Crohn’s disease is a chronic condition characterized by inflammation of gastrointestinal tract. Exact cause of the disease is yet to be determined. However, experts believe that genetics, autoimmune response and smoking can be the main causes of the disease. Common symptoms include persistent diarrhea, abdominal pain and cramps, exhaustion or weakness and sense of bloating. There is no cure. Treatments only help reduce and control the symptoms. People of all ages can be affected by Crohn’s disease and symptoms generally onset during childhood or early adulthood (20-35).
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What is Crohn’s disease?
Crohn’s disease is a type of inflammatory bowel disease, other type being ulcerative colitis. Crohn’s disease causes inflammation and irritation in the digestive system and lasts lifelong; however it may have weeks or even years of calm periods. It may affect any part of the digestive system, from mouth to anus. However, most commonly affected sections are the end of small intestines and start of large intestine (colon). Disease progression is generally slow and it may worsen over time.
Ulcerative colitis vs Crohn’s disease
Symptoms of Crohn’s disease can be confused with ulcerative colitis rather frequently. These two diseases have very similar symptoms; however, there are three main differentiating characteristics.
Crohn’s disease can develop in any segment from mouth to anus; however, end of small intestines (ileum) and start of large bowel are the most commonly affected sections. On the other hand, ulcerative colitis is limited to large intestines.
While Crohn’s disease can affect both the superficial layer and all other layers of the bowel, only the innermost layer of the large intestines is affected by ulcerative colitis.
In Crohn’s disease, bowel inflammation may skip normal areas between diseased patches of intestine. However, this is not the case for ulcerative colitis.
Experts are yet to find the exact cause of Crohn’s disease. However, many factors are believed to play a role in the development of the disease.
Autoimmune response: Autoimmune is a general term used to describe responses originating from hypersensitivity of the immune system. One of the causes of Crohn’s disease may be the immune system attacking healthy cells in the body. Experts think that the bowel system may be accidentally triggered by the bacteria in the digestive system. This immune system response can lead to the inflammation that causes the symptoms of Crohn’s disease.
Genetics: Crohn’s disease can be genetic. Studies showed an increased risk for individuals who have parents or siblings affected by the disease.
Other factors
Smoking
Drugs like aspirin or antibiotics, pain relievers like ibuprofen and contraceptive pills
Diagnosis of Crohn’s disease can be difficult sometimes as it may have similar symptoms with other diseases. If physical examination and laboratory tests (blood, urine and stool) indicate a suspected Crohn’s disease, doctors may refer their patients to a gastroenterology specialist for definitive diagnosis.
There is no definitive treatment for it, however, there are treatment options that can control or reduce the symptoms. Treatment is planned depending on the severity and symptoms of the disease. Main treatment options are:
Crohn’s disease medications
Drugs that suppress the inflammation in the bowel mucosa are generally used. One or multiple drugs may be prescribed depending on the severity of the disease. Patients may need to use these drugs for a long time.
Aminosalicylates
These drugs are used for the treatment of mild symptoms. Long-term use may be required. Aminosalicylates may have side effects like diarrhea, headache, heartburn, nausea and vomiting, and abdominal pain.
Steroids help reducing the immune system activity and inflammation. They are prescribed for patients with moderate and severe symptoms. They must be used with caution due to their side effects. Its side effects include weight gain, indigestion, sleep problems; slow development in children, bone mass loss, acne, high blood sugar, high blood pressure, infection possibility, and complicated state of mind. Doses may be increased in periods of exacerbation.
These drugs reduce the immune system activity and leads to lesser inflammation in your digestive system. They are prescribed to help improving the symptoms or when the patient is not responsive to other treatment options. This group of drugs may cause serious side effects due to their strong immune system suppression.
They may have side effects like higher infection risk, fatigue, complicated state of mind, getting or feeling sick, nausea and vomiting, pancreas inflammation and liver problems. Therefore, decision to use these drugs must be taken cautiously.
Biological drugs
If other drugs cannot help, more powerful medication called biological drugs may be necessary. Biological drugs are proteins that prevent the inflammation in the body. Generally they are injected intravenously once in every two to eight weeks. They may side effects like itchiness, joint pain, high fever, and high infection and tuberculosis risk. In some cases, such as treatment of abscess around rectum and fistula, antibiotics may be prescribed.
Bowel rest
If the symptoms of Crohn’s disease are severe, it must be necessary to rest intestines for a few days to weeks. There are three approaches for this method:
Drinking nutritional liquid.
Administration of a nutritional liquid via a feeding tube inserted into the stomach or the small intestines.
Administration of nutrition intravenously via serum.
Crohn disease diet
Enteral nutrition (liquid diet) is the nutrient intake instead of a normal diet through a special liquid that contains all necessary nutrients. Patient is fed this way for a several weeks. This method can be helpful in for reducing the symptoms of Crohn’s disease in children and young adults, and prevents development risk that may arise in case of steroid use.
Surgical intervention may be required for Crohn’s patients in some cases. Those cases are:
Inadequacy and side effects of the drugs
Formation of intestinal stricture
Abscess and fistula (canal forming between outer skin tissue and intestines) development
Deceleration of development in children.
Resection
Main operation used for Crohn’s disease is called resection. Resection is the removal of the diseased part of an organ. In the surgery, small incisions are made to the abdomen using the keyhole method (laparoscopy). Inflamed segment of the intestine is removed and healthy segments of the intestines are sewn together.
Strictureplasty
This method is applied in the presence of intestinal stricture. Stricture is removed without any bowel loss. However this surgery may not be suitable for all patients. Most of the time, surgeries are performed under general anesthesia.
Approximately one-week long hospitalization may be necessary and full recovery can take several months. Sometimes ileostomy (connecting the bowel to a pouch) can be required. As there is no definitive cure for Crohn’s disease, patients who undergo surgery have a high risk of relapse, even after many years.
Patients may undergo emergency surgery in case of obstruction or perforation of the intestine, uncontrolled intestinal bleeding or ceased intestinal motility.
What is the progression of Crohn’s disease?
Intestinal obstruction
Fistula and abscess formation due to inflammation passing through intestinal wall
Anal fissure that may lead to itch, pain or bleeding in the anus
Ulcer in mouth, intestine, anus or perineum (area between the anus and scrotum/vulva)
Malnutrition
Inflammation in joints, eyes and skin
Does Crohn’s disease cause cancer?
Crohn’s disease in the large intestines may lead to an increased risk of colon cancer. If treatment is received for Crohn’s and the disease is controlled, than colon cancer risk can be reduced. In addition, having regular cancer screenings will increase the likelihood of early diagnosis and treatment success.
There are “good” bacteria in your digestive system that helps digestion and provides protection against “bad” bacteria. If you are using antibiotics, the number of these good bacteria will be reduced. Probiotics are live microorganisms that you intake and they are very similar to the good bacteria in your intestines.
You may have these through certain foods or use probiotic supplements. Probiotics can be less or more beneficial depending on the location and stage/severity of your disease. Although yoghurt is one of the most common probiotic sources, many Crohn’s disease patients are sensitive against dairy products. However, cabbage pickle and kefir are among probiotic-containing nutrients.
Prebiotics
Prebiotics are food for probiotics and intestinal bacteria. Adding prebiotics to your diet can increase the functions of your normal intestinal bacteria. Using probiotics in combination with prebiotics can render probiotics more effective. Prebiotics are indigestible carbohydrates. Artichoke, honey, whole-wheat grains, banana, onion and garlic are prebiotic-containing foods.
Fish oil
Fish oil has been in use for many years to improve cholesterol health; however, recent studies claim that it is helpful for Crohn’s disease patients as well. Omega-3 fatty acids contained in fish oil has anti-inflammatory characteristics and can be helpful for reducing Crohn’s symptoms. Consult your doctor before starting on fish oil supplement. High doses of fish oil or using with blood thinner drugs can cause bleeding problems.
Slippery elm is a transparent herbal medicine. It protects irritated tissues and supports their healing process. Slippery elm contains a substance called mucilage that turns into a greasy gel when mixed with water. This substance provides relief to mouth, throat, stomach and intestines, and this improves Crohn’s symptoms.
Other herbal recommendations
Other herbal remedies helpful to alleviate the symptoms of Crohn’s disease are:
Aloe vera extract
Chamomile
Peppermint
Consult your doctor before trying herbal remedies. Some of them may dangerously react with your medication. In addition, they may cause unwanted side effects.
Recommendations for Crohn’s patients
Stop smoking and alcohol.
Avoid carbonated or fizzy drinks like cola, soda pop and mineral water.
Avoid popcorn, vegetable peeling, hazelnut and other highly fibrous foods.
Drink plenty of water
Eat less and frequently
Keep a meal diary to identify the foods that cause discomfort.
Pay attention to your sleep routine.
Try to avoid stress.
Use non-prescription drugs with caution. You must consult your doctor before using such medication. Because some of them may trigger symptoms and reduce the efficacy of other drugs that you use for Crohn’s disease. For example, anti-inflammatory pain relievers like ibuprofen may worsen the symptoms of some people.
In case of immunosuppressant or biological drug use, flu vaccine each year and one-time pneumonia vaccine are recommended as these drugs pose increased infection risk. However, avoid live vaccines like MMR (measles, mumps, rubeola) as they may make ill.
Most of the female Crohn’s disease patients can have a pregnancy and a healthy baby. However, some Crohn’s disease drugs can harm an unborn baby. In such case, consult your doctor to decide on a suitable treatment option.
Seek psychological support in case of mental problems in pediatric patients.
