WHAT IS CROHN'S DISEASE?
Crohn’s disease is a chronic, or long-term, condition that causes inflammation of the digestive tract. Crohn’s disease can be painful, debilitating, and sometimes life-threatening.
Crohn’s disease is an auto-immune mediated inflammatory condition that can affect any portion of the gastrointestinal (GI) tract, from the mouth to the anus.
The disease primarily involves the intestinal system, but it also has a variety of extraintestinal manifestations and can affect the skin, joints, bones, eyes, kidneys, and liver.
Symptoms of Crohn’s disease can be unpleasant. They include intestinal ulcers, discomfort, and pain.
Although Crohn’s disease typically starts in childhood or early adulthood, it can start at any age.
SymptomsIn Crohn's disease, any part of your small or large intestine can be involved, and it may be continuous or may involve multiple segments. In some people, the disease is confined to the colon, which is part of the large intestine.
Signs and symptoms of Crohn's disease can range from mild to severe. They usually develop gradually, but sometimes will come on suddenly, without warning. You may also have periods when you have no signs or symptoms (remission).
When the disease is active, signs and symptoms may include:
- Abdominal pain and cramping
- Blood in your stool
- Mouth sores
- Reduced appetite and weight loss
- Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)
Other signs and symptomsPeople with severe Crohn's disease may also experience:
- Inflammation of skin, eyes, and joints
- Inflammation of the liver or bile ducts
- Kidney stones
- Iron deficiency (anemia)
- Delayed growth or sexual development, in children
When to see a doctorSee your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn's disease, such as:
- Abdominal pain
- Blood in your stool
- Nausea and vomiting
- Ongoing bouts of diarrhea that don't respond to over-the-counter (OTC) medications
- Unexplained fever lasting more than a day or two
- Unexplained weight loss
What causes Crohn’s disease?It isn’t clear what causes Crohn’s disease. However, the following factors may influence your chances of developing it:
- your immune system
- your genes
- your environment
According to a 2012 study, certain factors can affect the severity of your symptoms. These include:
- whether you smoke
- your age
- whether or not the rectum is involved
- length of time you’ve had the disease
People with Crohn’s are also more likely to develop intestinal infections from bacteria, viruses, parasites, and fungi. This can affect the severity of symptoms and create complications.
Yeast infections are common in Crohn’s and can affect both the lungs and the intestinal tract. These infections must be diagnosed and properly treated with antifungal medications to prevent further complications.
Crohn’s diagnosisNo single test result is enough for your doctor to diagnose Crohn’s disease. They will begin by eliminating other possible causes of your symptoms.
Your doctor may use several types of tests to make a diagnosis:
- Blood tests can help your doctor look for certain indicators of potential problems, such as anemia and inflammation.
- A stool test can help your doctor detect blood in your GI tract.
- Your doctor may request an endoscopy to get a better image of the inside of your upper gastrointestinal tract.
- Your doctor may request a colonoscopy to examine the large bowel.
- Imaging tests like CT scans and MRI scans give your doctor more detail than an average X-ray. Both tests allow your doctor to see specific areas of your tissues and organs.
- Your doctor will likely have a tissue sample, or biopsy, taken during an endoscopy or colonoscopy for a closer look at your intestinal tract tissue.
Once your doctor has completed reviewing all the necessary tests and ruled out other possible reasons for your symptoms, they may conclude that you have Crohn’s disease.
Your doctor may go on to request these tests several more times to look for affected tissue and determine how the disease is progressing.
There are five types of Crohn’s disease, and each affects a different part of the GI tract:
- Ileocolitis: This is the most common type of Crohn’s disease. It affects the small and large intestines. Symptoms include diarrhea, unexplained weight loss, and pain in the lower and middle abdomen.
- Ileitis: This form of the condition only affects the small intestine. The symptoms are the same as in ileocolitis, but a person with a severe case could develop fistulas or an inflammatory abscess.
- Gastroduodenal Crohn’s disease: This affects the stomach and the beginning of the small intestine. Symptoms may include nausea, vomiting, loss of appetite, and unexplained weight loss.
- Jejunoileitis: This causes spots of inflammation in the upper portion of the small intestine, called the jejunum. Symptoms include abdominal cramping after meals, diarrhea, and, in severe cases, fistulas.
- Crohn’s colitis: This only affects the colon. Symptoms may include diarrhea, rectal bleeding, diseases around the anus, ulcers, fistulas, abscesses, joint pain, and skin lesions.
Crohn’s disease in childrenIBDs, such as Crohn’s disease, are common in children and adolescents. Crohn’s disease in children presents similarly to how it does in adults. Typical symptoms include:
- unexplained weight loss
- bloody diarrhea
- abdominal pain
Children with Crohn’s disease may also experience less common symptoms, such as poor growth and anemia.
When a doctor treats a child with Crohn’s disease, they must consider the effects of the disease on a child’s growth, development, bone health, and psychosocial functioning.
A 2017 report on 49 pediatric studies in children with Crohn’s disease found that up to one-third of children with inflammation developed bowel complications more than 5 years after they received their diagnosis.
The same report notes that 48–88% of the children had received at least one corticosteroid course, and up to one-third became dependent on steroids. The authors of the report point out there seems to be a trend toward lower surgery rates as the use of immunomodulators and biologicals increases.
The exact cause of Crohn's disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate, but don't cause, Crohn's disease. Several factors, such as heredity and a malfunctioning immune system, likely play a role in its development.
- Immune system. A virus or bacterium may trigger Crohn's disease; however, scientists have yet to identify such a trigger. When your immune system tries to fight off the invading microorganism, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.
- Crohn's is more common in people who have family members with the disease, so genes may play a role in making people more susceptible. However, most people with Crohn's disease don't have a family history of the disease.
Risk factorsRisk factors for Crohn's disease may include:
- Crohn's disease can occur at any age, but you're likely to develop the condition when you're young. Most people who develop Crohn's disease are diagnosed before they're around 30 years old.
- Although Crohn's disease can affect any ethnic group, whites have the highest risk, especially people of Eastern European (Ashkenazi) Jewish descent. However, the incidence of Crohn's disease is increasing among Black people who live in North America and the United Kingdom.
- Family history. You're at higher risk if you have a first-degree relative, such as a parent, sibling, or child, with the disease. As many as 1 in 5 people with Crohn's disease has a family member with the disease.
- Cigarette smoking. Cigarette smoking is the most important controllable risk factor for developing Crohn's disease. Smoking also leads to more severe diseases and a greater risk of having surgery. If you smoke, it's important to stop.
- Nonsteroidal anti-inflammatory medications. These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. While they do not cause Crohn's disease, they can lead to inflammation of the bowel, making Crohn's disease worse.
ComplicationsCrohn's disease may lead to one or more of the following complications:
- Bowel obstruction. Crohn's disease can affect the entire thickness of the intestinal wall. Over time, parts of the bowel can scar and narrow, which may block the flow of digestive contents. You may require surgery to remove the diseased portion of your bowel.
- Chronic inflammation can lead to open sores (ulcers) anywhere in your digestive tract, including your mouth and anus, and in the genital area (perineum).
Sometimes ulcers can extend completely through the intestinal wall, creating a fistula — an abnormal connection between different body parts. Fistulas can develop between your intestine and your skin, or between your intestine and another organ. Fistulas near or around the anal area (perianal) are the most common kind.
When fistulas develop in the abdomen, food may bypass areas of the bowel that are necessary for absorption. Fistulas may form between loops of the bowel, in the bladder or vagina, or through the skin, causing continuous drainage of bowel contents to your skin.
In some cases, a fistula may become infected and form an abscess, which can be life-threatening if not treated.
- Anal fissure. This is a small tear in the tissue that lines the anus or in the skin around the anus where infections can occur. It's often associated with painful bowel movements and may lead to a perianal fistula.
- Diarrhea, abdominal pain, and cramping may make it difficult for you to eat or for your intestine to absorb enough nutrients to keep you nourished. It's also common to develop anemia due to low iron or vitamin B-12 caused by the disease.
- Colon cancer. Having Crohn's disease that affects your colon increases your risk of colon cancer. General colon cancer screening guidelines for people without Crohn's disease call for a colonoscopy every 10 years beginning at age 50. Ask your doctor whether you need to have this test done sooner and more frequently.
- Other health problems. Crohn's disease can cause problems in other parts of the body. Among these problems are anemia, skin disorders, osteoporosis, arthritis, and gallbladder or liver disease.
Medication risks. Certain Crohn's disease drugs that act by blocking functions of the immune system are associated with a small risk of developing cancers such as lymphoma and skin cancers. They also increase the risk of infection.
Corticosteroids can be associated with a risk of osteoporosis, bone fractures, cataracts, glaucoma, diabetes, and high blood pressure, among other conditions. Work with your doctor to determine the risks and benefits of medications.
- Blood clots. Crohn's disease increases the risk of blood clots in veins and arteries.
Treatment for Crohn’s disease
A cure for Crohn’s disease isn’t available yet, but the disease can be managed. A variety of treatment options exist that can lessen the severity and frequency of your symptoms.
Several types of medications are available to treat Crohn’s. Antidiarrheal and anti-inflammatory drugs are commonly used. More advanced options include biologics, which uses the body’s immune system to treat the disease.
The medication or combination of medications you need depends on your symptoms, disease history, the severity of your condition, and how you respond to treatment.
The two main types of anti-inflammatory drugs doctors use to treat Crohn’s are oral 5-aminosalicylates and corticosteroids. Anti-inflammatory drugs are often the first drugs you take for Crohn’s disease treatment.
You typically take these drugs when you have mild symptoms with infrequent disease flares. Corticosteroids are used for more severe symptoms but should only be taken for a short time.
An overactive immune system causes inflammation that leads to the symptoms of Crohn’s disease. Drugs that affect the immune system, called immunomodulators, may reduce the inflammatory response and limit your immune system’s reaction.
Some doctors believe antibiotics may help reduce some of the symptoms of Crohn’s and some of the possible triggers for it.
For example, antibiotics can reduce drainage and heal fistulas, which are abnormal connections between tissues that Crohn’s can cause.
If you have severe Crohn’s, your doctor may try one of several biologic therapies to treat the inflammation and complications that can occur from the disease. Biologic drugs can block specific proteins that may trigger inflammation.
If less invasive treatments and lifestyle changes don’t improve your symptoms, surgery may be necessary. Ultimately, about 75 percent of people with Crohn’s disease will require surgery at some point in their lives, according to the CCFA.
Some types of surgery for Crohn’s include removing damaged portions of your digestive tract and reconnecting the healthy sections. Other procedures repair damaged tissue, manage scar tissue, or treat deep infections.
Food doesn’t cause Crohn’s disease, but it can trigger flares.
After a Crohn’s diagnosis, your doctor will likely suggest making an appointment with a registered dietitian (RD). An RD will help you understand how food may affect your symptoms and how your diet may help you.
In the beginning, they may ask you to keep a food diary. This food diary will detail what you ate and how it made you feel.
Using this information, the RD will help you create an eating plan. These dietary changes should help you absorb more nutrients from the food you eat while also limiting any negative side effects food may be causing.
Read on for more information on an eating plan for Crohn’s.
Crohn’s disease dietA diet plan that works for one person with Crohn’s disease may not work for another. This is because the disease can involve different areas of the GI tract in different people.
It’s important to find out what works best for you. This can be done by keeping track of your symptoms as you add or remove certain foods from your diet. Lifestyle and diet changes may help you reduce the recurrence of symptoms and lessen their severity.
Adjust fiber intake
Some people need a high fiber, high protein diet. For others, the presence of extra food residue from high fiber foods such as fruits and vegetables may aggravate the GI tract. If this is the case, you may need to switch to a low residue diet.
Research on this particular diet has been mixed, so speak with your doctor about your personal needs.
Limit fat intake
Crohn’s disease may interfere with your body’s ability to break down and absorb fat. This excess fat will pass from your small intestine to your colon, which can cause diarrhea.
However, a 2017 study on mice suggested that a diet higher in plant-based fats had the potential to change the gut microbiome in positive ways for Crohn’s disease. More research is needed and your doctor or an RD can help guide you in your fat intake.
Limit dairy intake
Previously, you may not have experienced lactose intolerance, but your body can develop difficulty digesting some dairy products when you have Crohn’s disease. Consuming dairy can lead to an upset stomach, abdominal cramps, and diarrhea for some people.
Drink enough water
Crohn’s disease may affect your body’s ability to absorb water from your digestive tract. This can lead to dehydration. The risk of dehydration is especially high if you’re having diarrhea or bleeding.
Consider alternative sources of vitamins and minerals
Crohn’s disease can affect your intestines’ ability to properly absorb other nutrients from your food. Eating nutrient-dense foods may not be enough. Talk with your doctor about taking multivitamins to find out if this is right for you.
Work with your doctor to figure out what best suits your needs. They may refer you to an RD or nutritionist. Together, you can identify your dietary plan and create guidelines for a balanced diet.
Natural treatments for Crohn’s
Some people use complementary and alternative medicine (CAM) to help manage symptoms of various conditions and diseases, including Crohn’s disease.
The Food and Drug Administration hasn’t approved these for treatment, but some people use them in addition to mainstream medications.
Don’t add any new treatments to your current treatment plan without consulting your doctor.
Some CAM treatments for Crohn’s disease include:
- Probiotics. These are live bacteria that can help you replace and rebuild the good bacteria in your intestinal tract. Probiotics may also help prevent microorganisms from upsetting your gut’s natural balance and causing a Crohn’s flare. Scientific data about effectiveness is limited.
- Prebiotics. These are potentially beneficial materials found in plants, such as asparagus, bananas, artichokes, and leeks, that help feed the good bacteria in your gut and increase their numbers.
- Fish oil. Fish oil is rich in omega-3s. According to a 2017 study, research is ongoing regarding its possible treatment of Crohn’s disease. Oily fish like salmon and mackerel are rich in omega-3s. You can find fish oil supplements online.
- Supplements. Many people believe certain herbs, vitamins, and minerals ease the symptoms of a variety of diseases, including inflammation associated with Crohn’s disease. Research is ongoing as to which supplements may be beneficial.
- Aloe vera. Some believe that the aloe vera plant has anti-inflammatory properties. Because inflammation is one of the key components of Crohn’s disease, people may use it as a natural anti-inflammatory. However, there is no current research that suggests aloe vera helps with Crohn’s.
- Acupuncture. This is the practice of strategically sticking needles in the skin to stimulate various points on the body. A 2014 study found that acupuncture, combined with moxibustion — a type of traditional Chinese medicine that involves burning dried medicinal herbs on or near your skin — improves symptoms of Crohn’s disease. More research is needed.
Tell your doctor if you use any CAM treatments or over-the-counter medications. Some of these substances can affect the efficiency of medications or other treatments.
Research is still ongoing to find more effective treatments and potentially an eventual cure for Crohn’s disease. But symptoms can be successfully managed and remission is possible.
Your doctor can help guide you in finding the right medications, alternative treatments, and lifestyle measures that can help.
If you’re having gastrointestinal symptoms, speak with your doctor to determine the cause and potential solutions.