Crohn's disease causes inflammation in the small intestine.
Crohn's disease usually occurs in the lower part of the small intestine, called
the ileum, but it can affect any part of the digestive tract, from the mouth to
the anus. The inflammation extends deep into the lining of the affected organ.
The inflammation can cause pain and can make the intestines empty frequently,
resulting in diarrhea.
Crohn's disease is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the intestines. Crohn's
disease can be difficult to diagnose because its symptoms are similar to other
intestinal disorders such as irritable bowel syndrome and to another type of IBD
called ulcerative colitis. Ulcerative colitis causes inflammation and ulcers in
the top layer of the lining of the large intestine.
Crohn's disease affects men and women equally and seems to run
in some families. About 20 percent of people with Crohn's disease have a blood
relative with some form of IBD, most often a brother or sister and sometimes a
parent or child.
Crohn's disease may also be called ileitis or enteritis.
What causes Crohn's disease?
Theories about what causes Crohn's disease abound, but none has
been proven. The most popular theory is that the body's immune system reacts to
a virus or a bacterium by causing ongoing inflammation in the intestine.
People with Crohn's disease tend to have abnormalities of the
immune system, but doctors do not know whether these abnormalities are a cause
or result of the disease. Crohn's disease is not caused by emotional distress.
What are the symptoms?
The most common symptoms of Crohn's disease are abdominal pain,
often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and
fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Children with Crohn's disease may suffer delayed development and stunted growth.
How is Crohn's disease diagnosed?
A thorough physical exam and a series of tests may be required to
diagnose Crohn's disease.
Blood tests may be done to check for anemia, which could indicate
bleeding in the intestines. Blood tests may also uncover a high white blood cell
count, which is a sign of inflammation somewhere in the body. By testing a stool
sample, the doctor can tell if there is bleeding or infection in the intestines.
The doctor may do an upper gastrointestinal (GI) series to look
at the small intestine. For this test, the patient drinks barium, a chalky
solution that coats the lining of the small intestine, before x rays are taken.
The barium shows up white on x-ray film, revealing inflammation or other
abnormalities in the intestine.
The doctor may also do a colonoscopy. For this test, the doctor
inserts an endoscope—a long, flexible, lighted tube linked to a computer and TV
monitor—into the anus to see the inside of the large intestine. The doctor will
be able to see any inflammation or bleeding. During the exam, the doctor may do
a biopsy, which involves taking a sample of tissue from the lining of the
intestine to view with a microscope.
If these tests show Crohn's disease, more x rays of both the
upper and lower digestive tract may be necessary to see how much is affected by
What are the complications of Crohn's
The most common complication is blockage of the intestine.
Blockage occurs because the disease tends to thicken the intestinal wall with
swelling and scar tissue, narrowing the passage. Crohn's disease may also cause
sores, or ulcers, that tunnel through the affected area into surrounding tissues
such as the bladder, vagina, or skin. The areas around the anus and rectum are
often involved. The tunnels, called fistulas, are a common complication and
often become infected. Sometimes fistulas can be treated with medicine, but in
some cases they may require surgery.
Nutritional complications are common in Crohn's disease.
Deficiencies of proteins, calories, and vitamins are well documented in Crohn's
disease. These deficiencies may be caused by inadequate dietary intake,
intestinal loss of protein, or poor absorption (malabsorption).
Other complications associated with Crohn's disease include
arthritis, skin problems, inflammation in the eyes or mouth, kidney stones,
gallstones, or other diseases of the liver and biliary system. Some of these
problems resolve during treatment for disease in the digestive system, but some
must be treated separately.
What is the treatment for Crohn's disease?
Treatment for Crohn's disease depends on the location and
severity of disease, complications, and response to previous treatment. The
goals of treatment are to control inflammation, correct nutritional
deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal
bleeding. Treatment may include drugs, nutrition supplements, surgery, or a
combination of these options. At this time, treatment can help control the
disease, but there is no cure.
Some people have long periods of remission, sometimes years, when
they are free of symptoms. However, the disease usually recurs at various times
over a person's lifetime. This changing pattern of the disease means one cannot
always tell when a treatment has helped. Predicting when a remission may occur
or when symptoms will return is not possible.
Someone with Crohn's disease may need medical care for a long
time, with regular doctor visits to monitor the condition.
Most people are first treated with drugs containing mesalamine, a
substance that helps control inflammation. Sulfasalazine is the most commonly
used of these drugs. Patients who do not benefit from it or who cannot tolerate
it may be put on other mesalamine-containing drugs, generally known as 5-ASA
agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of
mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and
Some patients take corticosteroids to control inflammation. These
drugs are the most effective for active Crohn's disease, but they can cause
serious side effects, including greater susceptibility to infection.
Drugs that suppress the immune system are also used to treat
Crohn's disease. Most commonly prescribed are 6-mercaptopurine and a related
drug, azathioprine. Immunosuppressive agents work by blocking the immune
reaction that contributes to inflammation. These drugs may cause side effects
like nausea, vomiting, and diarrhea and may lower a person's resistance to
infection. When patients are treated with a combination of corticosteroids and
immunosuppressive drugs, the dose of corticosteriods can eventually be lowered.
Some studies suggest that immunosuppressive drugs may enhance the effectiveness
The U.S. Food and Drug Administration has approved the drug
infliximab (brand name, Remicade) for the treatment of moderate to severe
Crohn's disease that does not respond to standard therapies (mesalamine
substances, corticosteroids, immunosuppressive agents) and for the treatment of
open, draining fistulas. Infliximab, the first treatment approved specifically
for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a
protein produced by the immune system that may cause the inflammation associated
with Crohn's disease. Anti-TNF removes TNF from the bloodstream before it
reaches the intestines, thereby preventing inflammation. Investigators will
continue to study patients taking infliximab to determine its long-term safety
Antibiotics are used to treat bacterial overgrowth in the small
intestine caused by stricture, fistulas, or prior surgery. For this common
problem, the doctor may prescribe one or more of the following antibiotics:
ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.
Diarrhea and crampy abdominal pain are often relieved when the
inflammation subsides, but additional medication may also be necessary. Several
antidiarrheal agents could be used, including diphenoxylate, loperamide, and
codeine. Patients who are dehydrated because of diarrhea will be treated with
fluids and electrolytes.
The doctor may recommend nutritional supplements, especially for
children whose growth has been slowed. Special high-calorie liquid formulas are
sometimes used for this purpose. A small number of patients may need periods of
feeding by vein. This can help patients who need extra nutrition temporarily,
those whose intestines need to rest, or those whose intestines cannot absorb
enough nutrition from food.
Surgery to remove part of the intestine can help Crohn's disease
but cannot cure it. The inflammation tends to return next to the area of
intestine that has been removed. Many Crohn's disease patients require surgery,
either to relieve symptoms that do not respond to medical therapy or to correct
complications such as blockage, perforation, abscess, or bleeding in the
Some people who have Crohn's disease in the large intestine need
to have their entire colon removed in an operation called colectomy. A small
opening is made in the front of the abdominal wall, and the tip of the ileum is
brought to the skin's surface. This opening, called a stoma, is where waste
exits the body. The stoma is about the size of a quarter and is usually located
in the right lower part of the abdomen near the beltline. A pouch is worn over
the opening to collect waste, and the patient empties the pouch as needed. The
majority of colectomy patients go on to live normal, active lives.
Sometimes only the diseased section of intestine is removed and
no stoma is needed. In this operation, the intestine is cut above and below the
diseased area and reconnected.
Because Crohn's disease often recurs after surgery, people
considering it should carefully weigh its benefits and risks compared with other
treatments. Surgery may not be appropriate for everyone. People faced with this
decision should get as much information as possible from doctors, nurses who
work with colon surgery patients (enterostomal therapists), and other patients.
Patient advocacy organizations can suggest support groups and other information
People with Crohn's disease may feel well and be free of symptoms
for substantial spans of time when their disease is not active. Despite the need
to take medication for long periods of time and occasional hospitalizations,
most people with Crohn's disease are able to hold jobs, raise families, and
function successfully at home and in society.
Can diet control Crohn's disease?
No special diet has been proven effective for preventing or
treating this disease. Some people find their symptoms are made worse by milk,
alcohol, hot spices, or fiber. People are encouraged to follow a nutritious diet
and avoid any foods that seem to worsen symptoms. But there are no consistent
rules. People should take vitamin supplements only on their doctor's advice.
National Institutes of Health (NIH)
Nutritional and Herbal Therapy for Crohn's
People with Crohn's disease need to develop
better diets, if they have not already. There is a link between a high fat, high
sugar diet with low fruit and vegetable intake with that of Crohn's disease.
Increase intake of fruits, vegetables and
whole grains and decrease fat and sugar intake.
Include the good fats: omega-3 fatty
acids to your diet. Omega-3 oils provide anti-inflammatory action to help
reduce symptoms of Crohn's and may help prevent reoccurrence.
Take a multi-vitamin/mineral daily to make
up for any loss of essential nutrients due to the intestine's decreased
inability to absorb.
Probiotics may be helpful in
strengthening the digestive tract and improving absorption and decreasing
symptoms of Crohn's.
The herb, Turmeric, has
anti-inflammatory actions and helps decrease symptoms.
The Chinese herbal formula, Xiang Sha
Liu Jun Wan, can soothe inflammation and symptoms of Crohn's disease.
Regular consumption of Green Tea
can also decrease inflammation and protect against cancer.