Crohn's Disease

Crohn’s disease occurs when the body’s immune system misidentifies bacteria, foods and other substances as foreign objects. As the immune system proceeds to attack these foreign objects, white blood cells accumulate in the lining of the intestines, producing inflammation and ultimately ulcerations and bowel injury.

Risk Factors

• Age: Crohn’s disease can develop at any age, but most people are diagnosed between the ages of 20 and 30.
• Ethnicity: Individuals of Ashkenazi Jewish descent have the highest risk of this disease, and Caucasians have the second highest risk.
• Family history: Risk increases if a close relative, such a parent or sibling, has the disease. As many as one in five people with Crohn’s disease have a family member who also has Crohn’s.
• Cigarette smoking: This is the most controllable risk factor. Smoking can lead to a more severe disease and increase the need for surgery.
• Where you live: If you live in an urban area or in an industrialized country, you have a greater risk of developing Crohn’s disease. It appears that environmental factors, including a diet or high fat or refined foods, contribute to the risk of Crohn’s disease People who live in northern climates may also have greater risk.

Signs of Possible Crohn’s Disease

• Abdominal pain (often in the lower right area)
• Diarrhea
• Rectal bleeding
• Weight loss
• Arthritis
• Skin problems
• Fever
• Bleeding, which may be serious and persistent, leading to anemia

Children who have Crohn’s disease may suffer delayed development and stunted growth.

Detection

Blood tests are done to check for anemia, which can indicate bleeding in the intestines. Blood tests can also uncover a high white blood cell count, which can signal inflammation in the body. The doctor may also perform a visual exam of the colon.

Treatment

Treatment options include drugs, nutrition supplements, surgery or a combination of these options. The goal of treatment is to control inflammation, correct nutritional deficiencies and relieve symptom such as abdominal pain, diarrhea and rectal bleeding. Treatment also depends on the location and severity of the disease, complications, and the patient’s response to medical treatments for recurring symptoms.

Crohn’s disease can recur at various times over a person’s lifetime. This poses the difficulty of determining if the treatment has been beneficial.

Drug Therapy

• Anti-inflammation drugs: Preliminary drug treatment includes mesalamine, a drug that helps control inflammation. Possible side effects include nausea, vomiting, heartburn, diarrhea and headaches.
• Cortisone or steroids: Cortisone and steroids are often very effective. In the beginning, when the disease is most severe, prednisone is usually prescribed in a large dose. The dosage will be lowered when symptoms are under control. The potential for infection is a concern associated with this drug.
• Immune System Suppressors: Drugs that suppress the immune system, called immunesuppresive agents, work by blocking the immune reaction that contributes to inflammation. Possible side effects include nausea, vomiting, diarrhea and lower a person’s resistance to infection.
• Infliximab (Remicade): This drug is the first of several that blocks the body’s inflammation response. Infliximab is the first drug approved specifically to treat Crohn’s disease.
• Antibiotics:  Antibiotics can treat bacterial overgrowth in the small intestine caused by stricture, fistulas or prior surgery.
• Anti-diarrheal and fluid replacements: Diarrhea and abdominal pain are often relieved when the inflammation subsides. Patients who are dehydrated because of diarrhea will also be treated with fluids and electrolytes.
• Nutrition Supplementation: Doctors may recommend nutritional supplements, especially for children with slowed growth. Special high-calorie liquids may be used for this purpose. Although no foods are known to cause Crohn’s disease, bulky grains, hot spices, alcohol and milk products may increase diarrhea and cramping during a flare-up.
• Surgery: Surgery becomes necessary when medications can no longer control symptoms. It is used to relieve symptoms that do not respond to medical therapy, and to correct complications such as blockage, perforation, abscess or bleeding in the intestine. Surgery cannot eliminate Crohn’s disease, and patients sometimes need more than one operation. Depending on the severity of the situation, some patients may require removal of a portion of their intestine or the entire colon. The benefits and risks of surgery should be compared carefully with other treatments.

Prevention

There is no way to prevent Crohn’s disease, but it can be controlled by maintaining a well-balanced, nutritious diet. By storing vitamins and nutrients between episodes, people with Crohn’s disease decrease complications from weight loss or anemia.

Crohn’s disease can increase the risk of colon cancer, particularly if it affects a large portion of the colon or rectum. Patients should have their colon checked every one to two years for cancer or for changes that can precede cancer.