Crohn’s Disease

What is Crohn’s disease?

Crohn’s disease is a lifelong (chronic) autoimmune disorder that tends to irritate and inflame the digestive tract. It usually affects the small and large intestine. The two most prevalent types of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis.

Crohn’s disease can lead to unpleasant symptoms, which mostly include diarrhea and abdominal pain or stomach cramps.

Types of Crohn’s Disease

Crohn’s disease is a condition that can affect various parts of the digestive tract starting from the mouth to the anus or butthole. It mainly triggers inflammation in the small and/or large intestine.

The types of Crohn’s disease are:

• Ileocolitis: This is the most prevalent form of Crohn’s disease. It causes inflammation in the lower small intestine and some parts of the large intestine.
• Colitis: This is an inflammation within the lining of the large intestine.
• Ileitis: This is the inflammation and swelling in the small intestine or ileum.
• Gastroduodenal: Causes irritation and inflammation affecting the stomach and the duodenum (the top part of the small intestine).
• Jejunitis: This condition causes patchy spots of inflammation that affect the jejunum, the upper half of the small intestine.
• Perianal disease: This is an inflammation around the anus that affects some people and can lead to fistulas and abscesses.

Symptoms of Crohn’s Disease: What to Look Out For

Crohn’s disease can affect any part of the small or large intestine and might also include multiple segments or be continuous. For some people, the condition only occurs in the colon, a section of the large intestine.

The signs and symptoms can vary from mild to severe and often develop gradually, though they can sometimes appear unexpectedly with no warning. You might also experience periods of remission where the signs or symptoms are absent.

When active, the symptoms of the disease often include the following;

• Diarrhea
• Abdominal pain and cramping
• Fever
• Mouth sores
• Fatigue
• Bloody stool
• Poor appetite and sudden weight loss
• Pain or drainage around the anus caused by fistula, an inflammation from a passageway into the skin.

Other signs and symptoms

Severe cases of Crohn’s disease can also cause symptoms beyond the intestinal tract. They include:

• Inflammation of joints, skin and eyes
• Inflammation of bile ducts or the liver
• Kidney stones
• Anemia (iron deficiency)
• Delayed growth or sexual development in minors

Causes of Crohn’s Disease

The actual cause of Crohn’s disease is unknown. Medical professionals previously linked the condition to diet and stress. However, they now consider these factors to possibly worsen but not cause the disease.

Some of the factors that are likely to contribute to the development of Crohn’s disease are:

• Immune system: There is a chance that a virus or bacterium might prompt Crohn’s disease, though scientists have yet to determine the trigger. As the immune system attempts to fight off foreign elements and environmental triggers, an unusual immune response also provokes the immune system to attack cells within the digestive tract.
• Heredity: Genetics tend to play a role in Crohn’s disease, as it is more prevalent in individuals with family members who have the condition. On the contrary, many people with the disease do not have a family history of the disorder.

Risk factors of Crohn’s disease

• Age: Even though Crohn’s disease can strike at any age, it usually occurs in young people. The majority of individuals with the condition are usually diagnosed before the age of 30.
• Ethnicity: Crohn’s disease can affect anyone, irrespective of the ethnic group. However, whites, especially those of Eastern European (Ashkenazi) Jewish origin, are at a higher risk. Nonetheless, the rate of occurrence among Blacks in North America and the UK is rising. Also, the disease is increasingly affecting the Middle Eastern population and US migrants.
• Family history: Having a blood relative, including parents, siblings, or a child, with Crohn’s disease increases your risk. Up to 1 in 5 persons with Crohn’s disease have a family history.
• Cigarette smoking: This is a risk factor that can be significantly controlled. Cigarette smoking not only increases the risks of developing Crohn’s disease but also causes severe conditions and a higher possibility of undergoing surgery.
• Nonsteroidal anti-inflammatory medications (NSAIDs): NSAIDs typically comprise ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve), and diclofenac sodium. Although these medications don’t directly cause Crohn’s disease, they may trigger inflammation of the bowel, which could worsen the condition.

What Is the Connection between Crohn’s Disease and Inflammatory Bowel Disease (IBD)?

Crohn’s disease is categorized as one of the two primary types of IBD, the other being ulcerative colitis. These conditions usually have the same symptoms and treatment approaches, although they also exhibit varied differences.

Basically, IDB is an umbrella term that defines chronic inflammatory diseases mainly affecting the gastrointestinal tract. Crohn’s disease can occur in any region of the digestive system, starting from the mouth to the anus. On the other hand, ulcerative colitis only affects the rectum and colon.

The actual connection between Crohn’s disease and ulcerative colitis remains unspecified. Yet, professionals believe that they share similar risk factors in terms of genetic and environmental. Some people might also have two conditions at the same time, a disorder called indeterminate colitis.

Irrespective of their similarities, there are vital differences between Crohn’s disease and ulcerative colitis. In Crohn’s disease, the pattern of inflammation is usually patchy and could affect any part of the gastrointestinal tract. With ulcerative colitis, inflammation is continuous, starting from the rectum and stretching towards the colon.

In addition, the treatment options for both Crohn’s disease and ulcerative colitis tend to differ. Even though some medications overlap, the treatment approach is based on the type as well as the severity of the disease.

The Role of Diet in Managing Crohn’s Disease Symptoms

When it comes to Crohn’s disease symptoms management, diet plays a vital role in addition to promoting general health. Although there isn’t a specific one-size-fits-all diet for persons with Crohn’s disease, some dietary changes can help ease symptoms and relieve inflammation.

It is important to avoid any kind of food known to cause symptoms. Examples are spicy foods, dairy products, high-fiber foods, fatty or fried foods, caffeine, and alcoholic beverages. You can consider keeping a diary to help you identify certain trigger foods.

In addition, certain foods may benefit people with Crohn’s disease. They can include lean proteins, low-fiber foods, well-tolerated fruits and vegetables, healthy fats including olive oil or avocado, and whole grains.

You should note that responses to the types of foods often vary among people, and what works for you might not work for someone else. Therefore, consulting with a professional dietitian specializing in gastrointestinal conditions can be essential in creating a tailored diet plan.

Maintaining a proper diet, besides particular food options, is important for those with Crohn’s disease. For example, eating enough nutrients, including vitamins, proteins, and minerals, can be beneficial. Nutrient deficiencies are usually common among those with the condition because of poor appetite and malabsorption.

Importance of Early Diagnosis of Crohn’s Disease

How is Crohn’s disease diagnosed?

In most cases, individuals diagnosed with Crohn’s disease initially visit the doctor because of symptoms like unexplained weight loss, constant diarrhea, or stomach cramping. You may have to consult with a gastroenterologist, a physician specializing in digestive problems, as part of the diagnosis.

The medical provider will look into your medical history as well as the symptoms and your family history. A physical examination will also be conducted to check if there are any signs of Crohn’s disease, such as tenderness or swelling in the stomach. In addition, a series of tests may be necessary to help rule out other health conditions.

Lab tests

Lab tests analyze tissue or fluid samples for microscopic signs of Crohn’s disease. They include:

• Blood Test: This checks the blood cell counts as well as the chemistry for any signs of the disease. While a high white blood cell count might mean infection or inflammation, low red blood cell levels point to anemia, which is common with Crohn’s disease. In addition, an active inflammation may elevate C-reactive protein (CRP), a protein the liver produces. 
• Stool test: This diagnostic test assesses the stool sample for microbes or parasites. Doctors can also use the test to rule out certain infections causing chronic diarrhea. A calprotectin fecal test, for instance, measures intestinal inflammation.

Imaging procedures

Imaging tests can be ordered to take pictures of the digestive tract for further evaluation. These procedures include:

• Computed Tomography (CT) Scan: A CT scan uses X-rays to produce images of the digestive tract. It enables the medical provider to assess the severity of the inflammation. A CT enterography, involving taking a solution to highlight the small intestine and make it more visible on the images, may be necessary.
• Magnetic Resonance Imaging (MRI): This procedure utilizes magnets and radio waves to take detailed images of the inner body. MRI is mostly helpful in assessing fistulas near the small intestine and anus. Taking a contrast fluid before the test may be necessary to enhance image clarity (MRI enterography).

Endoscopy

This procedure involves sending a tiny tube equipped with a camera and light (endoscope) into the digestive tract to capture images and videos of the inflamed areas. Sedation during these examinations is necessary.

The types of endoscopy are:

• Colonoscopy: This procedure involves using an endoscope to assess the colon and ileum. The medical provider may also take out a small tissue sample (biopsy) to check the white blood cells.
• Upper endoscopy: During upper endoscopy, an endoscope is passed down through the mouth into the throat. This enables the doctor to view the inside parts from the mouth to the start of the small intestine using the attached camera.
• Capsule endoscopy: This approach involves swallowing a tiny plastic capsule equipped with a light and small camera to take images as it goes through the digestive tract.

Management and Treatment

Currently, there is no cure for Crohn’s disease, and the available therapies effectiveness work differently for every individual. Your doctor will work closely with you to determine the appropriate treatment and ensure that living with the condition becomes manageable.

The Crohn’s disease treatment options can include:

Medication

Crohn’s disease treatment involves medications to ease inflammation and subdue the immune response. According to studies, addressing inflammation is likely to enhance the long-term results of the condition. Also, treatment to help manage certain symptoms, including diarrhea and pain, may be necessary.

These medications can include the following:

• Steroids: Corticosteroids and budesonide helps ease inflammation for a short period. However, they are rarely suitable for long-term management of symptoms.
• Anti-inflammatory drugs: 5-aminosalicylates are examples of anti-inflammatory drugs mainly prescribed for ulcerative colitis. These medications, however, offer limited benefits for Crohn’s disease.
• Immunomodulators: These medications work by modifying the immune system’s activities. Immunosuppressant types such as azathioprine and methotrexate help calm the immune response.
• Biologics: These work by targeting proteins responsible for activating excessive immune response. Different types of biologics are available and can be administered through a shot or IV. They include integrin inhibitors, TNF inhibitors, Il-12/23 inhibitors, and Il-23 inhibitors.
• Small molecule advanced therapies: JAK-inhibitors are pills that help calm immune response and treat Crohn’s disease. Currently, only Upadacitinib (Rinvoq®) is FDA approved.
• Antibiotics: These medications are used to treat Crohn’s disease complications like abscesses or fistulas caused by severe infections.
• Antidiarrhea medication: These prescription drugs, such as loperamide (Imodium A-D®), are used to stop and manage severe diarrhea.
• Pain: Various therapies are available to help manage Crohn’s disease-related pain.

All medications come with varying benefits and risks. Your healthcare provider will help to determine the proper treatment options for your condition and follow up to ensure that they are working effectively.

Contact your doctor if the prescription drugs aren’t working or cause unfavorable side effects.

Nutrition

Including proper nutrients in your meals can improve overall health and even treat the condition for a short period. If you cannot meet your nutritional needs, you may have to consider enteral nutrition, which involves receiving formula through a feeding tube.

Based on the state of your condition, your doctor will typically give particular recommendations and perform tests to ensure you receive enough nutrients.

Surgery

A surgical procedure may be recommended to treat Crohn’s disease complications. Surgery to remove fistulas, intestinal perforations (holes), blockages, and strictures may be necessary.

Prevention

How can you prevent Crohn’s disease?

Although preventing Crohn’s disease may be impossible, you can relieve symptoms and minimize flare-ups by considering these approaches:

• Quit smoking: The best way to reduce complications and flare-up risks of Crohn’s disease is by quitting smoking.
• Avoid trigger medications: Using certain medications such as NSAIDs (nonsteroidal anti-inflammatory drugs) can increase flare-up risks in people with Crohn’s disease. You should thus consult with your doctor on the types of drugs to avoid.
• Avoid trigger foods: Although there are no foods in particular that cause inflammation, some may increase the likelihood of having symptoms. For example, if lactose intolerance can be a problem, then you should avoid dairy products and carbonated beverages. Your doctor may also recommend avoiding fiber if you have a stricture. Keeping a food diary to help you identify foods that are gentle on your stomach and those that aren’t is generally a wise idea.
• Eat strategically: Frequently consuming small meals rather than infrequent larger ones can lower the risks of Crohn’s disease symptoms. Go for low-fat foods when eating, and always drink enough water. Avoiding alcohol and caffeine may also be beneficial. Discuss with your doctor about a healthy meal plan that suits your needs.
• Take care of your mental health: Improving your general well-being by having adequate rest and regular exercise can help manage Crohn’s disease. Taking care of your mental wellness is very important since stress and anxiety are common responses to the disease diagnosis. Also, consulting a mental health specialist can be helpful.

Coping and Support

In addition to the physical effects, Crohn’s disease can also be emotionally taxing. If you have severe signs and symptoms, your life may just revolve around the endless urge to rush to the toilet. Also, if the symptoms are mild, abdominal pain and gas could make it challenging to go out in public.

All these scenarios can generally affect your life and even cause depression. You can thus consider these actions:

• Be informed: Learning everything there is to know about Crohn’s disease is one of the greatest ways to take control of your health. Resources like the Crohn’s & Colitis Foundation may be helpful.
• Join a support group: While support groups can offer important information concerning your condition and give you emotional assistance, they are not ideal for everyone. Some group members usually have knowledge of the latest treatments and integrative therapies, which you may find helpful. It could also feel reassuring to be with other people having Crohn’s disease.
• Talk to a therapist: Seeking advice from mental health experts familiar with IBD and associated emotional challenges can be beneficial for some people.

In general, living with Crohn’s disease can be depressing. However, the ongoing research shows improvement in the outlook.