as ulcers, fistulas, and abscesses. It can also cause joint pain and skin lesions.

The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate, but don't cause, Crohn's disease. Several factors likely play a role in its development.

Immune system : It's possible that a virus or bacterium may trigger Crohn's disease; however, scientists have yet to identify such a trigger. When your immune system tries to fight off an invading microorganism or environmental triggers, an atypical immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity : Crohn's disease is more common in people who have family members with the disease, so genes may play a role in making people more likely to have it. However, most people with Crohn's disease do not have a family history of the disease.

Symptoms of Crohn’s disease vary, depending on which part of the gut the condition affects. They often include:

Pain : The level of pain varies from person to person and depends on where the inflammation is in the gut. People tend to experience pain in the lower right side of the abdomen.

Ulcers in the gut : These are raw areas that may bleed. If this happens, a person may find blood in their stools.

Mouth ulcers : These are a common symptom.

Diarrhea : This can range from mild to severe, and there may be mucus, blood, or pus. A person may also feel the urge to have a bowel movement but find that nothing comes out.

Fatigue : People with Crohn’s disease often feel very tired, and they may have a fever.

Altered appetite : At times, a person may experience appetite loss.

Weight loss : This can result from a loss of appetite.

Anemia : A loss of blood can lead to anemia.

Rectal bleeding and anal fissures : The skin of the anus becomes cracked, leading to pain and bleeding.

There’s no way to prevent Crohn’s disease. These healthy lifestyle changes can ease symptoms and reduce flare-ups:

1. Stop smoking.

2. Eat a healthy, low-fat diet.

3. Exercise regularly.

4. Manage stress.

A doctor will ask a person about their symptoms. A physical examination may reveal a lump in the abdomen resulting from when loops of inflamed bowels became stuck together.

How to test

The following tests may help in the diagnosis:

stool and blood tests

sigmoidoscopy, which involves using a short, flexible, tube-like tool, a sigmoidoscope, to investigate the lower bowel

colonoscopy, which involves using a flexible, tube-like tool, a colonoscope, to investigate the colon

endoscopy, which involves inserting a long, thin, flexible tool called an endoscope down through the esophagus and into the stomach to investigate the upper part of the gut

CT scan or barium enema X-ray, which help reveal changes in the bowel

biopsy

Treatment for Crohn’s disease varies depending on what’s causing your symptoms and how severe they are for you. In children, the goal in treatment is to induce remission (the time between symptom flare-ups), maintain remission and manage any complications of Crohn’s disease over time.

Your healthcare provider may recommend one or more of these treatments for Crohn's disease:

Antibiotics : Antibiotics can prevent or treat infections. Severe infections can lead to abscesses (pockets of pus). Or they can cause fistulas (openings or tunnels that connect two organs that don’t normally connect).

Antidiarrheal medication : Prescription medications like loperamide (Imodium A-D®) can stop severe diarrhea.

Biologics : These medications include monoclonal antibodies to suppress the immune response.

Bowel rest : To give your intestines a chance to heal, your provider may recommend going without food or drink for several days or longer. To get the nutrition you need, you may receive intravenous (parenteral) nutrition. Only drink a prescribed liquid or have a feeding tube during this time.

Corticosteroids : Cortisone, prednisone and other corticosteroids ease inflammation brought on by autoimmune disease.

Immunomodulators : These drugs calm inflammation by suppressing an overactive immune system. They include azathioprine and cyclosporine.

Surgery : Surgery won’t cure Crohn’s disease, but it can treat complications. You may need surgery to correct intestinal perforations (holes), blockages or bleeding.

There is no known cure for Crohn’s disease. People can help manage their symptoms using natural treatments that are complementary to prescription medications.

Some natural approaches to Crohn’s disease symptoms include:

Dietary changes : During a flare-up, avoid high fiber foods, dairy, sugar, high fat foods, and spicy foods. Between flare-ups, drink more water, eat small meals, boil or steam food instead of frying it, and keep a food diary to track the effects of different foods.

Behavioral changes : Consider quitting smoking, if this applies. And try relaxation practices and techniques, such as meditation, mindfulness, and yoga. Exercise and mental health counseling could be helpful, as well.

Supplements : Certain supplements, including curcumin, probiotics, bromelain, and wormwood, may prove effective.

Essential oils : Some essential oils, such as patchouli, peppermint, and fish oil, may help reduce inflammation.

There is not enough scientific evidence to confirm that any of these approaches are safe and effective.

However, experts say that quitting smoking can help reduce the severity of symptoms and the frequency of flareups. People with Crohn’s who continue to smoke are more likely to have intestinal strictures and other complications.