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In the Know - All About...Crohn's Disease

In the Know

All about… Crohn’s disease

 

Crohn’s disease is an inflammatory bowel disease (IBD).  

 

Crohn’s disease causes inflammation of the digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.  

 

Crohn’s inflammation often spreads deep into the layers affected tissue.  Crohn’s can be both painful and debilitating, and sometimes may lead to life-threatening complications.

 

While there’s no known cure, various treatments can greatly reduce signs and symptoms—and even bring about long-term remission.  With treatment, many people with Crohn’s disease are able to function well.

 

Symptoms

Crohn’s symptoms usually develop gradually but sometimes come on suddenly without warning.  These can range from mild to severe.  Periods of remission are also not uncommon.

 

Active symptoms include diarrhea, fever, fatigue, abdominal pain and cramping, bloody discharge, mouth sores, reduced appetite and weight loss, and pain or drainage near or around the opening due to inflammation from a tunnel into the skin (fistula)

 

Other signs and symptoms include inflammation of skin, eyes, joints, liver or bile ducts, and delayed growth or development in children.

 

Complications

 

Crohn’s disease may lead to one or more of the following complications:

 

Bowel obstruction.  Crohn’s affects the thickness of the intestinal wall.  Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents.

 

Ulcers. Chronic inflammation can lead to open sores (ulcers) anywhere in the digestive tract, including the mouth.

 

Fistulas.  Sometimes ulcers can extend completely through the intestinal wall, creating a fistula—an abnormal connection between different body parts.  When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption.  Fistulas may occur between loops of bowel, into the bladder or elsewhere, or out through the skin, causing continuous drainage of bowel contents to the skin.  In some cases, a fistula may become infected and form an abscess, which can be life-threatening if not treated.

 

Malnutrition.  Diarrhea, abdominal pain and cramping may make it difficult for the patient to eat or for the intestine to absorb enough nutrients to keep the patient nourished.  

 

Colon cancer.  The disease’s effects on the colon increase risk of colon cancer.  General colon cancer screening guidelines call for a colonoscopy every ten years beginning at age 50.  Crohn’s patients should ask their doctors if they need that test earlier and more frequently.

 

Causes

The exact cause of Crohn’s disease remains unknown.  A number of factors, such as heredity and a malfunctioning immune system, likely play a role in its development.

 

Immune system

It’s possible that a virus or bacterium may trigger Crohn’s disease.  When the immune system tries to fight off an invader, an abnormal response causes the system to attack the digestive tract.

 

Heredity

Most people with Crohn’s don’t have a family history, but Crohn’s is more common in people who have family members with the disease, so genes may play a role.

 

Diagnosis

There is no single test to specifically diagnose Crohn’s disease.  Crohn’s is likely to be diagnosed only after other possible causes for signs and symptoms are ruled out.

 

To diagnose Crohn’s, a doctor will likely use a combination of any of the following:

 

Blood tests will test for anemia (low red blood cell count), infection, or fecal blood.

 

Procedures include: colonoscopy, which looks at the entire inside of the colon with a tiny camera on an inserted tube; CT and/or MRI scans; capsule endoscopy (a tiny camera in a pill); or balloon-assisted enteroscopy, which allows doctors a better view of the insides of the small bowel.

 

Treatment

With Crohn’s, there is no one treatment that works for everyone.  The goal of Crohn’s treatment is to reduce the inflammation behind the symptoms and improve long-term prognosis by limiting complications.

 

In best-case scenario, treatment may lead not only to relief but also to long-term remission.

 

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first treatment for Crohn’s.  They include corticosteroids (usually prescribed short-term); oral 5-aminosalicylate drugs (not widely used); immunosuppressants (Azasan, Imuran, Purinethol or Purixan); TNF inhibitors (Cimzia, Humira or Remicade), or Trexall (for people who don’t respond well to other drugs).  A psoriasis drug called Stelara has also been shown to be useful in treating Crohn’s, too.

 

Antibiotics

 

Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease.  Frequently prescribed antibiotics include Cipro and Flagyl.

 

Other medications

In addition to controlling inflammation, some medications may help relieve other signs and symptoms.

 

Fiber supplements like Citrucel or Metamucil can help relieve mild to moderate diarrhea.  Imodium A-D may be effective for more severe cases.

 

Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol, others) may be recommended—but not other OTC pain relievers based on ibuprofen (like Advil or Motrin IB) or naproxen sodium (like Aleve).  Ibuprofen or naproxen sodium are likely to make symptoms worse.

 

Iron supplements may be needed to counteract iron deficiency anemia resulting from chronic intestinal bleeding

 

Vitamin B-12 shots counteract the vitamin B-12 deficiency associated with Crohn’s.

 

Medication risks

Certain Crohn’s drugs block functions of the immune system are associated with a small risk of cancers like lymphoma or skin cancers.  They also increase risk of infection.  Work with your doctor to determine risks and benefits of various medications.

 

Corticosteroids can be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes and high blood pressure, among others.

 

Entyvio and Tysabri work by stopping certain immune cell molecules from binding to other cells in the intestinal lining.  But because Tysabri is associated with a rare but serious risk of a certain brain disease that usually leads to death or severe disability, patients must be enrolled in a special restricted distribution program to use it.

 

Nutrition therapy

In some cases, a doctor may recommend a special diet via feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat Crohn’s disease.  This can improve overall nutrition and allow the bowel to rest.  Bowel rest can reduce short-term inflammation.

 

The doctor may prescribe a combination of short-term nutrition therapy and medications like immune system suppressors.  Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.

 

The doctor may also recommend a low-residue or low-fiber diet to reduce the risk of intestinal blockage where the patient has a narrowed bowel (stricture).

 

Surgery

Doctors may recommend surgery if diet and lifestyle changes, drug therapy, or other treatments don’t relieve signs and symptoms.  Almost half of Crohn’s patients will need at least one surgery—but, surgery does not cure Crohn’s disease.

 

In surgery, the surgeon will remove a damaged portion of the digestive tract and then reconnect healthy sections.  Surgery may also be used to close fistulas and drain abscesses.

 

Also, the benefits of Crohn’s surgery are usually temporary.  Unfortunately, the disease often recurs, frequently near reconnected tissue.  As such, the best approach is to follow surgery with medication to minimize the risk of recurrence.

 

Diet

While there is no evidence that what you eat actually causes Crohn’s disease, certain foods and beverages can aggravate signs and symptoms, especially during a flare-up.

 

Therefore, it can be helpful to track what you eat and drink every day, and how food/drink makes you feel, by keeping a food diary.  Your food diary may help you discover which food or drink cause symptoms to flare, allowing you to try eliminating them.  

 

In the meantime, here are some helpful suggestions:

 

Limit dairy products. Many people with inflammatory bowel disease find that symptoms improve by limiting or eliminating dairy products—you may be lactose intolerant.

 

Try low-fat foods.  People with Crohn’s disease of the small intestine may be unable to digest or absorb fat normally.  Try avoiding butter, margarine, cream sauces and fried foods.

 

Limit fiber.  High-fiber foods like as fresh fruits and vegetables and whole grains, may worsen symptoms of inflammatory bowel disease.  Try steamed, baked or stewed fruits and veggies instead.

 

Spicy foods, alcohol, and caffeine may also make signs and symptoms worse.

 

Other dietary measures

Eat smaller meals.  Patients may find that eating five or six small meals a day rather than two or three larger ones leaves them feeling better.

 

Drink plenty of liquids daily—water is best!  Drinks containing caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.

 

Consider multivitamins.  Because Crohn’s can interfere with the ability to absorb nutrients, especially on a limited Crohn’s diet, multivitamin and mineral supplements are often helpful.

 

See a dietitian.  A professional registered dietitian will help you develop a diet and meal plan if you begin to lose weight or your diet has become very limited.

 

Don’t smoke!

Smoking increases risk of developing Crohn’s—and once you have it, smoking can make it worse.  Smokers with Crohn’s are likelier to have relapses and need medications and repeat surgeries.

 

Stress

Stress doesn’t cause Crohn’s—but can make signs and symptoms worse and trigger flare-ups. Learn ways to help manage stress, like exercise, biofeedback and relaxation and breathing exercises.

 

Prognosis

Crohn’s disease doesn’t just affect patients physically—it takes an emotional toll as well.  If signs and symptoms are severe, life may revolve around a constant need to use the facilities—even mild symptoms can make it difficult to be out in public.  All these factors can alter life and even lead to depression.  But here are some things you can do:

 

Be informed.  One of the best ways to be more in control is to become a Crohn’s expert—to teach yourself as much as possible about Crohn’s disease.

 

Join a support group.  Although support groups aren’t for everyone, they can provide valuable information about your condition as well as emotional support.  Group members frequently know about the latest medical treatments or integrative therapies.  You may also find it reassuring to be with others with Crohn’s disease.

 

At the end of the day, although living with Crohn’s disease can be discouraging, research is ongoing—and the outlook is improving.