Definition & Overview

Crohn’s disease affects the digestive tract. It usually develops near the end of the small intestine or the beginning of the large intestine, but it can also appear in the stomach, anus, esophagus, colon, throat, or mouth. The disease causes an inflammation of the digestive tract lining, which can result in severe abdominal pain, diarrhea, weight loss, fatigue, and malnutrition.

Since inflammation caused by Crohn’s disease affects the bowel tissue, it can develop into a life-threatening condition.

The exact causes of Crohn’s disease are yet to be identified, but there is a possibility that the immune system plays a role. If the immune system reacts abnormally to normal bacteria in the intestines, it can result to Crohn’s disease.

To date, there are no known cures for the disease. The available treatments are for managing the associated symptoms so that the affected person may continue functioning as normally as possible.

Cause of Condition

In the past, doctors believed that stress and diet were the primary causes of Crohn’s disease. However, in recent years, researchers have found that these factors may only aggravate the disease, but not necessarily be the causes. To date, the exact causes are yet to be identified.

However, research has shown that hereditary factors and the immune system also play a role in the development of the disease.

There is a possibility that a virus or bacterium acts as a trigger. When the immune system detects the presence of a virus or bacteria, it will naturally fight it. However, by attacking the invading virus or bacteria, the immune system may also attack the cells in the digestive tract.

Studies have also shown a possibility that Crohn’s disease can be hereditary. The disease is common in individuals whose families have it, which means that if you have a family history of the disease; it is likely that you could acquire it as well. Although it is possible that the disease is being passed down from generation to generation, many patients don’t have parents or relatives with the disease.

Even though the exact cause of the Crohn’s disease has yet to be identified, doctors have come up with a list of risk factors, such as smoking, age, ethnicity, area of residence, and non-steroidal anti-inflammatory drugs or NSAIDs.

One of the reasons why Crohn’s disease can develop into a life-threatening condition is because of the possible complications, such as:

  • Ulcers – if the inflammation persists, it can cause ulcers anywhere along the digestive tract.

  • Fistulas – If ulcers develop in the digestive tract due to chronic inflammation, these can result in the creation of fistulas (abnormal connection between body parts), which require surgical removal.

  • Inflammation - whether the inflammation is confined to the bowel wall or spreads through the wall, it can develop into serious complications such as stenosis.

  • Bowel Obstruction – Crohn’s disease thickens the bowel wall. In time, the walls can get so thick that they can begin to block the normal flow of digestive content. When this occurs, surgery will be required to remove the diseased portion.

  • Colon cancer – If Crohn’s disease affects the colon, there is a good chance that you’ll develop colon cancer. For this reason, people who have been diagnosed with Crohn’s disease need to be screened for colon cancer every 10 years.

  • Anal fissure – if the infection affects the anal tissue, it can create small tears that are not only painful, especially during bowel movement, but can also develop into a perianal fistula.

  • Malnutrition – abdominal pains and consistent episodes of diarrhea can prevent a person with Crohn’s disease from eating a normal diet, which can result in malnutrition. This can then lead to anemia.

Other than the complications mentioned above, it is also possible for Crohn’s disease to cause other complications such as liver and gallbladder disease, and osteoporosis.

Key Symptoms

Crohn’s disease will display a variety of symptoms depending on which area of the digestive tract is affected. However, most patients with the disease experience abdominal pains and diarrhea. Some people experience 20 episodes of diarrhea per day. Blood may also be present during any or all of the episodes.

Patients also usually lose weight, especially when they have difficulties in swallowing and digesting food. Other symptoms, such as mouth sores and anal tears are less common.

Who to See & Types of Treatment Available

If you develop any of the above symptoms, you should consult your doctor as soon as possible. If you experience severe abdominal pains, frequent vomiting, fever and chills, or if you have a weak or fast pulse, it is highly recommended to proceed to a hospital’s emergency department.

After performing a physical exam and asking about the symptoms you’re experiencing, the diagnosing physician will conduct a series of laboratory exams and imaging tests, such as a barium x-ray, biopsy, stool analysis, and colonoscopy.

As there is no available cure for Crohn’s disease, the doctor will only be able to treat the symptoms. The primary focus of the treatment is to reduce the inflammation in the intestine. For this, you will be prescribed with medications that will prevent flare-ups.

If the inflammation has caused bowel obstruction, you’ll need to undergo surgery to remove the diseased portion to improve the flow of your digestive contents. For cases that only display mild symptoms, the doctor may only prescribe antidiarrheal medications, such as loperamide. You may also be given antibiotics for any infections. Meanwhile, severe cases of Crohn’s disease will require hospital treatment. This will include a combination of medications, such as corticosteroids, biologics, and immunomodulators. Once the symptoms are under control, you can be released from the hospital, but you’ll need to continue your medications. Regular visits to your doctor will also be required to closely monitor your condition.

References:

  • Cheifetz AS. Management of active Crohn disease. JAMA. 2013 May 22;309(20):2150-8.

  • Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009;104(2):465-483.

  • Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

  • Sands BE, Siegel CA. Crohn's disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 111.

  • Lichenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 143.

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