Crohn's disease has an inflammatory pattern that goes deeper into the intestinal wall than the inflammation associated with ulcerative colitis. Consequently, Crohn's disease may cause the intestinal wall to thicken, resulting in narrowing and even complete blockage of the bowel channel. In addition, erosion of the bowel wall can extend into other abdominal tissue and even through the abdominal wall or rectum, causing extensive abdominal infections. Although Crohn's disease usually affects the small intestine, it can also occur in the mouth, esophagus, stomach, duodenum, large intestine, appendix, and anus.
Crohn's disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of inflammatory bowel disease (IBD), most often a brother or sister and, sometimes, a parent or child.
About 90 percent of people with Crohn's disease experience frequent and progressive symptoms of abdominal pain (often the lower right area), diarrhea, and weight loss. Fever and persistent rectal bleeding may also occur, often resulting in anemia and fatigue. Although uncommon, Crohn's may develop in the childhood years and cause additional problems of delayed development and stunted growth.
In addition to a thorough history and physical exam, your health care provider may order diagnostic tests to determine if there are inflammatory conditions in the bowel. These tests help your physician determine the etiology and extent of disease.
Diagnostic Tests for Crohn's Disease
Check for signs of bleeding, such as anemia, or uncover a high white blood cell count which indicates inflammation.
Fecal occult blood test
Tests a sample of stool for microscopic evidence of bleeding.
Use of a small flexible tube allowing the physician to examine the lining of the upper intestine for signs of inflammation or bleeding.
Upper GI series
Barium, a chalky liquid that is swallowed, coats the bowel so that abnormal areas will be more easily visualized on a series of x-rays.
Directly examines the lining of the bowel for signs of inflammation or bleeding.
Barium, a chalky liquid given as an enema, coats the bowel so that abnormal areas will be more easily visualized on x-ray.
The treatment for Crohn's disease varies depending on the extent and severity of thedisease, complications, and response to medical therapies. Crohn's is a chronic disease, with no known cure. However, there are a variety of treatments that make the disease more manageable. Health care providers select the most appropriate interventions to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. This may include drugs, nutrition support, surgery, or a combination of these options. Some people have long periods of remission, when they are free of symptoms. However, because the disease usually recurs at some point, careful monitoring of symptoms and medical follow-ups are very important in minimizing the complications associated with Crohn's disease.
Most people are first treated with medications to help control inflammation. In active, severe cases, immune suppressing medications are given to block the immune reaction that causes the inflammation. Additional medications to control diarrhea and relieve pain and treat infections are given as needed.
Nutritional support and nutritional supplements may be recommended for those with weight loss or children whose growth has been slowed. Special high calorie liquid formulas are sometimes used for this purpose. A small number of people may need to eliminate oral food and fluids, temporarily, to give the inflamed intestines a rest. During these periods, parenteral nutrition where special nutrition formulas are given intravenously, may be needed.
There is no specific diet that is routinely recommended for IBD. Maintaining good nutrition is of primary importance for those with IBD. Nutritional counseling with a registered dietitian can help with planning a diet that minimizes symptoms. It may be a challenge to avoid foods that trigger symptoms and still get balanced nutrition. Likewise, the inflammatory condition can impair complete absorption of the nutrients that are consumed. In these cases, a dietitian or health care provider may recommend nutritional supplements.
Sometimes surgery is required, either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine. Although surgery to remove the diseased part of the intestine may be needed to correct the complications, it is not a cure for Crohn's disease. Over time, the inflammation tends to recur in sections of the intestine that remain.
Cancer and Crohn's Disease
The risk of cancer in Crohn's disease is lower than in ulcerative colitis. Crohn's typically involves the small intestine and small intestinal cancer is extremely rare in all populations. However, those with long-standing Crohn's disease are at a slightly greater risk of developing cancers in both affected and non-affected areas of the small and large intestine, as well as other nearby tissues.