Crohn’s Disease

What is Crohn’s Disease?

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that can affect anywhere in the gastrointestinal (GI) tract, from mouth to anus. The severity of Crohn’s can range from mild to severe; the pattern for any individual can range from remission (no symptoms) to flares.

What Causes Crohn’s Disease?

Crohn’s disease is an immune disorder. There are various influences such as genetic susceptibility, infectious agents, and triggers in the diet and environment. However, all the factors that trigger abnormal immune function are not completely known. It is more likely that a combination of factors is involved and that these factors are not necessarily the same for all individuals.

How is Crohn’s Disease Diagnosed?

Crohn’s is different from Ulcerative Colitis in that the inflammation and ulcers can occur through all layers of the bowel wall, which would explain why abscesses (collection of pus), strictures (narrowing, which can lead to blockage), and fistulas (abnormal connections between bowel and other organs due to inflammation) are more characteristic for Crohn’s than Ulcerative Colitis. Such inflammatory communications can occur from bowel to bladder, bowel to vagina, bowel to bowel, or bowel to skin.

Nearly half of Crohn’s patients have both ileum (the end of the small bowel) and colon inflammation; approximately 1/5 have only colon inflammation, 1/3 have inflammation only in the small bowel.

Crohn’s inflammation can “skip” in the GI tract, meaning areas of ulcers can mingle with normal bowel lining. The location of the inflammation impacts the symptoms and signs that a patient will have. A person with small bowel disease may present with problems absorbing nutrients, abdominal pain, and obstruction and might not have diarrhea or rectal bleeding. A patient with colon involvement may present more with rectal bleeding and diarrhea. A patient with stomach involvement may present with nausea, vomiting. Other problems may include weight loss, anemia, fevers, failure to thrive.

Furthermore, to complicate the clinical diagnosis, GI symptoms may not correlate well with whether there is actual inflammation in the GI tract. Diarrhea symptoms may or may not be from active Crohn’s colitis (for example, diarrhea may be seen in infections, irritable bowel syndrome, medication side effects, etc.). Also, sometimes a patient may have minimal to no symptoms but have active Crohn’s disease, which may progress to complications if not treated.

Finally, approximately 1/4 to 1/3 of patients can have symptoms outside the GI tract, such as joint pains, joint swelling, inflammation of the eye, mouth sores, skin rashes, blood clots, kidney stones, bone loss, liver inflammation, bile duct inflammation, and strictures.

Testing includes colonoscopy (to look at the lining of the colon for inflammation and to take biopsies), EGD (upper endoscope test to look for upper tract Crohn’s), capsule endoscopy (to better see the lining of the small intestines that is not reached by EGD or colonoscopy), radiographic imaging (such as CT scan or MRI), standard blood tests (blood count, nutritional, inflammatory tests), specialty IBD blood tests and stool studies (inflammation and to rule out infection). Although not one of these tests diagnoses Crohn’s, the pattern of findings can support the diagnosis.

What is the Management For Crohn’s Disease?

Stop cigarette smoking. Crohn’s disease activity is worse, and treatment does not work as well in cigarette smokers.

NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen) could potentially worsen the inflammation and should be avoided.

Good nutrition, healthy lifestyles, keeping up with immunizations are beneficial.

There are studies to see if there are specific anti-inflammatory types of diets or anti-oxidant supplements that may help the condition, but diets and supplements won’t cure Crohn’s disease.

Although there is no cure for Crohn’s disease, there are many treatment options.

Treating Crohn’s early leads to better long-term outcomes and decreases complications of the disease. However, due to the many different ways Crohn’s can affect an individual, the gastroenterologist will help determine specific treatments tailored to each patient.

Medications to slow down diarrhea (although won’t help with the inflammation): Imodium, cholestyramine, colestipol, dicyclomine, hyoscyamine.

Examples of medications to help with inflammation:

• -antibiotics (metronidazole, ciprofloxacin)
• -corticosteroids (prednisone, budesonide)
• -5-aminosalicylic acids (sulfasalazine, Pentasa, Asacol, Lialda, Apriso)
• -immunomodulators (mercaptopurine, azathioprine, methotrexate)
• -biologics such as Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab), Entyvio (vedolizumab), Stelara (ustekinumab)
• There is ongoing research on other medications

Surgery may be needed for removing diseased bowel or draining an abscess/infection.

Removing the affected bowel does not cure Crohn’s disease since Crohn’s disease can occur anywhere in the GI tract and does tend to recur in the remaining bowel. Therefore, the aim of surgery in Crohn’s disease is to save as much of the bowel as possible.

What Should I Do If I Am Planning on Getting Pregnant and/or Breastfeed?

The first goal is to make sure the Crohn’s disease is in remission or as close to remission as possible since this improves pregnancy outcomes.

There are some medications that should ideally be stopped several months before pregnancy, and there are some that may be continued through pregnancy, so informing the gastroenterologist of plans for pregnancy is important. There may be instructions to avoid certain medications during pregnancy to decrease the infant’s infection risk after birth, as well as the infant’s type of immunizations allowed after certain biologics.

However, stopping medications without consulting with the gastroenterologist can be harmful since active IBD increases pregnancy complications.

Finally, there are guidelines regarding which medications may be continued during lactation.

What is the long-term outcome for Crohn’s disease?

Long-term complications may include infections (such as internal abscess), strictures, fistulas, nutritional problems, and cancer.

Up to 3/4 of patients will undergo surgery for Crohn’s disease. Recurrence of Crohn’s disease after surgery can occur, and this is monitored by the gastroenterologist.

Crohn’s patients with significant colon involvement may have increased colon cancer risk and may need closer monitoring by colonoscopy than compared to the general population.

The goal for treatment is to achieve as normal a quality of life and functional status as possible. This is achievable for many patients and even more so given the different medications that have become FDA approved since Remicade was approved in 1998 for Crohn’s Disease.

Crohn’s patients should have regular clinical, blood, and endoscopy monitoring by a gastroenterologist. Even if the patient is not on medications, monitoring for active disease is important.

Preventative health measures include recommendations of vaccinations monitoring for osteoporosis skin cancers.

All our physicians evaluate and manage patients with Crohn’s disease. If you would like to schedule a consultation visit or have questions about potential IBD research studies, please call our office at 864-232-7338.