Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Viewer Question: Can Crohn's disease be manifested with
constipation and
flatulence (farting)? My daughter has been on medication for constipation for months and it is not working and she experiences extreme bloating, abdominal pain, and constipation with some
diarrhea and is miserable.
Doctor's Response: Extreme bloating, abdominal pain, and
constipation with some diarrhea are unusual symptoms of
Crohn's disease.
Common symptoms of Crohn's disease include abdominal pain,
diarrhea, and weight loss. Less common symptoms include poor appetite, fever, night sweats, rectal pain, and rectal bleeding. Some
individuals with Crohn's disease also develop symptoms outside of the gastrointestinal tract; these symptoms include arthritis, skin rash, and inflammation of the iris of the eye.
Crohn's disease (also spelled Crohn disease) is a chronic inflammatory disease of the intestines. It
primarily causes ulcerations (breaks in the lining) of the small and large
intestines, but can affect the digestive system anywhere from the mouth to the
anus. It is named after the physician who described the disease in 1932. It also
is called granulomatous enteritis or colitis, regional enteritis, ileitis, or
terminal ileitis.
Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called
ulcerative colitis. Together, Crohn's disease and ulcerative colitis are frequently referred to as
inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's disease have no medical cure. Once the diseases begin, they tend to fluctuate between periods of inactivity (remission) and activity (relapse).
Inflammatory bowel disease affects approximately 500,000 to two million people in the United States. Men and women are
affected equally. Americans of Jewish European descent are 4 to 5 times more likely to develop IBD than the general population. IBD has historically been considered predominately disease of Caucasians, but there has been an increase in reported cases in African Americans suffering from IBD. The prevalence appears to be lower among Hispanic and Asian populations. IBD most commonly begins during
adolescence and early adulthood (usually between the ages of 15 and 35). There is a small second peak of newly-diagnosed cases after age 50. The number of new cases
(incidence) and number of cases (prevalence) of Crohn's disease in the United States are rising, although the reason for this is not completely understood.
Crohn's disease tends to be more common in relatives of patients with Crohn's disease. If a person has a relative with the disease, his/her risk of developing the disease is estimated to be at least 10 times that of the general population and 30 times greater if the relative with Crohn's disease is a sibling. It also is more common among relatives of patients with ulcerative colitis.
What causes Crohn's disease?
The cause of Crohn's disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn's disease. To date, however, there has been no convincing evidence that the disease is caused by infection per se. Crohn's disease is not contagious. Although diet may affect the symptoms in patients with Crohn's disease, it is unlikely that diet is responsible for the disease.
Activation of the immune system in the
intestines appears to be important in
IBD. The immune system
is composed of immune cells and the proteins that these immune cells produce.
Normally, these cells and proteins defend the body against harmful bacteria, viruses,
fungi, and other foreign invaders. Activation of the immune system causes inflammation
within the tissues where the activation occurs. (Inflammation is an important
mechanism of defense used by the immune system.)
Normally, the immune system is activated only when the body is exposed to
harmful invaders. In individuals with IBD, however, the immune system is abnormally
and chronically activated in the absence of any known invader. The continued
abnormal activation of the immune system results in chronic inflammation and
ulceration. The susceptibility to abnormal activation of the immune system is
genetically inherited. Thus, first degree relatives (brothers, sisters,
children, and parents) of people with IBD are more likely to develop these
diseases. Recently a gene called NOD2 has been identified as being associated
with Crohn's disease. This gene is important in determining how the body
responds to some bacterial products. Individuals with mutations in this gene are
more susceptible to developing Crohn's disease.
Other genes are still being discovered and studied which are important in understanding the pathogenesis of Crohn's disease including autophagy related 16-like 1 gene (ATG 16L1) and IRGM, which both contribute to macrophage defects and have been identified with the Genome-Wide Association study2. In this regard, there have also been studies which show that in the intestines of
individuals with Crohn's disease, there are higher levels of a certain type of bacterium, E. coli, which might play a role in the pathogenesis1. One postulated mechanism by which this could occur is though a genetically determined1 defect in elimination of the E. coli, by intestinal mucosal macrophages. The exact roles that these various factors play in the development of this disease remain unclear.
How does Crohn's disease affect the intestines?
In the early stages, Crohn's disease causes small, scattered, shallow,
crater-like ulcerations (erosions) on the inner surface of the bowel. These erosions
are called aphthous ulcers. With time, the erosions become deeper and larger,
ultimately becoming true ulcers (which are deeper than erosions), and causing
scarring and stiffness of the bowel. As the disease progresses, the bowel
becomes increasingly narrowed, and ultimately can become obstructed. Deep ulcers
can puncture holes in the wall of the bowel, and bacteria from within the bowel
can spread to infect adjacent organs and the surrounding abdominal cavity.
When Crohn's disease narrows the small intestine to the point of obstruction,
the flow of the contents through the intestine ceases. Sometimes, the
obstruction can be caused suddenly by poorly-digestible fruit or vegetables that
plug the already-narrowed segment of the intestine. When the intestine is
obstructed, digesting food, fluid and gas from the stomach and the small
intestine cannot pass into the colon. The symptoms of small intestinal
obstruction then appear, including severe abdominal cramps,
nausea,
vomiting,
and abdominal distention. Obstruction of the small intestine is much more likely
since the small intestine is much narrower than the colon.
Deep ulcers can puncture holes in the walls of the small intestine and the
colon, and create a tunnel between the intestine and adjacent organs. If the
ulcer tunnel reaches an adjacent empty space inside the abdominal cavity, a
collection of infected pus (an abdominal abscess) is formed. Individuals with
abdominal abscesses can develop tender abdominal masses, high fevers, and
abdominal pain.
When the ulcer tunnels into an adjacent organ, a channel (fistula) is formed.
The formation of a fistula between the intestine and the bladder
(enteric-vesicular fistula) can cause frequent
urinary tract infections and the
passage of gas and feces during urination.
When a fistula develops between the
intestine and the skin (enteric-cutaneous fistula), pus and mucous emerge from a
small painful opening on the skin of the abdomen.
The development of a fistula
between the colon and the vagina (colonic-vaginal fistula) causes gas and feces
to emerge through the vagina.
The presence of a fistula from the intestines to
the anus (anal fistula) leads to a discharge of mucous and pus from the fistula's
opening around the anus.
How is Crohn's disease different from ulcerative colitis?
While ulcerative colitis causes inflammation only in the colon (colitis)
and/or the rectum (proctitis), Crohn's disease may cause inflammation in the colon,
rectum, small intestine (jejunum and ileum), and, occasionally, even the
stomach, mouth, and esophagus.
The patterns of inflammation in Crohn's disease are different from ulcerative
colitis. Except in the most severe cases, the inflammation of ulcerative colitis
tends to involve the superficial layers of the inner lining of the bowel. The
inflammation also tends to be diffuse and uniform (all of the lining in the
affected segment of the intestine is inflamed.)
Unlike ulcerative colitis, the
inflammation of Crohn's disease is concentrated in some areas more than others,
and involves layers of the bowel that are deeper than the superficial inner
layers. Therefore, the affected segment(s) of bowel in Crohn's disease often is
studded with deeper ulcers with normal lining between these ulcers.
Crohn's Disease - Symptoms at Onset of DiseaseQuestion: The symptoms of crohn's disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Canker sore is a small ulcer crater in the lining of the mouth. Canker sores are one of the most
common problems that occur in the mouth. Canker sores typically last for
10-14 days and they heal without leaving a scar.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Erythema nodosum can resolve on its own in 3 to 6 weeks, leaving a bruised area. Treatments include anti-inflammatory medications and cortisone by mouth or injection.
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your healthcare provider prior to tapering off steroid medications.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Vitamin D deficiency has been linked with rickets, cancer, cardiovascular disease, severe asthma in children and cognitive impairment in older adults. Causes include not ingesting enough of the vitamin over time, having limited exposure to sunlight, having dark skin, and obesity. Symptoms include bone pain and muscle weakness. Treatment for vitamin D deficiency involves obtaining more vitamin D through supplements, diet, or exposure to sunlight.
Clostridium difficile (C. difficile) is a bacterium that is related to the
bacterium that cause tetanus and botulism. The
C. difficile bacterium has two
forms, an active, infectious form that cannot survive in the environment for
prolonged periods, and a nonactive, "noninfectious" form, called a spore, that
can survive in the environment for prolonged periods. Although spores cannot
cause infection directly, when they are ingested they transform into the active,
infectious form.
Digestion RSS
Healthy Living Tips
This site complies with the