Crohn’s Disease


Crohn’s disease

crohn's disease illustration of inflamed colon, gi disease, gi tract disease, gastrointestinal issue

Crohn’s disease is inflammation of any part of the digestive tract. It is often found in the intestines where the small intestine and the colon meet, causing pain and discomfort.

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Causes

While the exact cause of Crohn’s disease is unknown, this autoimmune disorder is linked to a problem with the body’s immune system response. Instead of protecting the body, the immune system’s overactive response causes chronic inflammation.

Risk Factors

Crohn’s disease may occur at any age, but typically affects people between ages 15 to 35 – especially those with these risk factors:

  • Family history of Crohn’s disease
  • Jewish ancestry
  • Smoking

Symptoms

  • Abdominal cramps and pain
  • Fever, fatigue
  • Pain when passing stool or persistent diarrhea
  • Appetite loss or unintentional weight loss

Diagnostic Tests

  • Barium enema
  • Colonoscopy
  • Computed tomography (CT scan) of the abdomen
  • Endoscopy, including capsule endoscopy
  • Magnetic resonance imaging (MRI) of the abdomen
  • Sigmoidoscopy
  • Enteroscopy
  • Upper GI series
  • A stool culture may be done to rule out other possible causes of symptoms

Treatment

There is no known cure for Crohn’s disease, but the following diet and lifestyle changes can help manage symptoms:

  • Eat a well-balanced, healthy diet with small meals throughout the day
  • Drink plenty of water, also in small amounts throughout the day
  • Avoid high-fiber foods (brand, beans, nuts, seeds, popcorn, etc), fatty/greasy foods and foods that cause gas
  • Manage stress

Over-the-counter medication, such as loperamide (Imodium) and aspirin, can be used to treat diarrhea and pain. Fiber supplements may also help. Other medications may be prescribed, including:

  • Aminosalicylates (5-ASAs) to help control mild to moderate symptoms. Some forms of the drug are taken by mouth; others must be given rectally.
  • Corticosteroids (prednisone and methylprednisolone) are used to treat moderate to severe Crohn’s. They may be taken by mouth or inserted into the rectum.
  • Medicines such as azathioprine or 6-mercaptopurine quiet the immune system’s reaction.
  • Antibiotics may be prescribed for abscesses or fistulas.

For patients who do not respond to medication, a type of surgery called bowel resection may be needed to remove a damaged or diseased part of the intestine or to drain an abscess. However, removing the diseased portion of the intestine does not cure the condition.

Complications

It's possible for patient of Crohn's disease to develop one or more of the following complications:

  • Anal fissure: A small tear in the tissue around the anus, often causing painful bowel movements and potentially leading to a perianal fistula.
  • Arthritis: A potential health issue associated with Crohn's disease.
  • Bowel obstruction: Occurs when the normal flow in the intestines gets blocked.
  • Blood clots: Crohn's increases the risk of blood clots in veins and arteries.
  • Colon cancer: If Crohn's disease affects your colon, your risk of colon cancer increases.
  • Fistulas: Abnormal connections between different body parts, often occurring near or around the anal area (perianal).
  • Gallbladder: Crohn's disease may impact the gallbladder.
  • Liver disease: Crohn's disease may also affect the liver.
  • Low iron (anemia): A potential consequence of Crohn's.
  • Malnutrition: Difficulty in eating or absorbing enough nutrients due to diarrhea, abdominal pain, and cramping.
  • Medication risks: Certain drugs used to treat Crohn's, which block immune system functions, are associated with a small risk of developing cancers like lymphoma and skin cancers, as well as an increased risk of infections.
  • Skin disorders: Hidradenitis suppurativa is a condition that many people with Crohn's may develop.
  • Ulcers: Sores that can develop on the inner lining of the digestive tract.

When to See a Doctor 

If you notice consistent changes in your bowel habits or experience any signs and symptoms associated with Crohn's disease, it's strongly advised to schedule an appointment with either your primary care doctor or Charleston GI doctors. Patients should seek a doctor immediately upon noticing:

  • Abdominal pain: Any persistent discomfort in your stomach area.
  • Blood in your stool: If you observe blood during bowel movements.
  • Nausea and vomiting: Feeling queasy and throwing up.
  • Diarrhea lasting more than two weeks: Unusual and prolonged bouts of loose stools.
  • Unexplained weight loss: Dropping pounds without an apparent cause.
  • Fever: If you have a fever along with any of the symptoms mentioned above.

Taking prompt action when these signs appear is crucial for effective diagnosis and management of potential health issues.

Prevention

DIET

While there's no solid proof that specific foods cause Crohn's disease, certain items can worsen symptoms during a flare-up. Keeping a food diary can help track what you eat and how you feel. If you notice certain foods triggering symptoms, try cutting them out. Some general dietary tips include:

  • Considering multivitamins: Crohn's can interfere with nutrient absorption, so supplements may be beneficial. Consult your doctor before adding any to your routine.
  • Eating small meals: Opt for five or six small meals a day rather than a few large ones.
  • Limiting dairy products: Many people with Crohn's find relief from issues like diarrhea and abdominal pain by cutting back on or avoiding dairy. Lactose intolerant? Using products like Lactaid might help.
  • Staying hydrated: Drink plenty of fluids, especially water. Avoid alcohol and caffeinated drinks, which can worsen diarrhea, and be cautious with carbonated drinks to minimize gas.
  • Consulting a dietitian: If you're losing weight or have a limited diet, a registered dietitian can provide valuable guidance.

SMOKING

Smoking not only increases the risk of developing Crohn's but also worsens the condition once you have it. Quitting smoking not only benefits your digestive tract but also improves overall health.

STRESS

While stress isn't the cause, it can exacerbate symptoms and trigger flare-ups. Manage stress with:

  • Biofeedback: This technique helps reduce muscle tension and slow heart rate using a feedback machine, aiming to achieve a relaxed state for better stress management.
  • Exercise: Even light exercise can reduce stress, alleviate depression, and normalize bowel function. Discuss an exercise plan with your doctor.
  • Relaxation and breathing exercises: Regularly practice techniques like deep, slow breathing to calm down. Consider yoga or meditation classes, or use resources like books, CDs, or DVDs at home to enhance your stress coping skills.

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Crohn’s Disease Frequently Asked Questions

What is Crohn's disease?
Crohn’s disease is a chronic inflammatory bowel disease that often causes abdominal pain, fatigue, weight loss, diarrhea, and anemia.

This GI condition affects the digestive tract’s lining, and while it cannot be cured, some treatments have proven effective in managing symptoms. In some patients, certain medications like immunosuppressants and steroids can slow the disease’s progression, and in other cases, surgery is beneficial. Because the disease can also have serious complications, it is important that patients get routine colorectal cancer screenings.

 

Is Crohn's disease fatal?
Yes, if left untreated, Crohn’s disease can result in death. Chronic inflammation can lead to potentially life-threatening complications, but with proper care from a gastroenterologist, most patients never experience complications.

 

Can it be cured with surgery?

In truth, it's important to know that surgery doesn't equal a cure.

When you undergo surgery for Crohn’s disease, the damaged part of your digestive tract gets removed, and then the healthy parts get stitched back together. This procedure can also address issues like closing fistulas and draining abscesses.

Unfortunately, the relief from surgery is often temporary. The disease tends to make a comeback, and it likes to show up around the reconnected tissue. To lower the chances of it bouncing back, the smart move is to follow up surgery with medication. This combination of surgery and medication gives you a more solid plan for handling the disease in the long haul.

Diet changes, lifestyle adjustments, medications, and other treatments can help. And when they don't, your doctor might bring up the option of surgery. About half of folks dealing with the disease end up having surgery at some point, but surgery doesn't always equal a cure.

 

What's life expectancy with Crohn's disease?
According to 2020 data, the average life expectancy for women with Inflammatory Bowel Disease (IBD) is 78.4 years, and for men, 75.5 years.

 

Is Crohn's disease an autoimmune disease? 
Some medical experts believe Crohn’s disease to be an autoimmune disease, but others remain unconvinced. Continued research is being conducted, and while most medical professionals agree on the immune system’s involvement, they are unsure about labeling Crohn’s disease as an autoimmune disorder. 

An autoimmune disorder causes the body’s immune system to attack itself, targeting healthy bacteria instead of harmful ones. To learn more about other potential causes, schedule an appointment with your GI specialist.

 

How do you get Crohn's disease?
Unfortunately, the cause of Crohn’s disease is still unknown. Lifestyle factors, like diet and stress, were once thought to be causes, but now it seems more likely that genetics or an improperly functioning immune system may be to blame.

 

How is Crohn's disease diagnosed? 
At Charleston GI, our board certified gastroenterologists may use one of the following methods to diagnose Crohn’s disease:

  • Barium enema
  • Colonoscopy
  • Computed tomography (CT scan) of the abdomen
  • Endoscopy, including capsule endoscopy
  • Magnetic resonance imaging (MRI) of the abdomen
  • Sigmoidoscopy
  • Enteroscopy
  • Upper GI series
  • A stool culture (to rule out other conditions)

 

What does Crohn's disease poop look like?
Crohn’s disease patients may notice that their stools have a yellow coating. This is due to mucus and is no cause for concern. In fact, abnormal stools are a common symptom, especially when patients are experiencing a flare-up. Abnormal stools may appear loose/watery, hard, bloody, strangely colored, or covered in mucus.

 

Is Crohn's disease contagious?
No. There is no evidence that Crohn’s disease is contagious or can be spread through pathogens.

 

Is Crohn's disease genetic? 
It is unclear whether Crohn’s disease is genetic, but it does appear to run in families. Research shows that about 15% of those affected have a first-degree relative who also suffers from Crohn’s disease. 

 

What should you not eat when you have Crohn's disease?
Your gastroenterologist can help create a nutrition plan, customized to meet your specific needs. Most patients are advised to avoid:

  • Alcohol
  • Butter, mayonnaise, margarine, oils
  • Carbonated beverages
  • Coffee, tea, chocolate
  • Corn
  • Dairy products (if lactose intolerant)
  • Fatty or fried foods
  • High-fiber foods

 

What can you eat with Crohn's disease? 
Your GI specialist can help customize your diet plan, and may encourage consumption of the following foods:

  • Fruits and vegetables
  • Yogurt
  • Oily fish
  • Cooked carrots
  • Cereals
  • Potatoes
  • Low-fiber foods

 

Is Crohn's disease a disability? 
According to the Social Security Administration, Crohn’s disease is considered a qualifying condition under listing 5.06, Inflammatory Bowel Disease. If your medical records show that your GI condition meets criteria, your disability claim will be approved.

 

What does Crohn's disease feel like? 
Because it causes inflammation of your digestive tract, Crohn’s disease results in a variety of GI symptoms, like abdominal pain, fatigue, diarrhea, unintentional weight loss, and malnutrition. Keep in mind that symptoms are often linked to the area of the digestive tract that is inflamed. 

Pain may be mild or severe, often affecting the abdomen, joints, lower abdomen, or rectum. In addition to pain, other gastrointestinal symptoms include diarrhea, nausea, vomiting, flatulence, bloating and more.

 

What are Crohn's disease symptoms in women? 
Men and women are equally likely to be diagnosed with Crohn’s disease. In addition to the symptoms commonly experienced by men, women also frequently experience menstrual period-related problems. Research shows that many women the disease experience more GI symptoms during menstruation than women without the disease. Women may also experience infertility, anemia, osteoporosis, or sexual dysfunction.

 

Who is at risk for Crohn’s disease?
Risk factors may include:

  • Age
    While Crohn's disease may occur at any age, most people are diagnosed before age 30.
  • Ethnicity
    White people have the highest risk, especially those of Eastern European Jewish descent. 
  • Family history
    As many as 1 in 5 people with Crohn's disease have a first-degree family member with the disease.
  • Smoking
    Cigarette smoking not only increases the risk of getting Crohn’s, but of needing surgery. 
  • Nonsteroidal anti-inflammatory medications
    Medications like ibuprofen (Advil, Motrin), naproxen sodium (Aleve), and diclofenac sodium may lead to bowel inflammation, worsening the disease.

 

When should I see a doctor for Crohn’s disease? 
If you are experiencing any lingering changes in your bowel habits, or any of the symptoms listed below, schedule an appointment with a gastroenterologist near you.

  • Abdominal pain
  • Nausea and vomiting
  • Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications
  • Bloody stools
  • Fever lasting more than a day or two
  • Unexplained weight loss

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