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Crohn's Disease

Definition

Named for Dr. Burrell Crohn who first described the condition, it is a disease of unknown cause that can affect any part of the intestinal tract from the mouth to the anus. It most commonly affects the last few inches of the small intestine (the terminal ileum). It may affect this area alone or in combination with other segments of the small intestine or colon. The disease process results in ulceration of the lining of the intestine. The ulcers may become deep and actually erode through the bowel between loops of bowel, from the bowel into the urinary bladder or vagina or out the abdominal wall.

Causes

Several theories exist about what causes Crohn’s disease, but none have been proven. The most popular theory is that the body’s immune system reacts abnormally in people with Crohn’s disease, mistaking bacteria, foods, and other substances for being foreign. The immune system’s response is to attack these “invaders.” Research shows that the inflammation seen in the GI tract of people with Crohn’s disease involves several factors: the genes the patient has inherited, the immune system itself, and the environment. Foreign substances, also referred to as antigens, are found in the environment. One possible cause for inflammation may be the body’s reaction to these antigens, or that the antigens themselves are the cause for the inflammation.

Who Develops Crohn’s?

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 inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but it is more often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohn’s disease, and African Americans are at decreased risk for developing Crohn’s disease.

Symptoms

Symptoms of Crohn's disease include abdominal pain, cramps, distention, and diarrhea often associated with weight loss

Diagnosis

A thorough physical exam and a series of tests may be required to diagnose Crohn’s disease. The testing could include blood tests, x-rays and endoscopy.

  1. Treatment
    Medical treatment usually sufficient to control the disease and will heal the ulceration present in the bowel. If medical treatment is unsuccessful or if a fistula had developed, surgery may be necessary to remove a segment of the diseased bowel. Many patients with Crohn's disease have involvement of the anus which can give need for additional treatments.
  2. Medications 
    1. Corticosteroids— can provide very symptom control. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered once symptoms have been controlled.
    2. Anti-inflammation Drugs: Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs.
    3. Immune System Suppressors: Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation.
    4. Antibiotics: Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery.
    5. Anti-body Blocking agents: This drug is the first of a group of medications that blocks the body’s inflammation response. The U.S. Food and Drug Administration approved the drug 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-TNF substance. Additional research will need to be done in order to fully understand the range of treatments Remicade may offer to help people with Crohn’s disease.
  3. Diet
    There are no known foods that cause Crohn’s disease. However, when people are suffering a flare in disease, foods such as bulky grains, hot spices, alcohol, and milk products may increase diarrhea and cramping.
  4. Surgery
    Two-thirds to three-quarters of patients with Crohn’s disease will require surgery at some point in their lives. Surgery becomes necessary when medications can no longer control symptoms. Surgery is used either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine. Surgery to remove part of the intestine can help people with Crohn’s disease, but it is not a cure.

Summary

Crohn’s disease is a disease that affects the intestines. The cause of the disease is not fully known at this time. Crohn’s disease can be medically managed but may also need surgery. Crohn’s disease can be managed but often returns in events known as flares.

Organizations

  1. Crohn’s and Colitis Foundation of America - www.ccfa.org
  2. American Society for Gastrointestinal Endoscopy - www.asge.org
  3. American Gastroenterological Association - www.gastro.com
  4. American College of Gastroenterology - www.acg.gi.org
  5. American Liver Foundation - www.liverfoundation.org

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