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Crohn's Disease

What is Crohn's Disease?

Crohn's disease is a chronic inflammatory bowel disease where areas of the bowel develop ulcerations (sores). This condition usually affects the last section of the small intestine and the first part of the large intestine, but it can affect any portion of the digestive tract. Crohn's disease is also called colitis, granulomatous enteritis, regional enteritis, ileitis, and terminal ileitis.

Crohn's and ulcerative colitis are two inflammatory bowel diseases that affect around one million people in the U.S. Jewish European Americans are four times more likely to develop these conditions than other ethnic groups. Also, men and women are equally affected by inflammatory bowel disease, and the typical age of onset is between 15 to 35 years.

Causes

Scientists do not know what causes Crohn's disease. They suspect that it occurs when the body's immune system reacts abnormally to intestinal bacteria. The immune cells and proteins in the bowel protect the body against harmful bacteria, viruses, and other foreign invaders. The continuous abnormal activation of the immune system on the intestine causes ulceration and inflammation of the bowel. It is known that Crohn's disease runs in families, and smoking increases the risk of this condition. Scientists have recently identified a gene called NOD2, which is associated with this condition.

Types of Crohn's Disease

There are four subtypes of Crohn's disease. These include:

  • Crohn's colitis – This is an inflammation of the colon only, which results in abdominal pain, bloody diarrhea, anal fistulas, and rectal abscesses.
  • Crohn's enteritis – This refers to inflammation of the small intestine, which results in abdominal pain, diarrhea, and bowel obstruction.
  • Crohn's terminal ileitis – This is inflammation that affects the end section of the small intestine, called the terminal ileum. Symptoms include abdominal pain, diarrhea, and small intestine obstruction.
  • Crohn's enterocolitis and ileocolitis – These terms describe inflammation of both the colon and small intestine. Symptoms include bloody diarrhea, abdominal pain, and small intestine obstruction.

Symptoms

There are several factors that can increase the symptoms of Crohn's disease, causing a flareup. These include smoking, hormonal changes, infections, and stress. These symptoms wax and wane. The symptoms of Crohn's disease include:

  • Abdominal pain
  • Diarrhea
  • Bloody stool
  • Weight loss
  • Poor appetite
  • Mouth sores
  • Anal tears (fissures)
  • Intestinal openings (fistulas)
  • Bowel blockages
  • Fever
  • Night sweats

Diagnosis

When a patient is evaluated for Crohn's disease, the doctor will do several diagnostic tests and a comprehensive physical examination. The tests include:

  • Colonoscopy or sigmoidoscopy – This involves a lighted, flexible tube inserted in the colon to evaluate for signs of inflammation.
  • Barium X-ray – This involves ingestion of a solution to allow the radiologist to assess the small intestine and colon.
  • Biopsy – During a colonoscopy, the doctor will take a sample of tissue to test for inflammatory bowel disease.
  • Stool analysis – This test is done to evaluate the stool for blood and infection.

Treatment

The treatment for Crohn's disease depends on the type and severity of the symptoms. The goal of therapy is to stop inflammation of the intestine and prevent flareups. Only a few people have persistent, severe symptoms. Most people with Crohn's have mild to moderate symptoms that come and go.

  • Meal plan – Because Crohn's diease makes it difficult for someone to absorb nutrients from food, the doctor will recommend a high-calorie, high-protein diet.
  • Mild symptoms – For mild symptoms the doctor will usually recommend an antidiarrheal medication, such as loperamide.
  • Moderate symptoms – When symptoms occur regularly, medications include aminosalicylates, antibiotics, corticosteroids, and immunomodulators.
  • Severe symptoms – When flareups are severe, people with Crohn's are usually hospitalized and given intravenous corticosteroids, which decrease bowel inflammation.
  • Ongoing treatment – To keep Crohn's in remission, ongoing treatment with a combination of medications is needed. This involves the use of one or more of the above mentioned drugs.

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