What is Crohn's Disease?
Crohn's disease is a type of inflammatory bowel disease, an autoimmune disease in which the body’s immune system attacks healthy tissue. The body's immune system recognizes the lining of the digestive tract as foreign and attacks that cause inflammation. This inflammation leads to ulcers.
Normally, Crohn's disease affects the last part of the small intestine (ileum) and some parts of the large intestine. However, it can affect the entire digestive tract (mouth to eh anus)
Crohn's disease can be genetic as it tends to run in families. However, it is not entirely due to genetics.
Types of Crohn's Disease
Inflammatory: inflammation only in the affected location
Fibrostenotic: inflammation causing scar tissue and narrowing of the bowel
Fistulizing: inflammation that tunnels through all three layers of the bowel and causes connection/track between the gastrointestinal tract and another part of the body
Symptoms
Abdominal pain
Diarrhea
Fatigue
Anal pain
Weight loss
Symptoms that are outside of bowel-related symptoms
Mouth sores
Arthritis
Inflammation of eyes: uveitis or scleritis
Floaters in the vision, eye pain, blurred vision, sensitivity to light
Anal related problems
Fissures (tear), ulcers, fistulas, narrowing of the anus
Skin lesions
Erythema nodosum (EN): tender, erythematous nodules
Diagnosis
There is no single diagnostic test for Crohn's disease. Thus, a combination of tests and procedures confirms the diagnosis.
Tests:
Blood and stool tests
Blood test to show anemia, infection, specific inflammatory markers
Stool tests to show inflammation and/or pathogenic bacteria
Imaging Tests
Capsule endoscopy
Endoscopy
Colonoscopy
CT scan
MRI
X-rays
Treatment/Care
The goals of treatment include the management of symptoms, the accomplishment of remission, prevention of flares, and control of the inflammation.
Anti-inflammatory medications
Steroids
-5-aminosalicylates and sulfasalazine
Immunomodulators for severe Crohn: azathioprine, 6-mercaptopurine, methotrexate
Biologic response modifiers: work in combination with medications above
Expensive and reserved for severe symptoms
Infliximab (Remicade), Adalimumab (Humira), Certolizumab pegol (Cimzia), Vedolizumab (Entyvio), and Ustekinumab (Stelara)
Surgery
If medical treatment fails to control the symptoms and complications, surgery must be considered for the following cases. Surgery does not cure Crohn's disease.
Fistula removal
Strictureplasty – widens narrowed section and opens the blockage
Small or large bowel resection – remove the damaged portion and rejoin the healthy ends
Proctocolectomy and colectomy – very rare case when the color or rectum is removed.
Lifestyle Changes
Exercise
Stop smoking: may worsen Crohn's disease symptoms and cause complications that require surgical intervention
Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) (Motrin, Advil) and naproxen (Aleve)
Colon Cancer Screening: Crohn's disease increases the risk of developing colorectal cancer. Therefore, it is recommended to start a colonoscopy early and more often
Diet
Food does not cause inflammation of the bowel. However, some foods and beverages can aggravate the symptoms.
Avoid problematic foods: spicy foods, alcohol, caffeine
Avoid high-fat foods: the small intestine cannot digest fat normally. Thus, this can worsen diarrhea.
Drink more water
Avoid large meals
Reduce dairy: may develop lactose intolerance in which people have difficulty digesting the lactose in dairy products. The symptoms could include abdominal pain, gas and diarrhea with intake of dairy products
Plan with dietitian: if the diet is too limited or experiencing weight loss unintentionally, highly recommend visiting a registered dietitian
If you are looking into implementing any lifestyle changes or diet, our team of doctors and dietitian can help! DoctorHere’s care team is here for you to provide a one-on-one personalized plan. If you would like to know more about DoctorHere, please visit www.doctorhere.com/membership
References
Bernett CN, Krishnamurthy K. Cutaneous Crohn Disease. In: StatPearls [Internet]. StatPearls Publishing; 2022.
Sands BE. From symptom to diagnosis: clinical distinctions among various forms of intestinal inflammation. Gastroenterology. 2004;126(6):1518-1532.
Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. Official journal of the American College of Gastroenterology | ACG. 2018;113(4):481.